National consensus on the capabilities that inform the role of advanced practice paramedics: A Delphi study

Abstract

Advanced Practice Paramedics (APPs) are highly skilled paramedics who operate in diverse clinical settings both within and outside traditional ambulance services. International evidence demonstrates that APPs enhance patient outcomes in areas such as critical and primary care. In Australia, the expansion of APP roles and responsibilities has gained momentum; however, no nationally recognised framework exists to define their expected capabilities. This gap leads to inconsistencies in education, practice and role clarity. A standardised capability framework is therefore vital to guide the development, implementation and integration of APP roles within the Australian healthcare system. The primary aim of this study was to develop a comprehensive list of APP capabilities tailored to the Australian context through expert consensus. A modified Delphi approach was used across four iterative phases to establish consensus. An expert panel of clinical, academic, organisational and regulatory/governance leaders was identified via the Knowledge Resource Nomination Worksheet. Participants reviewed, rated and refined proposed APP capabilities derived from international frameworks and relevant literature. Consensus was defined as a minimum of 70% agreement among participants. Of the experts invited, 43 consented to participate in the Delphi process. A final set of 33 capabilities, achieving 96% overall consensus, was developed. These capabilities spanned four key domains: Clinical Practice (14), Leadership and Management (10), Education (7) and Research (2). Iterative feedback ensured each capability was clear, relevant and aligned with the Australian healthcare context. The resulting capability framework provides a robust foundation for standardising APP roles within Australia, promoting consistency in education, practice and professional expectations. This framework not only supports the national advancement of APPs but may also serve as a model for international adaptation, contributing to the global development and recognition of advanced practice roles in paramedicine.

Keywords

advanced paramedic practice capability framework capabilities paramedic

Introduction

The increasing diversification of out-of-hospital care delivered by paramedics, covering the full clinical acuity spectrum, from primary care and social needs to critical care has highlighted the dependence of public health systems on paramedics adopting advanced practice roles.^1–3 Globally, the evolution from standard paramedic roles towards advanced practice has led to the emergence of various roles often described as specialised or extended practice positions.^4,5 Examples of these extended practice roles include intensive and critical care paramedics,⁶ community or extended care paramedics⁷ and paramedic practitioners.^8,9 These roles leverage existing paramedic strengths to focus on addressing more specific and complex healthcare challenges, ranging from providing care to the most acutely unwell, to focusing on reducing unnecessary transportation to emergency departments by addressing healthcare needs within community settings. In the Australian context, existing titles such as extended care paramedic and intensive or critical care paramedic typically denote role-specific competencies within clearly defined clinical scopes, rather than indicating broader, higher-level clinical autonomy. In this paper, we introduce the umbrella term Advanced Practice Paramedic (APP) to distinguish paramedics practising autonomously at an advanced clinical level, irrespective of clinical focus area, from these existing extended-scope roles. Here, we suggest autonomy refers to the capacity to independently initiate, manage and evaluate care episodes within an agreed scope of practice and clinical governance framework, without the requirement for direct oversight. Adopting the term APP specifically avoids the legally protected title ‘specialist’, as defined under Australia's National Law,¹⁰ and clearly differentiates broader advanced practice roles from more narrowly scoped extended roles previously described. Our approach to defining APP in this broad way aligns closely with international approaches to advanced practice, such as the UK's Advanced Clinical Practitioner role,¹¹ and mirrors other Australian advanced practice roles, such as Nurse Practitioners, where a single advanced practice definition and title encompass practitioners across multiple specialty areas.¹²

While it's important to recognise some paramedics in existing extended roles may already be practising at a level approaching advanced practice, formal recognition of advanced practice as a distinct level of autonomous paramedic practice has yet to be clearly established in Australia. Internationally, APP like roles have diversified to adapt to changing community needs and have been integrated into both traditional ambulance service models of care as well as broader healthcare system roles worldwide.^9,13–18 Alongside the development of advanced practice roles, a robust capability framework is essential to guide the education, regulation and practice of paramedics stepping into these roles.^19,20 A capability framework is a structured outline of capabilities that define the essential responsibilities, behaviours and attributes required for individuals within a specific profession or role.^21,22 It serves as a comprehensive roadmap outlining the knowledge, skills, behaviours and qualities necessary to practice.^20,23,24 In identifying capabilities it's important to delineate the difference between capabilities, competencies and skills – terms that are frequently applied with different meanings. For the purposes of this study, capabilities are defined to encompass responsibilities, attributes, behaviours and knowledge. In contrast, competencies are more focused, detailing the specific knowledge and abilities necessary to perform or execute a particular skill or task.^25–27 Finally, skills are defined as the precise, individual actions or techniques required within a competency. A well-defined capability framework lays a foundation for developing competencies and guides education, training and professional development initiatives.^20,24 This ensures that individuals possess the diverse skills needed to succeed in their given roles across varying contexts.²⁰

The absence of a dedicated capability framework for APPs in Australia represents a critical gap, not only in standardising expectations for advanced practice within the profession but also in safeguarding public safety. Without a structured framework, there is limited guidance on essential capabilities, leading to potential inconsistencies in education, practice and understanding of APP roles. This lack of clarity can result in disharmony within the profession and confusion among stakeholders.^20,28 To address this issue, it is critical to develop a broadly accepted and harmonised capability framework that aligns APP roles with their current responsibilities and expectations. Using a Delphi methodology is an ideal approach, as it seeks expert consensus to identify and prioritise the key capabilities required for APP roles. Establishing a national capability framework will promote consistency in role expectations, education and regulatory standards, supporting the delivery of high-quality, consistent care.^15,29 Therefore, this study aimed to achieve consensus on the essential capabilities that can underpin the development of a national APP capability framework in Australia.

Methods

Delphi methodology overview

This study utilised a modified Delphi methodology to reach a consensus on the capabilities that are deemed most appropriate in the creation of an APP capability framework tailored to the Australian context.³⁰ To facilitate this, experts were identified and recruited through a systematic process, based on their knowledge and expertise surrounding APP. Participants were invited to partake in a four-phase online Delphi process. Consistent with a modified Delphi design, Phase 1 began with a literature-derived list of candidate capabilities (instead of an open item-generation step as seen in traditional Delphi designs)³¹ and the study concluded with a final binary accept/reject vote after three Likert rounds, rather than continuing Likert scoring until statistical stability. A modified Delphi technique was also selected because it (i) enables structured, anonymous feedback from geographically dispersed experts; (ii) allows iteration with controlled feedback so that panellists can reconsider their views without the pressures of face-to-face group dynamics; and (iii) is well-established for developing professional capability frameworks where empirical evidence is limited and expert judgement must be aggregated systematically.^32,33 Alternative consensus methods such as nominal group technique were considered but rejected because they either require in-person meetings or lack the iterative refinement necessary for refining complex capability statements. The methods and results are reported using the standard for Conducting and REporting of DElphi Studies (CREDES).³²

Research paradigm

Although the Delphi process is often described as a method of inquiry, all research is underpinned by a broader theoretical framework or research paradigm. In this study, the Delphi process was anchored in an interpretivist ontology and guided by the paradigm of realism. Realism holds that a single external reality exists, yet individual interpretations of that reality can vary based on each person's experiences and context.³⁴ Where realism diverges from purely interpretivist approaches is in its acknowledgment that, through iterative and systematic inquiry, researchers can progressively approximate an understanding of this singular reality by accumulating experiential evidence and perspectives.³⁵ Within the Delphi context, realism is manifested in the integration of diverse expert opinions and experiences, converging towards an agreed central understanding of essential APP capabilities.

Identification of participants

Delphi studies fundamentally rely on the rigorous identification and selection of expert participants. To structure this process, the research team followed Delbecq et al.'s guidance,³⁶ aiming to ensure a comprehensive overview of APP. Experts were recruited from four domains deemed critical to APP: (1) Clinical Leaders, (2) Governance/Regulatory Leaders, (3) Organisational Leaders and (4) Academic Leaders. Each domain had specific inclusion criteria (Table 1). In cases where individuals met multiple sets of criteria, they were assigned according to their preferred domain. To systematically recruit experts with varied perspectives, the Knowledge Resource Nomination Worksheet (KRNW), a structured tool frequently used in Delphi studies, was employed.³³ The research team began by compiling an initial participant list through their professional networks, categorising potential contributors under the most appropriate domain. Once these networks were fully utilised, further participants were identified by searching authors in the APP literature³⁷ to locate additional Academic Leaders, and second, by reviewing the publicly available membership of the Paramedicine Board of Australia, the National Board that, in partnership with the Australian Health Practitioner Regulation Agency, sets professional standards and makes registration decisions for paramedics in Australia, to identify individuals with governance or regulatory leadership expertise. After populating the KRNW, potential experts were invited to join the Delphi study via an electronic survey link. At that point, a snowball recruitment strategy was implemented: invited participants were asked to nominate other individuals who they believed met the expert definitions, thereby expanding the overall pool of potential contributors.

Table 1.

Expert definitions.

Expert category	Definition
Academic Leader	Identified based on having at least one research contribution to APP roles, including peer-reviewed publications and/or grey literature, as a primary author.
Organisational Leader	Recognised within healthcare networks for experience in managing APP implementation, recruitment and role management within organisations.
Clinical Leader	Demonstrates extensive clinical experience in the education of APPs, serves in an educational or clinical organisation (e.g., a manager) or assists in creating clinical guidelines for APP roles.
Regulatory/Governance Leader	Recognised for having experience in policymaking and regulation related to APP roles.

Delphi questionnaire

The Delphi questionnaire was conducted online via the use of Qualtrics software. Each phase survey and accompanying instructions were pilot tested by three members of the research team (AR, LM and BS); feedback on clarity, completeness and potential wording bias was incorporated before distribution. The four-phase Delphi process is described in Figure 1.

Figure 1.

Overview of Delphi process.

Phase 1 – Rating of initial capabilities

To establish a national consensus on the capabilities that should underpin an Australian APP capability framework, we first provided participants with a consolidated list of all existing APP capabilities. These capabilities were identified via a scoping review of the APP literature.³⁷ Capabilities were grouped across four different known domains that were identified in the literature being (1) Clinical Practice, (2) Leadership and Management, (3) Education and (4) Research. At this stage participants were asked to rate each capability on a Likert-type agreement scale (1 = ‘inappropriate’, 5 = ‘extremely appropriate’), to indicate its suitability for inclusion in an Australian APP capability framework. Capabilities with a total of 80% or greater of participants scoring each capability a 4 (somewhat appropriate) or 5 (extremely appropriate) were then considered to be suitable for inclusion in a final presentation of APP capabilities. Participants were also invited to input any amendments or suggestions surrounding each capability which could inform possible revisions via free text. Additionally, in the free-text response area participants could leave suggestions for new capabilities that they believed were integral to APP though not already presented.

Phase 2 – Rating of refined capabilities and presentation of new capabilities

Following the initial rating, any capability that attracted substantive free-text feedback about clarity or conceptual overlap was revised or, where appropriate, merged with a related item and re-presented. Participants were shown both the original and the revised versions of these capabilities and asked to rate the revised versions using the same 5-point Likert scale and 80% threshold employed in Phase 1. Additionally, new capabilities proposed via Phase 1 free-text feedback were introduced for the first time. These new capabilities were also evaluated using the same Likert scale and scoring mechanism as in Phase 1.

Phase 3 – Refinement of new capabilities

In Phase 3, capabilities that were further revised based on Phase 2 feedback were presented again. Participants continued to use the same 5-point Likert scale and the 80% threshold for evaluating these updated capabilities, with both the original and newly revised versions displayed for clarity. Free-text responses remained available for participants to offer further feedback or recommendations.

Phase 4 – Acceptance or rejection of capability framework

In the final phase, participants were presented with a compilation of capabilities that had been accepted during Phases 1–3. These were organised according to their respective domains for clarity. Participants were then asked whether they accepted or rejected the capabilities within each domain in a binary accept or reject approach. An optional free-text response box was provided to allow participants to explain or clarify their choices if desired.

Consensus and convergence of opinion

To achieve consensus on the requisite capabilities for APPs in Australia, this study was designed with a minimum of four Delphi rounds. In the iterative rating rounds (Phases 1–3) each capability was scored on a 5-point Likert scale; items endorsed by ≥80% of panellists at the ‘4–5’ level were carried forward. An 80% threshold was used for Likert-based refinement rounds to ensure that only strongly supported items proceeded to the final vote.³⁸ The confirmatory round (Phase 4) then employed a binary accept/reject vote with a 70% consensus threshold, consistent with Delphi recommendations for dichotomous closure rounds.³⁹ In Phase 4, if agreement on capabilities were below 70% the survey would be recirculated, providing participants with their previous responses, the overall mean scores and relevant qualitative feedback to facilitate reconsideration and refinement. To streamline the process and reduce fatigue, two stopping criteria were established as outlined by Okoli and Pawlowski:³³

Halting after reaching 70% consensus.

Ending iteration if successive rounds showed no statistically significant changes in mean rankings, assessed by McNemar's test.

This structured approach allowed for a balanced convergence of participants insights while respecting participant time, ultimately solidifying a consensus-driven framework for APP capabilities.

Analysis

Descriptive statistics were used for quantitative variables and the research team analysed free-text responses via a descriptive content analysis at each phase and created themes to summarise participant qualitative data.^40,41 Researchers AR and BS reviewed each free-text response critically and proposed revisions to individual capabilities based on participant responses which were then presented to the entire research team for further analysis and review. Table 2 outlines the application of Graneheim and Ludman's trustworthiness criteria in the content analysis approach drawn from Lincoln and Guba's work.^40,42

Table 2.

Trustworthiness criteria.

Credibility	Credibility of the content analysis was completed by involving a range of expert participants with varied perspectives and industry expertise, ensuring a well-rounded understanding of the topic. Additionally, the analysis process was documented with key themes supported by direct quotations from free-text responses, allowing for transparency between participant feedback and identified themes.
Confirmability	At the conclusion of each phase, an inductive content analysis was conducted independently by two researchers (AR and BS). Following individual analyses, the researchers convened to systematically compare and discuss findings, with particular focus on identifying both converging and diverging patterns within the data. Through discussions, themes were refined and validated, creating a summary that captured key insights.
Dependability	Following each phase, at least two researchers met to summarise the free-text responses and quantitative results, disclosing any potential biases in the process.
Transferability	Given that the study exclusively involved Australian experts to develop capabilities for a national framework, transferability is inherently focused on applicability within Australian healthcare contexts. However, the process and framework development may offer foundational insights for other countries seeking to establish or refine their own capability standards for APP, particularly within similar healthcare systems.

Ethics

This research received ethics approval through Monash University, Human Research Ethics Committee, project ID 43558.

Results

Phase 0 – Populating the KRNW

Included participants

A total of 85 participants were identified as experts and invited to participate. The author team populated 71 expert names and invited them to Phase 0 of the Delphi. Through the snowballing technique, an additional 14 participants who met the established criteria were invited to participate by being nominated by other participants. Of the 85 participants invited to participate, 46 consented to involvement. Participants identified their area of expertise based on the provided expert criteria descriptions. Eleven identified as academic experts, 7 as organisational experts, 20 as clinical experts and 8 as regulatory/governance experts giving a representative sample across all four targeted areas. Participation rate at each phase of the Delphi by expert category can be found in Supplementary Table 1.

Phase 1 – Rating of initial capabilities

Phase 1 questionnaire was sent to 46 participants with a response rate of 71.7% (n = 33). Through searching relevant literature 43 individual capabilities were identified, presented and scored (see Table 3 for results organised by domain). Of the 43 capabilities presented, 30 (70%) were accepted in Phase 1 having received greater than or equal to 80% of participants scoring the capability a score of 4 or 5.

Table 3.

Phase 1 results.

Capability	% Scored 4 or 5
Clinical Practice
1.1 Practice within their respective code of professional conduct and within their scope of practice, being responsible and accountable for their decisions, actions and omissions at the advanced level of practice.	91%
1.2 Integrate a critical understanding of their broadened level of responsibility and autonomy and the limits of own competence and professional scope of practice, including when working with increased complexity, risk, uncertainty and incomplete information.	91%
1.3 Act on professional judgement about when to seek assistance and support, demonstrating critical reflection on own practice, self-awareness, emotional intelligence and openness to change.	88%
1.4 Work in partnership with individuals, families and carers, using a range of assessment methods as appropriate (e.g., history taking; holistic assessment, identifying risk factors, mental health assessments, requesting, undertaking and/or interpreting diagnostic tests and conducting heath needs assessments.)	88%
1.5 Demonstrate effective communication skills, supporting people in making decisions, planning care or seeking to make positive changes, to promote person-centred approaches in health and care.	88%
1.6 Apply expertise and decision-making skills to inform clinical reasoning approaches when dealing with differentiated and undifferentiated individual presentations and complex situations, seeking and synthesising information from multiple sources to make appropriate evidence-based judgements and/or diagnoses.	94%
1.7 Initiate, evaluate and modify a range of interventions, which may include prescribing medicines, therapies, lifestyle advice and care, while ensuring a person-centred approach that respects and incorporates the individual's preferences, needs and values.	94%
1.8 Critically evaluate and apply professional judgment to manage risk appropriately, especially when there may be complex and unpredictable events and supporting teams to do likewise to ensure safety of individuals, families and carers.	91%
1.9 Work collaboratively with an appropriate range of multi-agency and inter-professional resources, developing, maintaining and evaluating links to manage risks and issues across organisations and settings.	79%
1.10 Lead by example as a clinical role model and advocate, fostering the development and delivery of adaptable care. This care should be responsive to changing requirements and informed by a comprehensive understanding of local population health needs, as well as the roles and contributions of various agencies and networks.	79%
1.11 Evidence the underpinning subject-specific competencies (i.e., knowledge, skills and behaviours) and demonstrate application of the capabilities to these in an approach that is appropriate to the individual role, setting and scope.	79%
1.12 Demonstrate proficiency in practicing according to relevant legislation, policies and procedures, with a commitment to safeguarding, whistleblowing and cultural safety by seamlessly integrating diverse cultural perspectives into every aspect of care.	79%
1.13 Appropriately review response to medication, recognising the balance of risks and benefits, which may occur in the context of factors such as polypharmacy, multimorbidity, frailty and cognitive impairment.	88%
1.14 Develops individualised care plans that mitigate bias and heuristics, using evidence-based approaches. Ensures the care plan is culturally appropriate and effectively communicated to the patient and their carers, maintaining a person-centred focus.	91%
1.15 Exhibits broad autonomy and judgment across significant areas of work, with the ability to critically analyse, interpret and evaluate complex information while undertaking reflective practice	82%
1.16 Recognises the limits of own expertise and involves other professionals as needed to contribute to patient care and self-development through reflective practice	88%
Leadership and Management
2.1 Proactively establish and nurture effective clinical and staff relationships, ensuring role clarity within teams to promote productive collaboration and high-quality safe patient care.	91%
2.2 Role model the values of their organisation/place of work, demonstrating a person-centred approach to service delivery and development.	82%
2.3 Critically evaluate own practice, and participate in multi-disciplinary service and team evaluation, demonstrating the impact of advanced clinical practice on service function, effectiveness, safety and quality (i.e., outcomes of care, experience and safety).	88%
2.4 Actively engage in clinical governance and peer review to inform own and other's practice, formulating and implementing strategies to act on learning and make improvements.	94%
2.5 Lead new practice and service redesign solutions in response to feedback, evaluation and need, working across boundaries and broadening sphere of influence.	73%
2.6 Actively seek feedback and involvement from individuals, families, carers, communities and colleagues in the co-production of service improvements.	97%
2.7 Critically leverage advanced clinical expertise in appropriate faciliatory ways to provide consultancy across professional and service boundaries, influencing clinical practice to enhance quality, reduce unwarranted variation and promote the sharing and adoption of best practice.	70%
2.8 Demonstrate team leadership, resilience and determination, managing situations that are unfamiliar, complex or unpredictable and seeking to build confidence in others.	85%
2.9 Continually develop practice in response to changing population health need, engaging in horizon scanning for future developments (e.g., impacts of genomics, new treatments and changing social challenges).	85%
2.10 Demonstrate receptiveness to challenge and preparedness to constructively challenge others, escalating concerns that affect individuals’, families’, carers’, communities’ and colleagues’ safety and well-being when necessary.	88%
2.11 Negotiate an individual scope of practice within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and upholding safety.	73%
2.12 Critically appraise and collaboratively shape various health care policies and practices through leadership and active engagement in the workplace and professional organisations.	76%
Education
3.1 Critically assess and address own learning needs, negotiating a personal development plan that reflects the breadth of ongoing professional development.	94%
3.2 Engage in self-directed learning, critically reflecting to maximise clinical skills and knowledge, as well as own potential to lead and develop both care and services.	94%
3.3 Critically evaluate and address individuals’ motivations, developmental stages and capacities. Collaborate effectively to enhance health literacy, empowering individuals to actively engage in their care decisions and optimise their overall health and well-being.	85%
3.4 Advocate for and contribute to a culture of organisational learning to inspire future and existing staff.	94%
3.5 Facilitate collaboration of the wider team and support peer review processes to identify individual and team learning.	85%
3.6 Identify further developmental needs for the individual and the wider team and supporting them to address these.	91%
3.7 Facilitate the development of the broader team by enhancing their capacity and capability through experiential and interprofessional learning and ensure the dissemination of acquired knowledge to contribute to furthering the profession.	82%
3.8 Leads as a role model, educator, supervisor, coach and mentor, seeking to instil and develop the confidence of others.	91%
Research
4.1 Engages in research activity, adhering to good research practice guidance, so that evidence-based strategies are developed and applied to enhance quality, safety and efficiency.	76%
4.2 Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin and improve own practice and to inform that of others.	91%
4.3 Take a critical approach to identify gaps in the evidence base and its application to practice, alerting appropriate individuals and organisations to these and how they might be addressed in a safe and pragmatic way.	76%
4.4 Actively identify potential need for further research to strengthen evidence for best practice. This may involve acting as an educator, leader, innovator and contributor to research activity and/or seeking out and applying for research funding.	73%
4.5 Develop and implement robust governance systems and systematic documentation processes, keeping the need for modifications under critical review.	70%
4.6 Disseminate best practice research findings and quality improvement projects through appropriate media and forums (e.g., presentations and peer review research publications).	79%
4.7 Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers, while actively supporting and promoting staff participation in research within an organisation or professional body.	88%

Note. Rating of initial capabilities.

Content analysis of free-text responses – Phase 1

The content analysis of free-text responses in Phase 1 generated three themes: (1) the need for improved clarity in the phrasing of capabilities, (2) the limited emphasis on research as a core component of APP and (3) clarifying the scope of practice, competence and autonomy.

Clarity in phrasing

Participants frequently expressed concerns about the phrasing of the existing capabilities, with several comments indicating that the language was overly complex.

“This is a word salad. More clarity required”

“A little wordy and repetitive in places, again I suggest they need robust editing for clarity.”

Comments such as these highlighted the need for more concise and direct language. These comments suggest the simplification and clearer expression of the capabilities would enhance understanding and translatability.

The role of research in APP

A second theme generated from expert feedback regarded the role of research within APP capabilities. While research was acknowledged as important, several participants noted that it should not be a core requirement for advanced practitioners.

Some caution in assuming that an advanced practitioner will also be interested and able to undertake their own research. Acting as a researcher shouldn’t be a requirement for an advanced practitioner, however, the abilities to appraise and synthesise the research is important.

Overall, the research domain received less engagement in the free-text responses compared to the other three domains. There were few suggestions for improvement or explanations regarding why these research capabilities were considered inappropriate.

Scope, competence and autonomy

A further theme of the feedback emphasised the need to clarify the scope of practice for advanced paramedics, ensuring it is distinct from other paramedic roles. The feedback highlighted that the current capability statements were not sufficiently clear in defining the competence required at the advanced practice level.

Competence is not just a function of knowledge, but the ability to apply it in diverse situations.

Additionally, participants emphasised that advanced practice should be defined by autonomy in decision-making, based on competence.

Autonomy comes with the responsibility to know when to seek guidance, maintaining accountability at all time.

Phase 2 – Rating of refined capabilities and presentation of new capabilities

Phase 2 had a response rate of 61% (n = 28) of participants respond to the rating of revised and new capabilities generated from Phase 1. Table 4 presents Phase 2 results that show that 16 of 17 capabilities were accepted. See Supplementary Table 1 for the revised capabilities along with a comparison of the original and updated versions.

Table 4.

Phase 2 results.

Capability	% Scored 4 or 5
Clinical Practice
1.1 Practice in accordance with their registration standards, inclusive of code of conduct and professional capabilities, demonstrating responsibility and accountability for decisions, actions and omissions, while operating within the limits of their own competence at an advanced level.	100%
1.4 Work in partnership with consumers, families and carers and other providers using a range of assessment methods as appropriate for the individual's area of advanced practice.	93%
1.5 Demonstrate effective culturally safe communication skills and engagement, supporting people in decision making and care planning to promote person-centred approaches.	93%
1.10 Lead by example, delivering adaptable care based on local health needs and the roles of key agencies.	85%
1.12 Practices in alignment with relevant regulatory and legislative requirements specific to the area of advanced practice, with a clear understanding of the distinctions between advanced and generalist practice.	89%
1.13 Review response to medication and apply safeguards by collaborating with appropriate expertise when recognising the balance of risks and benefits.	82%
1.14 Develops individualised management plans that mitigate bias and heuristics, using evidence-based approaches ensuring the care plan is culturally safe and effectively communicated to the patient and their carers.	93%
1.16 Recognises the limits of own expertise and seeks multidisciplinary advice to ensure safe patient care and where appropriate, undertakes safe transition of care.	100%
New Capability: Demonstrate technical mastery of skills and equipment associated with assessment, monitoring or interventions common to the advanced practice environment.	93%
Leadership and Management
2.2 Demonstrate leadership in advanced practice by modelling professional values and advocating for a culturally safe and person-centred approach to care.	100%
2.3 Critically evaluate through reflection of own practice, and participate in systems and team evaluation, demonstrating the impact of advanced clinical practice on healthcare system function, effectiveness, safety and quality (i.e., outcomes of care, experience and safety).	93%
2.7 Use advanced clinical expertise to provide consultancy across boundaries, improving clinical practice by enhancing quality, reducing variation and promoting best practices.	92%
2.8 Demonstrate leadership when working alone or in teams to manage situations that are unfamiliar, complex or unpredictable and where possible seek to build confidence in others to also take on leadership responsibilities.	85%
2.11 Work within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and ensuring safety, whilst recognising personal and professional limitations.	89%
New capability: Emphasises the importance of engaged followership as a vital aspect of leadership by empowering and facilitating the contributions of others, while fostering and supporting peers to enhance patient care.	65%
Education
3.3 Support the education of consumers, colleagues and the community in advanced practice by addressing their motivations, developmental stages and capacities in order to empower individuals in making informed care decisions and improving their overall health.	88%
3.5/6(merged) Facilitate collaboration within the wider team, supporting peer review processes to identify individual and team learning needs and assisting in addressing these through planning, implementing and evaluating continuous development initiatives.	96%

Note. Rating of refined capabilities and presentation of new capabilities.

Content analysis of free-text responses – Phase 2

The free-text responses from Phase 2 highlighted key areas for refining the capability statements for APP. Three themes were generated to summarise the feedback: (1) the distinction between advanced practice and standard roles, (2) the relevance of certain capabilities and (3) the importance of cultural sensitivity and patient-centred care.

Scope of advanced practice vs standard practice

A significant amount of feedback suggested that many of the capability statements appeared more applicable to standard practice (expressed in capability statements as generalist practice) rather than advanced practice. This overlap raised questions about whether certain capabilities should be categorised as advanced practice or whether they were more appropriate for healthcare practitioners at all levels.

This could be as applicable to general practice as advanced practice – there is nothing unique to advanced practice for this statement

Relevance and applicability of capabilities

There were concerns about the relevance and necessity of some of the capability statements, with feedback suggesting that certain capabilities seemed redundant or unnecessary for advanced practitioners. Some respondents felt that these capabilities were inherently part of any healthcare provider's role, such as ensuring patient safety or engaging in person-centred care.

This feels a little redundant to me as any advanced practitioner is doing this is as an intrinsic part of their role. I’m not sure that it needs to be explicitly stated this way.

Cultural sensitivity and patient-centred care

Another prominent theme was the need to better incorporate cultural sensitivity and patient-centred care into the capability statements. Participants recommended specific terminology such as ‘culturally sensitive care’, ‘health literacy’ and ‘advocacy’ to reflect the importance of these concepts.

Recommended terms … culturally sensitive care, diverse needs, advocacy, supporting health literacy, culturally informed care. Respecting core values and spiritual beliefs.

Furthermore, feedback highlighted the need to ensure that patient involvement is central to the care process.

Ensuring the co-constructed care plan is culturally safe

Phase 3 – Refinement of new capabilities

Phase 3 had a response rate of 61% (n = 28) to refine new and refined capabilities generated from Phase 2. See Supplementary Table 2 for revised capabilities and comparison of ratings between Phases 2 and 3. All six revised capabilities were accepted. See Table 5 for Phase 3 results.

Table 5.

Phase 3 results.

Capability	% Scored 4 or 5
Clinical Practice
1.10 Leads by example, providing adaptable care based on local health needs, collaborating with other health professionals and agencies as required.	100%
1.1/1.12 Merged: Practices in accordance with regulatory, legislative and professional standards, demonstrating responsibility and accountability for decisions, actions and omissions, while operating within the limits of their own competence at an advanced level.	93%
1.13 Monitors patient response to interventions, including medications, applying a risk-benefit approach and collaborates with others to ensure appropriate follow-up and escalation when necessary.	93%
1.14 Creates personalised, evidence-based management plans in collaboration with the patient and their caregivers, ensuring they are communicated clearly and effectively.	89%
Demonstrates competence in clinical skills associated with assessment, monitoring and interventions common to the advanced practice environment.	96%
Leadership and Management
2.8 Demonstrates leadership when working in teams to manage situations that are unfamiliar, complex or unpredictable and seeks, where possible, to empower others to also take on leadership responsibilities.	93%

Note. Rating of refined capabilities.

Content analysis of free-text responses – Phase 3

Phase 3 yielded limited free-text responses from participants. Much of the feedback echoed themes from earlier phases, emphasising the need for clarity and specificity in language, as well as clear distinctions between advanced and standard practice. However, Phase 3 also saw an increase in positive responses, highlighting significant improvements in the language and specificity of the revised capabilities.

This is much better stated and is more inclusive. This is a significant improvement

Phase 4 – Acceptance or rejection of capability framework

Phase 4 had a response rate of 54% (n = 26) achieving 96% consensus across all four separate domains of capabilities presented. This resulted in a finalised list of 33 capabilities distributed across the domains as follows: Clinical Practice with 14 capabilities, Leadership and Management with 10, Education with 7 and Research with 2 capabilities. Table 6 presents the complete list of the 33 accepted capabilities by domain.

Table 6.

Phase 4 results.

Capability
1.1 Practices in accordance with regulatory, legislative and professional standards, demonstrating responsibility and accountability for decisions, actions and omissions, while operating within the limits of their own competence at an advanced level.
1.2 Integrate a critical understanding of their broadened level of responsibility and autonomy and the limits of own competence and professional scope of practice, including when working with increased complexity, risk, uncertainty and incomplete information.
1.3 Act on professional judgement about when to seek assistance and support, demonstrating critical reflection on own practice, self-awareness, emotional intelligence and openness to change.
1.4 Work in partnership with consumers, families and carers and other providers using a range of assessment methods as appropriate for the individual's area of advanced practice.
1.5 Demonstrate effective communication skills that are culturally sensitive and advocate for diverse needs, supporting individuals in decision-making and care planning to ensure person-centred approaches.
1.6 Apply expertise and decision-making skills to inform clinical reasoning approaches when dealing with differentiated and undifferentiated individual presentations and complex situations, seeking and synthesising information from multiple sources to make appropriate evidence-based judgements and/or diagnoses.
1.7 Initiate, evaluate and modify a range of interventions, which may include prescribing medicines, therapies, lifestyle advice and care, while ensuring a person-centred approach that respects and incorporates the individual's preferences, needs and values.
1.8 Critically evaluate and apply professional judgement to manage risk appropriately, especially when there may be complex and unpredictable events and supporting teams to do likewise to ensure safety of individuals, families and carers.
1.9 Leads by example, providing adaptable care based on local health needs, collaborating with other health professionals and agencies as required.
1.10 Monitors patient response to interventions, including medications, applying a risk-benefit approach and collaborates with others to ensure appropriate follow-up and escalation when necessary.
1.11 Creates personalised, evidence-based management plans in collaboration with the patient and their caregivers, ensuring they are communicated clearly and effectively.
1.12 Exhibits broad autonomy and judgement across significant areas of work, with the ability to critically analyse, interpret and evaluate complex information while undertaking reflective practice
1.13 Recognises the limits of own expertise and seeks multidisciplinary advice to ensure safe patient care and where appropriate, undertakes safe transition of care.
1.14 Demonstrates competence in clinical skills associated with assessment, monitoring and interventions common to the advanced practice environment.
Leadership and Management
2.1 Proactively establish and nurture effective clinical and staff relationships, ensuring role clarity within teams to promote productive collaboration and high-quality safe patient care.
2.2 Demonstrate leadership in advanced practice by modelling professional values and advocating for a culturally safe and person-centred approach to care.
2.3 Critically evaluate through reflection of own practice, and participate in systems and team evaluation, demonstrating the impact of advanced clinical practice on healthcare system function, effectiveness, safety and quality (i.e., outcomes of care, experience and safety).
2.4 Actively engage in clinical governance and peer review to inform own and other's practice, formulating and implementing strategies to act on learning and make improvements.
2.5 Actively seek feedback and involvement from individuals, families, carers, communities and colleagues in the co-production of healthcare improvements.
2.6 Use advanced clinical expertise to provide consultancy across boundaries, improving clinical practice by enhancing quality, reducing variation and promoting best practices.
2.7 Demonstrates leadership when working in teams to manage situations that are unfamiliar, complex or unpredictable and seeks, where possible, to empower others to also take on leadership responsibilities.
2.8 Continually develop practice in response to changing population health need, engaging in horizon scanning for future developments (e.g., impacts of genomics, new treatments and changing social challenges).
2.9 Demonstrate receptiveness to challenge and preparedness to constructively challenge others, escalating concerns that affect individuals’, families’, carers’, communities’ and colleagues’ safety and well-being when necessary.
2.10 Work within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and ensuring safety, whilst recognising personal and professional limitations.
Education
3.1 Critically assess and address own learning needs, negotiating a personal development plan that reflects the breadth of ongoing professional development.
3.2 Engage in self-directed learning, critically reflecting to maximise clinical skills and knowledge, as well as own potential to lead and develop both care and services.
3.3 Support the education of consumers, colleagues and the community in advanced practice by addressing their motivations, developmental stages and capacities in order to empower individuals in making informed care decisions and improving their overall health.
3.4 Advocate for and contribute to a culture of organisational learning to inspire future and existing staff.
3.5 Facilitate collaboration within the wider team, supporting peer review processes to identify individual and team learning needs and assisting in addressing these through planning, implementing and evaluating continuous development initiatives.
3.6 Facilitate the development of the broader team by enhancing their capacity and capability through experiential and interprofessional learning and ensure the dissemination of acquired knowledge to contribute to furthering the profession.
3.7 Leads as a role model, educator, supervisor, coach and mentor, seeking to instil and develop the confidence of others.
Research
4.1 Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin and improve own practice and to inform that of others.
4.2 Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers, while actively supporting and promoting staff participation in research within an organisation or professional body.

Content analysis of free-text responses – Phase 4

Free-text responses in Phase 4 were minimal, with only a few participants providing comments within each domain. Among the feedback, a recurring concern was that the capabilities appeared too generic and not sufficiently tailored to advanced practice. One participant specifically highlighted a significant gap in the approved capabilities within the research domain, expressing disappointment with the limited emphasis on research:

I'm disappointed in the minimal research capabilities and the lack of those in advanced practice to take a lead role in enhancing the evidence base for the profession. We have shown a lack of maturity compared to other nations who see research as a key component of advance practice, and I feel we have missed the opportunity to embed research as a key domain in future practice.

Discussion

The purpose of this Delphi process was to gain expert consensus on capabilities which could inform a national capability framework for APPs in Australia. Through four phases a list of 33 capabilities reached consensus across the domains of clinical practice, education, leadership and research. The findings of this Delphi process align with broader debates in the literature about the challenges of developing clear and consistent capability frameworks, particularly in the health sector, where ambiguity in language can be problematic.²⁸ Capability frameworks often conflate functional and behavioural approaches, blending task-specific capabilities with broader professional behaviours in ways that create conceptual ambiguity.⁴³ For instance, some capability frameworks categorise specific knowledge areas as capabilities, deviating from the notion of capabilities as attributes demonstrated through behaviour.²⁸ These inconsistencies lead to a misalignment between a framework's definitions, conceptual underpinnings and intended applications and undermining their effectiveness. Additionally, educators often critique capability frameworks that reduce the concept of capabilities to discrete tasks and their associated standards, arguing this approach oversimplifies professional practice and overlooks the broad range of attributes required for effective performance.^{24,28,44–46} Literature emphasises that defining roles through isolated tasks is insufficient without considering the real-world context in which these tasks occur.⁴⁷ Conversely, industry perspectives highlight the challenges of assessing abstract attributes such as empathy and resilience, suggesting that their inclusion may undermine a framework's validity as a tool for evaluating professional competencies.^23,28,48,49

The challenges in defining and categorising capabilities are highlighted when attempting to distinguish between standard and advanced practice roles. This difficulty in clearly delineating the capabilities of standard and advanced practice within paramedicine mirrors a broader issue faced across many healthcare professions in establishing clear definitions of advanced practice.^5,50 In this study, participants noted at times overlap in the responsibilities attributed to standard paramedics and those proposed for APPs, making it challenging to delineate or attribute APP exclusive capabilities. This issue is not unique to paramedicine; similar challenges have been identified in professions such as nursing, where role boundaries between registered nurses and nurse practitioners can blur, given the advanced knowledge and specialised scope of the nurse practitioners.^26,51 Literature on nursing capability frameworks has pointed out that capabilities attributed to nurse practitioners can also be relevant to registered nurses, who often perform foundational tasks in preparation for escalated or advanced care, highlighting an inherent overlap in practice.^26,51,52 A core reason for this overlap lies in the reality that advanced practitioners operate as extensions of non-advanced roles, maintaining a strong basis in standard practice while applying additional advanced skills.

This overlap in role delineation highlights that advanced practitioners must not only extend foundational competencies but also strengthen less mature domains, most notably research.⁴³ Although consensus was strongest in the clinical, education and leadership domains consistent with other nursing literature,^53,54 the research domain provides valuable insight into areas of opportunity for future development in APP. In our Delphi, full consensus emerged only for research capabilities focused on critically appraising evidence and facilitating research engagement, not for leading original research itself. The ability to critically evaluate and integrate research findings into clinical practice is essential for driving innovation, identifying knowledge gaps and contributing to the broader evidence base that supports healthcare advancements.^55,56 Advanced practice clinicians often report that research responsibilities are more challenging to navigate compared to clinical, educational and leadership duties.^57,58 These challenges are frequently attributed to limited confidence, insufficient time to engage meaningfully with research activities and a lack of formal expectations or pathways which is a phenomenon observed across various sectors and internationally.^55,59–61 Some programmes, such as the US National Institute of Nursing Research doctoral tracks, show what targeted support can achieve,^62,63 yet these remain the exception. Introducing similar supports in Australia could turn this leading research gap into a clear, expected capability for future APPs.

While the research domain generated further insights, it is important to note that the highest levels of consensus across the Delphi rounds were achieved within the clinical practice domain, where 14 capabilities were ultimately retained. These capabilities reflected strong support for key elements of advanced paramedic autonomy, including clinical reasoning, complex decision-making, interprofessional collaboration and person-centred care, consistent with global literature on advanced practice roles.⁶⁴ Translating this into practice means educators teaching postgraduate APP courses should feel confidence mapping curricula to these agreed capabilities. Similarly, the education and leadership domains demonstrated robust consensus, with panellists endorsing the importance of mentoring, team development and system-level thinking as integral to the APP role, capabilities also recognised in nursing literature as essential for advanced clinical roles.^53,54 Embedding formal mentorship training and quality-improvement projects into APP programs would operationalise these expectations and create measurable leadership outputs during training. These findings reflect a maturing view of advanced practice in paramedicine, one that balances clinical excellence with leadership and education responsibilities. The convergence of expert opinion around capabilities in clinical leadership, team collaboration and person-centred care mirrors broader healthcare shifts towards integrated, systems-aware models of practice. These attributes position APPs to contribute meaningfully not only to direct care, but also to service redesign, quality improvement and interprofessional models of care delivery.^65,66

While many countries face common challenges in paramedicine, including growing demand for out-of-hospital care and an ageing population, which necessitate greater professional autonomy in advanced practice roles.⁶⁷ Literature suggests that establishing clear, evidence-based capability frameworks can help ensure consistent and safe standards of care in out-of-hospital settings.¹⁹ Professional autonomy is dependent on enhanced education and robust regulatory frameworks. By focusing on core capabilities that emphasise adaptability, autonomy and transferability, the framework developed in this study could inform national standards for APPs.^8,68

Limitations

Whilst a Delphi methodology is viewed as a robust research strategy and methodology was reported utilising the CREDES guideline there were still limitations to the study. Of the 85 participants invited to participate only 46 consented. There was also a noticeable attrition rate across the phases of the Delphi, however every phase had a representative sample greater than 20 with previous research indicating that consensus stability in Delphi studies is typically reached with a minimum of 20 participants.³⁹ We also acknowledge our decision to limit the expert panel to professionals practicing within the Australian healthcare system rather than including international participants. While international input might have expanded the generalisability of APP capabilities, often each country has unique general registration capabilities and regulatory requirements.^69–71 By focusing on Australian participants, we ensured that the resulting capability framework was directly relevant and tailored to Australia's specific healthcare landscape. The relative paucity of new research capabilities may reflect the nascent state of clinical-academic pathways in Australian paramedicine⁷²; future iterations of the framework should revisit this domain as research capacity matures. Finally, Delphi-derived agreement should be interpreted as expert convergence rather than definitive validation; the proposed capabilities require prospective validation by educational, regulatory and clinical authorities to confirm their utility.

Implications

The outcomes of this project have the potential to influence paramedic education and advance the profession. By establishing a capability framework informed by a diverse expert consensus on core capabilities, we can ensure that paramedics are equipped with the right balance of capabilities across the domains of clinical practice, leadership and management, education and research. Developing an Australian national framework based on these identified capabilities will enable APPs to meet the demands of an evolving healthcare environment and set clear expectations for their roles. Furthermore, it will provide regulatory authorities, education providers, healthcare organisations and policymakers with a robust framework to assess the readiness of paramedics for advanced practice roles, thereby enhancing the overall professionalism and credibility of APP roles.

Conclusion

A final compilation of 33 requisite capabilities to inform APP roles in Australia met expert consensus using a four-phase Delphi methodology. The iterative refinement process ensured that these capabilities, organised under the domains of clinical practice, leadership and management, education and research, accurately reflect the unique and evolving demands of APP roles. The final compilation provides clear, relevant and actionable capabilities that can guide the education, training and practice of APPs. Future work should encompass broad stakeholder consultation and iterative evaluation across Australia while also providing a flexible reference point for international adaptation. The adoption of these capabilities by relevant bodies holds potential to standardise APP roles nationally and contribute to the overall advancement and recognition of the paramedic profession within the healthcare system.

Supplemental Material

sj-docx-1-pam-10.1177_27536386251360833 - Supplemental material for National consensus on the capabilities that inform the role of advanced practice paramedics: A Delphi study

Supplemental material, sj-docx-1-pam-10.1177_27536386251360833 for National consensus on the capabilities that inform the role of advanced practice paramedics: A Delphi study by Alessia Restiglian, Lorna Martin, David Long, Louise Reynolds, Tony Walker, Ben Meadley, Ashleigh Finn, Alan Batt, Alecka Miles and Tania Johnston, Brendan Shannon in Paramedicine

Footnotes

Author contribution(s)

Alessia Restiglian: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Validation; Visualization; Writing – original draft; Writing – review & editing.

Lorna Martin: Methodology; Validation; Writing – review & editing.

David Long: Methodology; Validation; Writing – review & editing.

Louise Reynolds: Validation; Writing – review & editing.

Tony Walker: Validation; Writing – review & editing.

Ben Meadley: Validation; Writing – review & editing.

Ashleigh Finn: Validation; Writing – review & editing.

Alan Batt: Validation; Writing – review & editing.

Alecka Miles: Validation; Writing – review & editing.

Tania Johnston: Validation; Writing – review & editing.

Brendan Shannon: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing – review & editing.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Alan Batt is a Deputy Editor for Paramedicine, Dr David Long and Dr Louise Reynolds are Associate Editors for Paramedicine, all played no role in editorial decision making, which was conducted in adherence to the journal's blind review policy. All other authors declare no actual or perceived conflict of interests.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Alessia Restiglian

Lorna Martin

David Long

Ben Meadley

Ashleigh Finn

Tania Johnston

Brendan Shannon

Supplemental material

Supplemental material for this article is available online.

References

van Vuuren

Thomas

Agarwal

, et al. Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Serv Res 2021; 21: 1–15.

McManamny

Jennings

Boyd

, et al. Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature. Aust Health Rev 2018; 44: 114–120.

Andrew

Nehme

Cameron

, et al. Drivers of increasing emergency ambulance demand. Prehosp Emerg Care 2020; 24: 385. 2019/06/27.

Stenner

van Even

Collen

Paramedic independent prescribing: a qualitative study of early adopters in the UK. Br Paramed J 2021; 6: 30–37. 2021/08/03.

Hardy

Haywood

Rickett

, et al. Practice review: evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med 2021; 35: 461–472. 2021/01/28.

von Vopelius-Feldt

Benger

. Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians. Emerg Med J 2014; 31: 1009–1013.

O’Meara

Furness

Gleeson

. Educating paramedics for the future: a holistic approach. J Health Hum Serv Adm 2017; 40: 219–251.

O’Meara

. Shuffling toward paramedic practitioners in the United States. Paramedicine 2024; 21: 45–47.

O’Meara

Wingrove

Nolan

Frontier and remote paramedicine practitioner models. Rural Remote Health 2018; 18: 4550. 2018/08/16.

10.

Australian Health Practitioner Regulation Agency. Specialist registration, https://www.ahpra.gov.au/Registration/Applying-for-registration/Specialist-Registration.aspx (2024, accessed 20 April 2025).

11.

Mann

Timmons

Evans

, et al. Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: a qualitative exploratory study. Nurse Educ Pract 2023; 67: 103546.

12.

Cashin

Buckley

Donoghue

, et al. Development of the nurse practitioner standards for practice Australia. Policy Polit Nurs Pract 2015; 16: 27–37. 2015/07/15.

13.

Petschack

Lasslett

Ross

. The paramedic–general practitioner relationship: a scoping review. Aust J Prim Health 2023. DOI: https://doi.org/10.1071/PY23060

14.

O’Meara

Duthie

Paramedicine in Australia and New Zealand: a comparative overview. Aust J Rural Health 2018; 26: 363–368. 2018/10/12.

15.

Pap

Barr

Hutchison

, et al. Research agenda and priorities for Australian and New Zealand paramedicine: a Delphi consensus study. Paramedicine 2024; 21: 94–107.

16.

Eaton

Wong

Tierney

, et al. Understanding the role of the paramedic in primary care: a realist review. BMC Med 2021; 19: 145. 2021/06/26.

17.

Shannon

Baldry

O’Meara

, et al. The definition of a community paramedic: an international consensus. Paramedicine 2023; 20: 4–22.

18.

Makrides

Ross

Gosling

, et al. From stretcher bearer to practitioner: a brief narrative review of the history of the Anglo-American paramedic system. Australas Emerg Care 2022; 25: 347–353. 2022/06/07.

19.

Batt

AM.

Do we preach what we practice? The development of competency frameworks in healthcare professions . Thesis, Monash University, 2022. https://doi.org/10.26180/19164818.v1

20.

Batt

Tavares

Williams

The development of competency frameworks in healthcare professions: a scoping review. Adv Health Sci Educ Theory Pract 2020; 25: 913–987. 2019/12/05.

21.

Moullin

Sabater-Hernandez

Fernandez-Llimos

, et al. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst 2015; 13: 16. 2015/04/18.

22.

Gum

Lloyd

Lawn

, et al. Developing an interprofessional capability framework for teaching healthcare students in a primary healthcare setting. J Interprof Care 2013; 27: 454–460. 2013/07/05.

23.

Markus

Thomas

Allpress

. Confounded by competencies? An evaluation of the evolution and use of competency models. NZ J Psychol 2005; 34: 117.

24.

Thistlethwaite

Forman

Matthews

, et al. Competencies and frameworks in interprofessional education: a comparative analysis. Acad Med 2014; 89: 869–875. 2014/05/30.

25.

Vincent

. Differentiating competence, capability and capacity. Innov Perspect 2008; 16: 1–2.

26.

Gardner

Hase

Gardner

, et al. From competence to capability: a study of nurse practitioners in clinical practice. J Clin Nurs 2008; 17: 250–258. 2007/04/11.

27.

Lucas

Smith

The capable country: Cultivating capabilities in Australian education. 2018.

28.

Mills

Middleton

Schafer

, et al. Proposing a re-conceptualisation of competency framework terminology for health: a scoping review. Hum Resour Health 2020; 18: 15. 2020/02/23.

29.

de Meyrick

. The Delphi method and health research. Health Educ 2003; 103: 7–16.

30.

Stewart

Gibson-Smith

MacLure

, et al. A modified Delphi study to determine the level of consensus across the European union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLoS One 2017; 12: e0188348. 2017/11/21.

31.

Varndell

Fry

Elliott

Applying real-time Delphi methods: development of a pain management survey in emergency nursing. BMC Nurs 2021; 20: 149. 2021/08/20.

32.

Jünger

Payne

Brine

, et al. Guidance on conducting and REporting DElphi studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 2017; 31: 684–706.

33.

Okoli

Pawlowski

. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag 2004; 42: 15–29.

34.

Lawani

. Critical realism: what you should know and how to apply it. Qual Res J 2021; 21: 320–333.

35.

Habibi

Sarafrazi

Izadyar

. Delphi technique theoretical framework in qualitative research. Int J Eng Sci 2014; 3: 8–13.

36.

Delbecq

Van de Ven

Gustafson

DH.

Group techniques for program planning: A guide to nominal group and Delphi processes. 1975.

37.

Restiglian

Shannon

Advanced Paramedic Capability Framework. Open Science framework, 2024. https://osf.io/cnfb5/

38.

Hsu

C-C

Sandford

. The Delphi technique: Making sense of consensus. Pract Assess Res Eval 2007; 12: 1–8. https://doi.org/10.7275/pdz9-th90

39.

Giannarou

Zervas

. Using Delphi technique to build consensus in practice. Int J Bus Sci App Manag 2014; 9: 65–82.

40.

Graneheim

Lundman

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004; 24: 105–112. 2004/02/11.

41.

Vaismoradi

Turunen

Bondas

Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci 2013; 15: 398–405. 2013/03/14.

42.

Lincoln

Guba

EG.

Establishing dependability and confirmability in naturalistic inquiry through an audit. 1982.

43.

Dean

. Advanced clinical practitioners and the research pillar. Int J Adv Pract 2023; 1: 42–46.

44.

Grzeda

. In competence we trust? Addressing conceptual ambiguity. J Manag Dev 2005; 24: 530–545.

45.

Grant

The incapacitating effects of competence: a critique. Adv Health Sci Educ Theory Pract 1999; 4: 271–277. 2002/10/19.

46.

Whitehead

Kuper

Hodges

, et al. Conceptual and practical challenges in the assessment of physician competencies. Med Teach 2015; 37: 245–251. 2014/12/20.

47.

Sunagawa

Kozaki

Kitamura

, et al. A framework for organizing role concepts in ontology development tool: Hozo. Boella et al[8] 2005: 136–143.

48.

Lievens

Sanchez

De Corte

. Easing the inferential leap in competency modelling: the effects of task-related information and subject matter expertise. Pers Psychol 2004; 57: 881–904.

49.

Kuchinke

Han

H-Y

. Should caring be viewed as a competence?(Re-) opening the dialogue over the limitations of competency frameworks in HRD. Hum Resour Dev Int 2005; 8: 385–389.

50.

Stasa

Cashin

Buckley

, et al. Advancing advanced practice—clarifying the conceptual confusion. Nurse Educ Today 2014; 34: 356–361.

51.

Gardner

Duffield

Doubrovsky

, et al. Identifying advanced practice: a national survey of a nursing workforce. Int J Nurs Stud 2016; 55: 60–70. 2016/01/13.

52.

O’Connell

Gardner

Coyer

Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. J Adv Nurs 2014; 70: 2728–2735. 2014/08/12.

53.

Duffield

Diers

O’Brien-Pallas

, et al. Nursing staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res 2011; 24: 244–255. 2010/10/27.

54.

Swan

Ferguson

Chang

, et al. Quality of primary care by advanced practice nurses: a systematic review. Int J Qual Health Care 2015; 27: 396–404. 2015/08/05.

55.

Begley

Elliott

Lalor

, et al. Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). J Adv Nurs 2013; 69: 1323–1337.

56.

Elliott

Begley

Kleinpell

, et al. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis. J Adv Nurs 2014; 70: 1078–1093. 2013/10/15.

57.

Alsararatee

. Research strategies for trainee and qualified advanced clinical practitioners that enhance evidence-based practice. Br J Nurs 2024; 33: 663–665.

58.

Badu

SA.

The role of advanced clinical practitioners in clinical research. Br J Nurs 2023; 32: 284–290. 2023/03/24.

59.

Fothergill

Al-Oraibi

Houdmont

, et al. Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey. BMJ Open 2022; 12: e055475. 2022/01/07.

60.

van Oostveen

Goedhart

Francke

, et al. Combining clinical practice and academic work in nursing: a qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals. J Clin Nurs 2017; 26: 4973–4984.

61.

Braun-Inglis

Boehmer

Zitella

, et al. Role of oncology-advanced practitioners to enhance clinical research. Am Soc Clin Oncol 2020. DOI: https://doi.org/10.6004/jadpro.2022.13.2.2

62.

Iles-Smith

Ersser

. The DINARC© toolkit-clinical academic research capacity-building and post-doctoral development for nurses, midwives and allied health professionals (NMAHP). Int J Pract-Based Learn Health Soc Care 2019; 7: 25–35.

63.

Taylor

Drennan

Halter

, et al. Uptake of advanced clinical practice roles in the health service in England: perspectives at the micro level. SSM Qual Res Health 2022; 2: 100141.

64.

Ham

Berwick

Dixon

. Improving quality in the English NHS. London: The King's Fund, 2016.

65.

Nancarrow

Booth

Ariss

, et al. Ten principles of good interdisciplinary team work. Hum Resour Health 2013; 11: 19. 2013/05/15.

66.

Halcomb

McInnes

Williams

, et al. The experiences of primary healthcare nurses during the COVID-19 pandemic in Australia. J Nurs Scholarsh 2020; 52: 553–563. 2020/08/01.

67.

Eaton

Addressing the challenges facing the paramedic profession in the United Kingdom. Br Med Bull 2023; 148: 70–78. 2023/09/08.

68.

Reed

Cowin

O’Meara

, et al. Professionalism and professionalisation in the discipline of paramedicine. Australas J Paramed 2019; 16: 1–10.

69.

Australian Health Practitioner Regulation Agency. Professional Capabilities for Registered Paramedics. In: AHPRA PB, (ed.). 2021. https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx

70.

Health Education England. Multi-professional framework for advanced clinical practice in England. London: Health Education England, 2017. https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf

71.

Paramedic Association of Canada. National occupational competency profile for paramedics. 2011. https://paramedic.ca/competencies/

72.

Meadley

Andrews

Delardes

, et al. The evolution of clinician-academics in paramedicine: completing the picture of professionalism. Prehosp Disaster Med 2022; 37: 574–576. 2022/09/06.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB