Advanced Nurse Practitioners’ (Emergency) perceptions of their role, positionality and professional identity: a narrative inquiry

Aims To explore Advanced Nurse Practitioners' (Emergency) perceptions of their role, positionality and professional identity. Background Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 Advanced Nurse Practitioners currently registered increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) provide full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions. Design Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken. Methods Data were collected in ten in‐depth interviews and thematic analysis applied. Results Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, position in the organisation and emergent professional identity. Role‐transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimising waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher‐level decision‐making, autonomy and accountability are integral to advanced practice. Conclusion This study presents unique insights into the advanced nurse practitioner role covering recruitment, organisational culture changes required and support to ease transition emerged. Impact Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills‐sets will inform the targets for the future recruitment and retention of Advanced Nurse Practitioners are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically‐close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development

An international eDelphi study identifying the research and education priorities in wound management and tissue repair

Aim.  To incorporate an international and multidisciplinary consensus in the determination of the research and education priorities for wound healing and tissue repair. Background.  A compelling reason for the study is the lack of an agreed list of priorities for wound care research and education. Furthermore, there is a growth in the prevalence of chronic wounds, a growth in wound care products and marketing, and an increase in clinician attendance at conferences and education programmes. Design.  The study used a survey method. Methods.  A four-round eDelphi technique was used to collect responses from an international population of health professionals across 24 countries. Results.  Responses were obtained from 360 professionals representing many health care settings. The top education priorities related to the standardisation of all foundation education programmes in wound care, the inclusion of wound care in all professional undergraduate and postgraduate education programmes, selecting dressings and the prevention of pressure ulcers. The top research priorities related to the dressing selection, pressure ulcer prevention and wound infection. Conclusion.  Professionals from different backgrounds and countries who are engaged in wound management share a common set of priorities for research and education. Most notably, the priorities identified relate to long-established clinical challenges in wound care and underpin the principles of good patient care practices. The priorities are closely allied to an ageing population and identify many challenges ahead for practitioners engaged in wound management services. Relevance to clinical practice.  The provision of wound care is a major investment of health service resources and remains a clinical challenge today. Research is essential to building evidence-based practice and fundamental to development of quality in standards of practice; education is central to achieving competence to deliver effective care. The determination of research and education priorities is therefore an absolute requirement in developing services.</p

Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research

Background: Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. Aim: To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland. Methods: A qualitative design involving semi?structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1). Results: While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost?saving measure, also emerged as potential barriers to future sustainability. Conclusion: The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. Relevance to clinical practice: In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided