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.
Available from: Ivy Lynn Bourgeault
- "Notable exceptions were in oncology and palliative care, where CNSs had extensive clinical roles in pain and symptom management and care coordination. In contrast, Canadian studies described a number of ways CNSs were involved in direct patient care, including the assessment and management of acute and chronic illnesses, health promotion, discharge planning, care coordination and education (Bryant-Lukosius et al. 2007; Canam 2005; Charchar et al. 2005; Lasby et al. 2004; Schreiber et al. 2003). Interview participants observed that CNSs without a direct clinical role were more vulnerable to funding cutbacks because the loss of the role may not have immediate impact on practice settings. "
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ABSTRACT: The clinical nurse specialist (CNS) provides an important clinical leadership role for the nursing profession and broader healthcare system; yet the prominence and deployment of this role have fluctuated in Canada over the past 40 years. This paper draws on the results of a decision support synthesis examining advanced practice nursing roles in Canada. The synthesis included a scoping review of the Canadian and international literature and in-depth interviews with key informants including CNSs, nurse practitioners, other health providers, educators, healthcare administrators, nursing regulators and government policy makers. Key challenges to the full integration of CNSs in the Canadian healthcare system include the paucity of Canadian research to inform CNS role implementation, absence of a common vision for the CNS role in Canada, lack of a CNS credentialing mechanism and limited access to CNS-specific graduate education. Recommendations for maximizing the potential and long-term sustainability of the CNS role to achieve important patient, provider and health system outcomes in Canada are provided.
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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.
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