UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland.
School of Hospitality Management & Tourism, Dublin Institute of Technology, Dublin 6, Ireland.
J Clin Nurs. 2018 Mar;27(5-6):e882-e894. doi: 10.1111/jocn.13964. Epub 2018 Feb 1.
To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice.
There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system.
A qualitative study was conducted to initiate this important area of inquiry.
Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame.
Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence.
The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners.
The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D."
为未来的专科和高级护理及助产实践模式的发展提供信息和指导。
有大量的实证文献支持专科和高级实践角色对医疗保健的独特贡献。然而，几乎没有国际证据可以为爱尔兰医疗保健系统中未来的高级或专科实践模式的整合提供信息。
进行了一项定性研究，以启动这一重要的研究领域。
采用目的抽样法抽取 15 名受访者进行访谈。抽样框包括从事专科和高级实践的护士和助产士，以及来自立法、监管、政策、医学和教育等领域的参与者。
提出了新的专科和高级实践模式的论点。一些参与者提出，专科和高级执业者职业道路的灵活性是必不可少的。否则，就有可能被引导到专门的“筒仓”中，从而无法转向另一个综合实践领域。未来的专科和高级实践教育计划需要包括发展情感和政治智慧等主题。
专科和高级实践角色对卫生服务的贡献包括提供快速护理、服务间无缝的患者流动、提前出院以及作为患者护理轨迹的主要协调者。有人建议朝着培养专科和高级护士和助产士从业者的通用模式发展。
该模型设计在“U”范围内的各种情况下具有普遍适用性，在其包容性方面涵盖了所有主要利益攸关方“C”。该模型是动态的，与护士和助产士在整个健康连续体上的流动相关，而不是在非常专门化的“筒仓”中停滞不前“D”。
