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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland

Authors: Imelda Coyne, Catherine M. Comiskey, Joan G. Lalor, Agnes Higgins, Naomi Elliott, Cecily Begley

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Clinical specialist (CS) and advanced practitioner (AP) roles have increased in nursing and midwifery internationally. This study explored clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners in Ireland.

Methods

Using a case study design, interview, observational and documentary data from postholding sites (CSs or APs employed) were compared with data from non-postholding sites (no CSs or APs employed). Interviews and observations were conducted with postholders (n = 23), and compared with data from healthcare professionals (nurses or midwives, doctors) (n = 23) in matched services. Interviews were held with Directors of Nursing and Midwifery (n = 23), healthcare professionals (n = 41), service users (n = 41) with experience of receiving care or working with postholders, and non-postholders in matched services. The data were analysed using Nvivo (Version 8).

Results

The findings suggest that postholders’ practice appeared to differ from non-postholders’ in relation to case management and service provision. Postholders were seen as having an impact on readmission rates, waiting lists/times, collaborative decision-making, continuity of care and workload management. Postholders’ autonomy to manage caseloads was perceived to lead to smoother transition of patients/clients through the healthcare system. Service-users’ self-reports appeared to appreciate the individualised holistic care provided by postholders. Postholders’ role in facilitating person-centred care and promoting interprofessional team working, are essential elements in quality care provision and in global healthcare workforce planning.

Conclusions

To meet changing healthcare demands, promote person-centred care, and improve service delivery, more specialist and advanced practice posts in nursing and midwifery should be developed and supported within healthcare.
Footnotes
1
Clinical Specialist (CS) will be used to encompass both clinical nurse specialists and clinical midwife specialists.
 
2
Advanced Practitioner (AP) will be used to encompass both advanced nurse practitioner and advanced midwife practitioner.
 
3
Clinical Nurse Manager Grade 2 and 3 refers to nurses who have at least 5 years post registration experience of which 2 must be in the specialty or related area.
 
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Metadata
Title
An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland
Authors
Imelda Coyne
Catherine M. Comiskey
Joan G. Lalor
Agnes Higgins
Naomi Elliott
Cecily Begley
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1412-8

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