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Title: Crossing the boundaries : nurses in the medical domain : an examination of safety and outcomes in secondary care
Author: Grundy, Lynne
ISNI:       0000 0004 7425 4679
Awarding Body: Swansea University
Current Institution: Swansea University
Date of Award: 2014
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Background and Aims Nurses' roles, responsibilities and practice have changed and the boundaries between nursing and medicine have blurred. Few studies compare clinical outcomes of patients managed by Advanced Nurse Practitioners (ANPs) and junior doctors in acute secondary care. Aims of the study were to identify any observable differences between ANPs undertaking traditional junior doctor roles and junior doctors in relation to senior doctor congruence with diagnosis and clinical management planning, and clinical assessment practices. Setting The study took place in an acute hospital in the UK from April 2009 to August 2010. Design and methods This was a retrospective review of clinical records of patients presenting to the emergency medicine division. Data were collected from 311 randomly selected case notes of patients presenting to 10 ANPs and 10 junior doctors. Data were analysed using bivariate and multivariate techniques in SPSS version 19. Analyses were repeated including only patients presenting to Acute Medical Assessment Unit (AMA). Findings Statistically significant findings included: patients presenting to junior doctors were older, had more co-existing problems and were prescribed more medicines before presentation. Patients presenting to ANPs were more likely to have chest pain. ANPs were less likely to prescribe medicines. Clinical management plans were less likely to be agreed for patients with more coexisting problems. There were few inter-professional differences in senior congruence with clinical management planning and diagnosis and clinical assessment practices. These findings are reassuring as nurses' work moves into what was formerly the medical domain.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.N.Sc.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available