Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study

• Published in: Journal of advanced nursing 2012-08, Vol.68 (8), p.1780-1792
• Main Authors: Shiu, Ann T.Y., Lee, Diana T.F., Chau, Janita P.C.
• Format: Article
• Language: English
• Subjects: Adult; advanced nursing practice; Advanced Practice Nursing - organization & administration; Advanced Practice Nursing - trends; Aged; Aged, 80 and over; case study research; Clinical Competence - standards; continence; diabetes; Diabetes Mellitus - nursing; Evidence-Based Practice - organization & administration; Fecal Incontinence - nursing; Female; Hong Kong; Humans; Interprofessional Relations; Male; Middle Aged; Models, Organizational; nurse roles; Nurse's Role; Nursing; Nursing Administration Research; Organizational Case Studies; Organizational Culture; Practice Patterns, Nurses' - organization & administration; Qualitative Research; Urinary Incontinence - nursing; wound care; Wounds and Injuries - nursing
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/j.1365-2648.2011.05868.x

shiu a.t.y., lee d.t.f. & chau j.p.c. (2011) Exploring the scope of expanding advanced nursing practice in nurse‐led clinics: a multiple‐case study. Journal of Advanced Nursing68(6), 1780–1792. Aim.  This article is a report on a study to explore the development of expanding advanced nursing practice in nurse‐led clinics in Hong Kong. Background.  Nurse‐led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. Methods.  A multiple‐case study design was adopted with six nurse‐led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non‐participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within‐ and cross‐case analyses were conducted. Results.  The cross‐case analysis demonstrated six elements of good advanced nursing practice in nurse‐led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community‐hospital, wellness–illness, public–private and professional‐practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse‐led clinics. Conclusion.  The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse‐led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.