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

Abstract

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 communityhospital, 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.

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“…In the evaluation of programs a study in the Netherlands evaluated multiple perinatal risk factors. 38 Studies involving institutions commonly consider specific sites that are a refer-ence for the service provided, such as hospitals, 44 maternity hospitals, 38 clinics, 34 and long-term institutions. 24 In the evaluation of the role, the case study has explored the role played by nurses as an agent of change in protocol implementation.…”

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“…) and have been adopted in Hong Kong since the 1990s (Shui et al . ). Evaluations consistently show that various nurse‐led interventions have resulted in improved clinical outcomes and added value to the quality of care (Shiu et al .…”

Nurse-led orthopaedic clinic in total joint replacement

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“…In order to solve these remaining problems, there should be appropriate legislation to redefine the professional code of nursing practice, and organisational support to offer a clear policy for nurse prescribing. 12 Stakeholder and public awareness should be aroused to allow inter-departmental referral and granting public certification.…”