Revealing higher levels of nursing practice

The role of the nurse consultant in infection control

W ith the advent of the Controls Assurance Standards (NHS Executive, 1999), Clinical Governance (1999), The Management and Control of Hospital Acquired Infections in Acute NHS Trusts in England (Department of Health, 2000) and other circulars and directives, the role of the infection control nurse has never been so challenging, putting infection control firmly on the government and public agenda.

In line with this and the Health Service Circular 1999/217 Nurse Midwife and Health Visitor Consultants (Department of Health, 1999), it enabled the appointment of a nurse consultant in infection control at University Hospital Aintree, Liverpool.

This paper will review the background to the development of the role to date, how it applies to the discipline of infection control and suggest how to take the role forward in the future.

Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience

This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

Evaluating student paediatric advanced nurse practitioners' experiences of a paediatric pharmacology module: in the context of reflective learning

An evaluation of the first paediatric pharmacology module at Master's level was undertaken. The broad aims were: to ascertain whether the participants had achieved the modular learning outcomes; how their pharmacological knowledge base had altered as a result of the module; and whether their professional practice had been influenced subsequent to undertaking the module. The findings of the 12 participants who registered on the module are reported. Three tools were utilized to generate the data for this broadly qualitative study. The findings indicated that reflective thinking at the evaluative level enabled the participants to monitor their professional and personal performance and that their critical thinking skills and confidence had increased. The questionnaire survey had some limitations, but was seen as the only feasible method of achieving a representation as to whether the module had subsequently influenced the professional practice of the participants. The data presented convincing evidence of the relevance of study of a paediatric pharmacology module at Master's level for the professional and personal development of practitioners.

Part one: Restoring patients to health outcomes and indicators of advanced nursing practice in adult critical care

The key characteristics of advanced nursing practice have been a subject of international debate over the past decade. To address this debate, a grounded theory study was undertaken by one of the authors which sought to identify the key characteristics of advanced nursing practice in adult critical care. The outcome of the main study was a theory of legitimate influence in which enhancing patient stay and improving patient outcome represented the dual purpose of advanced nursing practice in critical care. Fundamental to these factors is strategic activity. This encompasses improving patient care, facilitating continuity of care and engaging in patient education. The outcome of these strategic activities can be evaluated through evidence of eased transition across complex hospital networks, patient satisfaction and enabling of independence. The findings reflect a change in the focus and delivery of care to the critically ill and their relatives by nurses practising at an advanced level. In the second paper of this series, the intervening conditions that affect the expression of legitimate influence will be discussed.

Nurse consultants as higher level practitioners: factors perceived to influence role implementation and development in critical care

This paper discusses the main factors perceived to influence higher level practice in critical care drawing upon personal experience as a critical care nurse consultant. Implementation and development of the role towards a higher level of practice has been influenced--both positively and negatively--by policy, legislative, organisational, cultural, professional and individual factors. Discussion focuses on professional, policy and organisational issues because--on reflection--these are the main factors that have facilitated and inhibited role implementation and development towards a higher level practice in the United Kingdom. Relevant research exploring advances in nursing practice in critical care, and how this has influenced the development of higher level practice in relation to the nurse consultant role, will also be discussed.

The expanded role of the critical care nurse: a review of the current position

The advanced practice role of the registered nurse is a topic that is currently being debated both nationally and internationally. This paper examines the literature as it relates to role expansion within nursing in general and more specifically to critical care nurses. The role of the critical care nurse is changing and this has occurred as a result of historical evolution, the use of increasing technology, the blurring of medical and nursing roles and current workforce shortages. The literature reviewed identifies some of the factors that have propelled this process and examines the use of terminology as it relates to advanced practice roles and their titles. Finally, the attributes and educational preparation required to perform at an increased level are examined.

Confusion prevails in defining 'advanced' nursing practice

The Australian nursing profession has accepted the challenge to support and encourage advanced nursing practice role development. A critical review of national and international literature highlights that there is no singular definition or understanding of 'advanced' nursing practice. Instead difficulty with nomenclature and clarification of levels of nursing are perpetuated by unclear distinction between 'advanced', 'specialist' and 'expert' nursing practice. This paper presents the findings of a review of the literature and posits that ambiguity and lack of consistency in defining 'advanced' nursing practice is hampering the progression of the profession towards the development of consistent advanced practice roles in Australia. It is proposed that a universally accepted definition would provide a vehicle for future Australian role development so that all advanced practice roles have a common genesis and national consistency results.

Discharge from intensive care: a view from the ward

Relocation stress is a common phenomenon in patients discharged from an intensive care unit (ICU) to a ward. A variety of nursing interventions, initiated by intensive care nurses, have been introduced following research in this area. Ward nurses are ideally situated to minimize stress in this patient population, yet their contribution has not been considered. The aim of this study was to identify the experience of the ward nursing staff when receiving a patient from the ICU. An exploratory pilot study was conducted over a 6-month period. The sample group comprised nursing staff in two wards, who regularly received ICU patients. Data collection methods were triangulated and involved the use of open-ended questionnaires and semi-structured interviews. Thirty-six questionnaires were sent, yielding a 36.1% (n = 13) response rate. Seven staff of various grades were interviewed. Data analysis was undertaken using Burnard's (1991) Thematic Content Analysis. Four major categories were identified in the analysis of the data. These were emotions; problems; communication; and interventions. However, the experience of ward staff receiving patients from intensive care differed according to grade.