Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study
As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.
Available from: Janita Chau
- "Contrary to the wealth of publications about the substantive areas of ANP and an increasing body of research on the impact of nurse-led services on clinical outcomes, there are few studies examining the elements of process of care that constitute good ANP (Bonsall & Cheater 2008). Some related empirical findings on the positive aspects of ANP can be identified, for example, using a holistic approach to client care (Wong & Chung 2006, Bhattacharya et al. 2007, Edward et al. 2008), improving community–hospital interface (Canam 2005, Stephen 2007), involving family in the care (Canam 2005) and initiating innovative interventions (Stephen 2007). While these findings extend our understanding , the available research-based information is fragmented and a systematic empirical exploration of such elements has been lacking. "
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ABSTRACT: This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong.
Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice.
A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted.
The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics.
The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.
Journal of Advanced Nursing 11/2011; 68(8):1780-92. DOI:10.1111/j.1365-2648.2011.05868.x · 1.74 Impact Factor
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ABSTRACT: Within the practice environment there are many demands to meet and many conflicting perspectives. The most recent example of this conflict is the polarity caused by the confusion and overlap between the established role of the clinical nurse specialist and the emerging role of the clinical nurse leader. The issues surrounding the confusion, concern, and potential for complimentary function are explored. The intent is to inform nursing leaders and provide points to use in making decisions regarding the roles and the focus on patient outcomes.
Nursing administration quarterly 10/2008; 32(4):301-7. DOI:10.1097/01.NAQ.0000336727.72501.22
Available from: longwoods.com
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ABSTRACT: The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.
Nursing leadership (Toronto, Ont.) 12/2010; 23 Spec No 2010(sp):114-39. DOI:10.12927/cjnl.2010.22272
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