An exploration of advanced nursing in a hospital context: people, processes, frameworks.

Abstract

This thesis for Doctor of Professional Practice (DProf) Health and Social Care presents a study with synthesis of in-depth research, conducted simultaneously with practice development (PD), informed by a relevant literature review. Exploration of advanced nursing, with a valuable addition to local and national discussion of advanced nurses; their roles and positive contributions to patient care and health service delivery is presented. Whilst contextual, this work also adds to international understanding of advanced nursing and its practice. The most signficant contribution to knowledge, is a model of advanced nursing, created from synergy of the PD and research. This helps unravel some of the mystery around the concept, whilst contributing a tool for articulating professional identity and a framework for being an advanced nurse in the hospital context. Advanced nurses practice is at a higher level compared to entry-level registrant nurses, with a greater degree of independent and autonomous practice. This draws on advanced skills and a knowledge-base enabling leadership of holistic patient assessment, critical reasoning and diagnostic decision-making that is often complex and unpredictable, within the context of individualised, person-centred care. The ever- changing, challenging political and professional environment of the United Kingdom [UK] National Health Service [NHS] is characterised by increasing workforce demands and population requirements for complex healthcare practices. Advanced nursing has responded by evolving and adapting innovatively, to help meet care deficits and gaps in services. The study commenced with two inter-linked PD projects. Project 1 [PD1]: 'Specialised Nurse Review' [SNR] based in an acute hospital focused on production and implementation of an advanced nursing framework. Project 2 [PD2] involved leading on education curriculum development for advanced nursing, at a local university. The PD successfully increased interest in and facilitated better understanding of advanced nursing, and supported role and practice development, alongside development of relevant education, all aimed at improving care and healthcare service delivery. Parallel to and drawing on PD1 and PD2, was a qualitative research study, which explored experiences of being an advanced nurse in the same hospital, using Interpretative Phenomenological Analysis (IPA). The research culminated in creation of an original advanced nursing model, conceptualised by three core, synthesised themes. Firstly, the four pillars of advanced practice, which enabled the advanced nurses' practice to be extrapolated and categorised. The two further themes of the 6Cs nursing values and dimensions of humanisation encapsulated the strong nursing and caring focus, at the heart of how they function. The model offers an innovative interpretation of advanced nursing features, underpinned by the intertwined themes. These were relatively new concepts that had not been applied to advanced nursing, in this synthesised manner previously. Throughout the DProf personal narrative articulated my lived experience, aiding development of my personal model of advanced nurse, practice developer, educator and researcher. Building contemplative scholarship resulted in my embodiment as a 'scholarly professional' embedded in advanced nursing. This has been a dynamic, transformative process, fostering appreciation of how this study can and is contributing locally and beyond, to development of advanced nursing. With increased confidence and capabilities, my personal contributions were recognised, through the research and PD, resulting in me leading and managing two additional PD projects, alongside participation in linked initiatives, regionally and nationally. The first of these, mirrored PD1, albeit within another hospital and the second was further validation of the advanced practice education curriculum originally developed through PD2. Thus, on reaching the final DProf destination, a new, enriched journey of advanced nursing is in motion.