Development Of Advanced Nursing Roles Research Articles

'We are pulled to the four corners': Qualitative role descriptions of advanced practice children's nurses in Malawi.

This study investigated emerging roles among specialist child health nurses (CHNs) in Malawi. Advanced nursing role development is globally advocated. Nursing role descriptions provide an evidential basis for workforce planning. Rigorously developed role descriptions are scarce worldwide, especially for Africa. Advanced nursing roles were introduced in Malawi's child health system a decade ago. We followed guidance on generating nursing role descriptions to collect and analyse qualitative data from interviews and focus groups, using qualitative content analysis. We used COREQ reporting standards. More than half (41/80) of Malawi's child health nursing workforce participated. Richly descriptive accounts of roles elicited three themes: leading and developing new services and improving existing ones; holding rare knowledge which uplifts care quality; and responsibility for developing the role. These responsibilities are experienced as a privilege and a burden, often meaning CHNs are 'pulled to the four corners'. We found evidence of remarkable achievements by Malawi's CHNs but also suggestions that they are under heavy strain. Because multi-stakeholder agreement about role content is crucial to successfully implementing advanced nursing roles, we hope the approach taken by this study, and the information generated, could be useful as part of human resources for health strategy development in other lower-resourced countries globally.

Strategies for improving care of oncologic patients: SHARE Project results

Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

An investigation of barriers and enablers to advanced nursing roles in Australian general practice

Over the past decade, there has been substantial increase in nurses' roles in primary health care, particularly in general practice settings. Simultaneously, there has been an expansion of advanced roles for nurses across a range of clinical environments. This paper draws upon findings from a study that sought to develop a framework to support development of advanced nursing roles in general practice. It presents findings from one part of that study that explored barriers and facilitators to the development of these roles. Twenty-three key leaders from nursing, general practice and professional organisations participated in semi-structured interviews. Data were analysed using thematic analysis. A range of factors was identified as key to developing advanced roles in general practice. These included increasing awareness and attractiveness of practice nursing, health reform activities, practice limitations, education and professional development. Understanding complex systems and workforce issues is required to promote active intervention that can facilitate development of advanced nursing roles in Australian general practice.

How does care coordination provided by registered nurses “fit” within the organisational processes and professional relationships in the general practice context?

The aim of this study was to develop understanding about how a registered nurse-provided care coordination model can "fit" within organisational processes and professional relationships in general practice. In this project, registered nurses were involved in implementation of registered nurse-provided care coordination, which aimed to improve quality of care and support patients with chronic conditions to maintain their care and manage their lifestyle. Focus group interviews were conducted with nurses using a semi-structured interview protocol. Interpretive analysis of interview data was conducted using Normalization Process Theory to structure data analysis and interpretation. Three core themes emerged: (1) pre-requisites for care coordination, (2) the intervention in context, and (3) achieving outcomes. Pre-requisites were adequate funding mechanisms, engaging organisational power-brokers, leadership roles, and utilising and valuing registered nurses' broad skill base. To ensure registered nurse-provided care coordination processes were sustainable and embedded, mentoring and support as well as allocated time were required. Finally, when registered nurse-provided care coordination was supported, positive client outcomes were achievable, and transformation of professional practice and development of advanced nursing roles was possible. Registered nurse-provided care coordination could "fit" within the context of general practice if it was adequately resourced. However, the heterogeneity of general practice can create an impasse that could be addressed through close attention to shared and agreed understandings. Successful development and implementation of registered nurse roles in care coordination requires attention to educational preparation, support of the individual nurse, and attention to organisational structures, financial implications and team member relationships.

Jordanian perspectives on advanced nursing practice: an ethnography

This study aimed to explore how different groups of participants perceived the concept of advanced nursing practice in Jordan. In Jordan, there are postgraduate educational programmes offering a Master's degree in clinical nursing for registered nurses. Intended to prepare nurses to practise at an advanced level as potential clinical nurse specialists in critical care, community health nursing and maternal newborn nursing, little was known prior to this study about the development of advanced nursing roles for nurses in Jordan and the drivers behind their establishment. Using ethnographic design, narratives from semi-structured interviews and non-participant observation with participants from five Jordanian hospitals and two public universities were collected and analysed according to thematic analysis. Four themes emerged from the data: core competencies, specific practice area vs. generic practice, beneficiaries of advanced nursing practice and drivers for educational change. The findings are similar to those found in other countries and highlight the need for a consensual understanding between nurse educationalists, professional bodies and employers about what advanced nursing practice in Jordan should be, so that a common framework can be identified. Paralleling the lack of consistency in understanding of advanced nursing practice in the broader literature, participants described a number of different elements of advanced practice that are relevant to the specific context of contemporary Jordanian nursing.

Role Development of Nurses Supervising Exercise Tolerance Tests

9 Chapter One: Introduction 10 The Exercise Tolerance Test 10 Background 12 The ETT Nursing Role 13 Development of Advanced Nursing Roles in New Zealand 13 Advancing Cardiovascular Nursing Roles and Role Expansion 15 The Research Question 16 Summary 17 Chapter Two: Literature Review 18 Introduction 18 Search Strategy 18 Historical Development of the ETT Nurse 19 Advancing Cardiovascular Nursing and Role expansion 27 Literature Discussion 32 Summary 35 Chapter Three: Methods 36 Interviews with ETT Nurses 37 Method 37 Participants 37 Data Collection 38 Ethical Issues 38 Data Analysis 39 Interview with Clinical Director of Cardiology 40

Barriers to developing the nurse practitioner role in primary care-the GP perspective.

Opportunities exist to develop an advanced nursing role in general practice and there is growing evidence that appropriately trained nurses can reduce cost and GP workload without compromising quality of care or patient satisfaction. Despite the shortfall of doctors entering British general practice and the difficulties doctors report in managing an increasing workload in primary care, few British practices have chosen to adopt this potential solution. An exploration of the barriers to the development of a nurse practitioner role is therefore timely. To explore the views of British GPs regarding their attitudes towards developing an advanced nursing role in general practice. A focus group study of GPs from four general practices in Yorkshire selected purposefully to represent a spectrum of experience in working with different nursing roles in general practice. Each focus group consisted of between 6 and 8 participants. A structured framework was used to elicit views, the group meetings were recorded and subjected to content analysis by two independent assessors. Inter-rater reliability was high (K = 0.921; 95% confidence limits 0.86-0.98). The study highlighted significant concerns by GPs with regard to the nurse practitioner role in general practice. Four themes were identified that may be impeding the development of advanced nursing roles in general practice. These are concerned with threats to GP status, including job and financial security, nursing capabilities, including training and scope of responsibility, and structural and organizational barriers. There is a need to acknowledge GP concerns and encourage a more widespread debate about the appropriate mix of skills required in primary care. Joint educational events and the development of GP preceptorship may help to develop a greater understanding of the potential value of advanced nursing roles in general practice.

The role of the nurse in paediatric asthma management

In recent years the role that specialist nurses play in chronic disease management has broadened and they are now recognised as valuable members of the multi-disciplinary team, demonstrating that their skilled practice contributes to the quality of patient care. Nurses in primary and secondary care are working as autonomous practitioners managing their own caseload of asthmatic patients and taking a key role in facilitating ongoing treatment regimes. The development of advanced nursing roles has provided an opportunity to broaden many nursing skills producing highly competent paediatric respiratory nurses. The purpose of this article is to outline the service that nurses offer to children with asthma and their families by discussing the role they play in patient care and management.

Nursing for the new millennium the growth and development of advanced practice roles.

Date: 6-7 August 1999 PLACE:The Park Hotel, Cardiff Date for receipt of abstracts: 31 August 1998 Hosted by the RCN Nurse Practitioner Association, this is the 7th international conference. The conference will highlight the ongoing development of nurse practitioner practice and the educational preparation that will be needed in the future. The organisers are particularly interested in papers looking at the growth and development of advanced nursing roles, evidence based and cost effective practice, and lifetime learning.