Bruce Judith C, Baumann Jennifer, Schmollgruber Shelley
School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Adv Nurs. 2019 Nov;75(11):2969-2979. doi: 10.1111/jan.14109. Epub 2019 Jul 26.
To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree.
In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique.
Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed.
Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component.
"Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%).
Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists.
The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.
探讨护理专家在获得研究生学位两年后对实践变革的体验及其影响。
由于莫桑比克本国护士缺乏进一步的学习机会，该国引入硕士学位以培养首批护理专家。
采用混合评估框架下的探索性、序列混合方法设计。
对护理专家（N = 12）进行焦点小组访谈获得定性数据，形成五个主题数据集，据此为序列定量部分制定调查问题。
访谈数据中出现的主题有“变革期望”“实践环境模糊”“感到无力”“产生一定影响”和“工作场所支持”。积极变革领域包括研究（100%）、证据运用（88.9%）和参与决策（77.8%）。对一些人来说，变革并未如预期发生，原因包括缺乏支持新毕业生的护士导师（55.6%）；与医生相比受尊重程度较低（44.4%）以及对硕士学位价值理解不足（44.4%）。服务质量提升和护理地位提高是影响最大的领域（77.8%）。
在新获得资格的护理专家的实践变革及影响体验中，确定了若干促进因素和限制因素。学位在提升护理地位方面的潜在变革似乎并未影响护理专家自身影响实践的能力和权力。单纯提高研究生培养能力并不能使护士在专家角色中获得权力。
研究结果表明，应制定两级战略以消除护理专家赋权和职业发展的障碍。确定指定的护士导师对于引导和维持新毕业的护理专家至关重要。应制定明确的研究政策，支持开展相关研究并在专家实践中运用证据。
