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Title: Aspects of advanced nursing practice
Author: Marsden, Janet Elizabeth
ISNI:       0000 0001 2441 293X
Awarding Body: Manchester Metropolitan University
Current Institution: Manchester Metropolitan University
Date of Award: 2012
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This PhD by publication brings together several pieces of research undertaken in order to explore issues in advanced practice in a number of different settings. The focus of the programme of work has been to gain a better understanding and widen available knowledge of the drivers and essential elements of advanced practice nursing roles. The whole body of the work is based on my continuing academic and professional role embracing clinical practice and education as well as research. It is my strongly held belief that these three components are intrinsically linked and that one without the others, for professionals in practice, is incomplete and inherently flawed as an underpinning to the work of health care professionals. The work on this thesis began because of concerns and issues around personal practice and has grown to involve national and international perspectives on a number of clinical areas. This programme of work with each new study considering different aspects of advanced practise while building on the results and conclusions of the preceding works, leads to a consideration of some of the implications for future practice, education and research in this important area of nursing. The opportunities for research were, in the main, on a small scale and unfunded. Qualitative techniques were chosen in order to explore the ideas and experience of the participants, rather than those preconceived ideas held by the researcher(s). The demographic and quantitative data collected in the surveys was represented by descriptive statistics only as no inferences (in a statistical sense) could possibly have been drawn from such data. The publications associated with the planned areas of enquiry add to the evidence base for advanced nursing practice and seek to promote discussion and debate and promote change around an essential element of healthcare provision. The studies consider aspects of advanced practice including: " Decision making and safety: Decision making reflects expertise and has been shown, in the work here as well as in many other areas, to be safe and effective. 9 Acceptability of roles: There is a huge volume of research available that shows overwhelmingly that patients like these advanced practice roles. Research undertaken here showed the acceptability of the role to the multidisciplinary team and the importance of the whole team to role functioning. " The organisation of advanced practice: Some issues identified in the study relating to aspects of role development such as prescribing, have subsequently been successfully addressed. Others, such as the rigidity of job descriptions and the lack of support for risk taking, still prove problematic, " The process of role development is, as has been highlighted in other literature, often ad hoc, local, ill thought through and without the infrastructure to support it. Nevertheless, roles are evidently successful. " Regulation of advanced practice: What has become clear throughout the process and the time span of the programme of research is that whether regulation is in place or not, nursing responds to the needs of the service and while regulation of one part of nursing ensures that the particular advanced practice role is protected, others evolve outside the framework as easier (and cheaper) options. " Policy as a driver of roles: It is clear that policy, whether local or national drives the areas in which advanced practice flourishes. Where there are gaps in service, nurses and now other health professionals undertaking such roles, move in to address the service imperatives. The nature of healthcare is about to change quite fundamentally in the UK, and if we are to be able to know what is going on and the effect it is having, research on advanced practice roles must continue. My intentions are to build on this work in the future and include replication studies as well as studies employing sequential explanatory designs to widen the scope of the research presented here. Other areas of potential research include outcomes for patients in acute care settings as well as issues such as value for money which, at present are very difficult to quantify. As nurses move into even more complex roles, it will also be important to keep an eye on the educational underpinnings of such roles. The private sector is playing an increasing part in the UK's health provision and, with a diverse range of organisations involved, little is known about advanced practice roles in these organisations. This gap in the original research, coupled with the much wider role of such providers in the future, also opens up future research possibilities.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available