Legitimate influence : the key to advanced nursing practice in adult critical care
At the inception of this research study the intent was to inform the debate regarding advanced nursing practice in adult critical care, in the United Kingdom. Argument within the nursing profession was vociferous concerning the nature of advanced nursing practice and to achieve some insight into the conundrum the following research question was posed, 'What is 'advanced' about advanced nursing practice in adult critical care? To pursue the research question in greater depth three aims were stated. These reflected a desire to explore the development and activity of advanced practice nurses in adult critical care; to gain a perspective of the processes involved in their socialisation and to develop a model which would reflect these elements. The research utilised grounded theory methods, within the constructivist paradigm. The purpose of this was to reflect a relativist ontology in which reality was the subject of joint interpretation and a subjectivist epistemology where the researcher and participant co-created an understanding of the phenomenon of advanced nursing practice in adult critical care, within a naturalistic context. The methodological procedures led to the construction of the substantive theory, Legitimate Influence: the key to advanced nursing practice in adult critical care. This represents a unique contribution to the extant body of nursing knowledge associated with advanced nursing practice. The central elements comprised a focus on enhanced patient stay and improved patient outcome, the development and maintenance of credibility, underpinned by an ability to engage in advanced clinical nursing practice and the development and dissemination of knowledge. The ubiquitous nature of power between, and within, professional groups was also evident in the constraints placed upon the exercise of Legitimate Influence. Participants were also able to articulate the difference between expert and advanced clinical nursing practice; critical care practice within the domain of medicine and nursing and the focus of future patient orientated nursing research. Emphasis was also placed on the importance restorative care, and the need to balance this with the exigencies of cure. The study concludes with recommendations for practice, research and policy.