Consultant nurse?consultant physician: a new partnership for patient-centred care?

Qualitative research interviewing: application and use of free association

BACKGROUND

Free association is a core concept of the free association narrative interview method, an approach that is well-known among researchers in the UK who are interested in using psychoanalytic ideas in qualitative psycho-social research.

AIM

To examine the relationship between the framing of the psychoanalytic concept of free association in the contexts of qualitative research interviewing, clinical psychoanalysis and psychoanalytically oriented psychotherapy.

DISCUSSION

This article considers the definition of free association in psychology and psychoanalysis. It then explores free association's role in the free association narrative method, in terms of interview technique and the analysis of interview material.

CONCLUSION

Researchers should carefully consider differences in the contexts of research, clinical psychoanalysis and psychotherapy to avoid makeshift integrations of clinical concepts.

IMPLICATIONS FOR PRACTICE

The free association narrative interview method is an attractive approach for researchers interested in applying psychoanalytic ideas in their studies. However, researchers should carefully reflect on the meanings of the clinical ideas and terminology they use.

Psychoanalytically informed research interviewing: notes on the free association narrative interview method

BACKGROUND

Following the development of the transdisciplinary field of British psychosocial studies, interest in the application of insights from psychoanalysis in qualitative research has grown in recent years among researchers in nursing and allied disciplines.

AIM

To address a paucity of attention to - and lack of clarity concerning - the implications of methodological developments and debate around the application of psychoanalytic perspectives and techniques in research, specifically the theory and practice of research interviewing as a psychoanalytically informed endeavour.

DISCUSSION

This paper draws from the author's doctoral research to provide a critical account of Hollway and Jefferson's ( 2000 , 2013 ) free association narrative interview method (FANIM). It describes FANIM's core elements and then moves on to consider its use by nursing and applied health and social care researchers, and then to criticism that has been levelled against Hollway and Jefferson's work regarding it.

CONCLUSION

FANIM provides valuable ideas about how to approach nursing research in a way inspired by psychoanalytic principles, but requires further evaluation by nursing researchers.

IMPLICATIONS FOR PRACTICE

Nurse researchers may take inspiration from particular aspects of FANIM. They should also reflect on whether they are mislabelling their approach as 'psychoanalytic' or 'psychoanalytically informed', if they only partly apply it.

Toward Advanced Nursing Practice along with People-Centered Care Partnership Model for Sustainable Universal Health Coverage and Universal Access to Health

Objective:

this study developed a people-centered care (PCC) partnership model for the aging society to address the challenges of social changes affecting people’s health and the new role of advanced practice nurses to sustain universal health coverage.

Method:

a people-centered care partnership model was developed on the basis of qualitative meta-synthesis of the literature and assessment of 14 related projects. The ongoing projects resulted in individual and social transformation by improving community health literacy and behaviors using people-centered care and enhancing partnership between healthcare providers and community members through advanced practice nurses.

Results:

people-centered care starts when community members and healthcare providers foreground health and social issues among community members and families. This model tackles these issues, creating new values concerning health and forming a social system that improves quality of life and social support to sustain universal health care through the process of building partnership with communities.

Conclusion:

a PCC partnership model addresses the challenges of social changes affecting general health and the new role of advanced practice nurses in sustaining UHC.

Perspectives of Medical Specialists on Sharing Decisions in Cancer Care: A Qualitative Study Concerning Chemotherapy Decisions With Patients With Recurrent Glioblastoma

BACKGROUND

In cancer care, difficult decisions concerning advanced treatment need to be made, weighing possible life prolongation against harmful side effects. Treatment is frequently started, showing the need to explore how decisions are made. Little is known about the perspectives of physicians on sharing decision making with patients. This qualitative study aimed to describe the perspectives of medical specialists on the decision-making process with patients with glioblastoma concerning starting new treatment.

METHODS

Qualitative interviews were held with medical specialists. One focus group was organized with medical professionals. Their opinions about elements of shared decision making and the applicability in the context of patients with glioblastoma were assessed. The topic list for the focus group was based on the analysis of the interviews. Qualitative analysis of the transcripts was performed by three researchers independently.

RESULTS

Medical specialists considered shared decision making to be important; however, they did not adhere to its elements. Stopping treatment was not considered equal to continuing treatment. Exploration of the patients' wishes was done implicitly, and shared responsibility for the decision was not highly recognized. The main barriers to shared decision making were preferences of both patients and specialists for starting or continuing treatment and assumptions of physicians about knowing what patients want.

CONCLUSION

Medical specialists recognized the importance of patient involvement but experienced difficulty in sharing decision making in practice. Elements of shared decision making are partly followed but do not guide decision making. To improve cancer care, education of medical specialists and adjustment to the elements are needed to involve patients.

Daring to be different: a qualitative study exploring the education needs of the nurse consultant

Nurse consultants are recognised experts and are one of the most senior nursing 'clinical' grades. How these roles have developed has varied but all require an armoury of expanded and extended skills. However, since their introduction in the UK little has been written about how they should be effectively prepared for the role. This study used a multi-method approach to establish a rich picture of the nurse consultant role (specialising in safeguarding children) in relation to their existing skills and perceived education needs. The job descriptions and specifications of a sample of consultant nurses (n=4) established role expectations and content, whilst in-depth individual semi-structured interviews with the nurses and six key 'stakeholders' explored perspectives about the educational preparation and ongoing learning needs of those either in the role or aspiring to be. The findings suggest that whilst there are differences there is also some convergence in their developmental needs. For example, that mentorship and academic and leadership support were integral to meeting their learning needs, to optimise effectiveness and to enhance future role development. It is vital therefore that those wishing to 'grow' consultant nurses implement a range of educational strategies to support the continued professional and clinical development of current and future post holders.

Being an effective nurse consultant in the English National Health Service: what does it take? A study of consultants specializing in safeguarding

AIMS

This study established key attributes and perceived strengths, weaknesses, opportunities and threats (SWOT) of nurse consultants specializing in safeguarding children.

BACKGROUND

The nurse consultant role in England spans four domains--clinical, leadership, education and research--and was intended to enable senior nurses to remain in clinical practice.

METHOD

ata identifying the time spent by the nurse consultants in the four domains was collated and a thematic content analysis of the SWOT of the role was ascertained from semi-structured interviews with nurse consultants (n = 4) and stakeholders (n = 6).

RESULTS

Strengths and opportunities in clinical (consultancy), leadership and educational functions were identified but some weaknesses and threats in terms of nurse consultant's contributions to research were also identified. The role was neither wholly strategic nor clinical. Role ambiguity meant that they were not always valued by managers, making the role potentially expendable.

CONCLUSIONS

Nurse consultants are pivotal within health-care organizations because they span clinical practice and leadership enabling them to support managers in strategic planning, commissioning and implementation of policy.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse consultants can support strategic practice development and influence quality and effectiveness service-wide. To succeed they must be understood, supported and nurtured by managers.

Supporting trail-blazing: A systematic review of the factors that facilitate or inhibit the implementation of new nursing roles: the experiences of UK consultant nurses

BACKGROUND

If emerging 'trail-blazers', such as the consultant nurse, are to be successful in developing and sustaining new ways of working then factors that support or inhibit new role developments need identification. There is a growing body of evaluative and anecdotal evidence about the experience of consultant nurses since the introduction of the role in the UK thirteen years ago.

OBJECTIVE

To synthesise the evidence on the experiences of UK consultant nurses in implementing a new role in order to identify inhibitors and facilitators of role development.

INCLUSION CRITERIA

This review sought qualitative and mixed methodology studies that yielded qualitative data about the phenomenon of interest, together with narrative opinion papers i.e. consultant nurses' experiences of role development.

SEARCH STRATEGY

The search in 14 databases considered studies and opinion papers published between January 1999 and April 2010 in English.

METHODOLOGICAL QUALITY

All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools.

DATA COLLECTION

Data were extracted from included papers using the standardised Joanna Briggs Institute data extraction tool.

DATA SYNTHESIS

Data synthesis used the Joanna Briggs Institute approach for meta-synthesis by meta-aggregation. Findings were synthesised into categories and categories were aggregated into synthesised findings.

RESULTS

On the basis of critical appraisal, no opinion papers were included in the review. A total of 11 qualitative studies were included, yielding a total of 313 findings. These were synthesised into 64 categories which were further synthesised into 11 synthesised findings about factors that facilitate and inhibit the role's implementation and development.

CONCLUSION

Drawing directly on consultant nurses' experiences, these findings add evidence to what is already known about what does and does not work in developing a consultant role. They indicate that an understanding about the role's core functions is needed, as is a supportive environment in which the consultant can fully operate.

IMPLICATIONS FOR PRACTICE

The implications for practice are derived from the results of the synthesised findings. An organisation, through its policies, practices, procedures and individuals, must support the consultant's leadership and collaborative goal directed approach to care delivery and service development. This can be achieved by allowing the consultant both autonomy and authority. The synthesised findings reinforce the need to optimise the facilitators and minimise the inhibitors of role development. They can also make a contribution to the conceptual understanding of the consultant role.

IMPLICATIONS FOR RESEARCH

Further research into the experiences of consultant nurses is necessary - in particular, how nurse consultants interpret their relationships with others, negotiate resources and demonstrate the impact of their role in each of the core functions, notably the leadership function.

Perspectives on specialist nursing in Saudi Arabia: a national model for success

In many parts of the world, vulnerable patient populations may be cared for by a clinical nurse specialist (CNS). Nurses desiring to develop themselves professionally in the clinical arena, within the specialty of their choice, have the opportunity to obtain the knowledge, skills, experience and qualifications necessary to attain advanced practice positions such as CNS or nurse consultant (NC). Although studies have demonstrated the benefits of such roles and while the World Health Organization (WHO) recommends it, advanced nursing practice is not yet integrated into the health care culture in Saudi Arabia. The reasons for this are multiple, but the most important is the poor image of clinical nursing throughout the country. This article aims to share a perspective on CNS practice, while casting light on some of the obstacles encountered within Saudi Arabia. A model is proposed representing specialist nurse-physician collaborative practice for implementation nationally. The model has been implemented in the care of the colorectal and stoma patient populations while taking into consideration patient population needs and local health care culture. This model is based on the concepts of holistic "patient-centered care", specialist nurse-physician collaborative practice, and the four practice domains for NCs (expert practice, leadership, research and education) as indicated by the Department of Health in the United Kingdom. We suggest this model will enable the introduction of advanced specialist nursing and collaborative partnerships in Saudi Arabia with benefits for patients, physicians, health care organizations and the nursing profession as a whole.

An exploration of personal initiative theory in the role of consultant nurses

The aim in this paper is to investigate the contribution personal initiative theory makes in understanding the consultant nurse role. The role was introduced in the UK in 2000 to improve patient outcomes, clinical leadership and retention of experienced clinicians. A larger study used a multi-method approach to collect quantitative and qualitative data from focus groups, interviews and a questionnaire administered nationally at two time points. Findings from longitudinal telephone interviews with 30 consultant nurses are the focus of this paper.

Three consultant nurses were selected as case studies to examine the potential of personal initiative theory when applied to new nursing roles. The activities of two of the three demonstrated a high level of personal initiative in the job. They persisted in overcoming problems faced in improving practice. The third scored lower: she emerged as a reactive conformist and less likely than the other two to pursue initiatives of her own.

Personal initiative theory has potential as a framework for evaluating the consultant nurse role, although further research is needed to test it. The longitudinal analysis revealed a determination to stay in the job and overcome difficult challenges when consultants show initiative and are making progress in achieving change.