Centre for Health Improvement, Leadership and Learning, Nottingham University Business School, University of Nottingham, Jubilee Campus, Nottingham, NG8 1BB , UK.
Centre for Health Improvement, Leadership and Learning, Nottingham University Business School, University of Nottingham, NG7 2RD, UK.
Nurse Educ Pract. 2023 Feb;67:103546. doi: 10.1016/j.nepr.2023.103546. Epub 2023 Jan 24.
An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings.
This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England?
DESIGN/SETTING: A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings.
We recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria.
One-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed.
The ACP role in England was undertaken in a broad range of clinical contexts. In England 'advanced clinical practitioner' was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development.
This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts.
全球范围内正在探索的扩展角色是高级临床医师（ACP）。在英国，这是一种针对联合健康专业人员、护士和助产士在一系列环境中的扩展角色。
本文重点关注三个研究问题：1）ACP 在英国的角色是什么？2）实施该角色的障碍和促进因素有哪些？3）ACP 对英国卫生服务的贡献是什么？
设计/设置：一项定性、探索性研究，旨在探讨在一系列临床环境中 ACP 角色的观点。
我们招募了 63 名利益相关者，包括 34 名从事 ACP 角色或 ACP 教育的护士。采用有目的的滚雪球抽样技术确定符合纳入标准的参与者。
2020 年期间进行了一对一的半结构化访谈，对访谈进行了录音、逐字转录、匿名处理，并进行了主题分析。
英国的 ACP 角色在广泛的临床背景下开展。在英国，“高级临床医师”并不是一个受保护的头衔。英国 ACP 角色的理解和运用存在高度的变异性和模糊性。促进实施过程的因素包括培训和教育、临床监督和组织支持。该角色缺乏保护以及经验差异是障碍。雇主的支持促进了 ACP 角色的发展，但在个人或组织层面，如果支持有限，则会成为障碍。我们的研究强调了 ACP 角色在改善患者结局和劳动力发展方面的广泛方式。
本研究概述了 ACP 可以为卫生服务做出的贡献、促成因素以及实施该角色的关键障碍和促进因素。这项工作表明，ACP 可以对服务设计、劳动力发展和患者结局做出积极贡献，同时也承认，需要做很多工作来确保在所有专业和临床环境中获得保护地位和平等地位。
