School of Nursing, College of Health, Massey University, Albany, Auckland, New Zealand.
Office of La Trobe Rural Health, La Trobe University, Bendigo, Victoria, Australia.
J Adv Nurs. 2024 May;80(5):1914-1926. doi: 10.1111/jan.15938. Epub 2023 Nov 6.
To explain the process by which nurses' roles are negotiated in general practice.
Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated.
Constructivist grounded theory.
Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category.
The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed.
The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations.
What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles.
The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method.
Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.
解释一般实践中护士角色协商的过程。
初级保健护士在健康社会模式下开展重要工作，以满足他们所服务人群的需求。最近，面对需求增加和劳动力短缺，他们也通过任务转移承担了更多的医疗责任。尽管他们的专业角色变得更加复杂，但人们对其协商过程知之甚少。
建构主义扎根理论。
2020 年 12 月至 2022 年 1 月，对来自新西兰 17 家全科诊所的 22 名参与者进行了半结构化访谈。由于 COVID-19 的影响，有 11 次访谈是通过 Zoom™进行的。同时进行的数据生成和分析，使用恒定性比较方法和常见的扎根理论方法，确定了参与者的主要关注点，并围绕核心类别构建了一个实质性的解释理论。
新西兰一般实践中护士角色协商的实质性解释理论提出，护士角色的协商是一个三阶段的过程，涉及占据空间、定位以不同方式行事以及利用机会。护士和其他人根据他们对需求响应护理实践的概念，在这些阶段中采取行动和相互作用，朝着定义场所的结果前进。定义场所的概念是在个人的价值观、信仰和期望与预先存在的组织规范之间达成妥协，在此过程中，个人和群体规范的需求响应护理实践概念本身也得到了发展。
该理论为一般实践中护士角色协商的过程提供了新的见解。研究结果支持采取策略，使护士、雇主和卫生系统管理者能够更好地协商专业角色，以满足他们所服务人群的需求，同时最大限度地利用护理技能和能力。
对专业和/或患者护理的影响：研究结果可以为护士提供更好地协商初级保健环境复杂性的信息，平衡系统要求与人群的健康需求。
研究解决了什么问题？在健康不平等的情况下，新西兰的全科护士与其他地方的护士一样，是满足复杂初级卫生需求的关键。关于护士在提供者组织内协商角色的过程存在证据差距。更深入地了解这些过程可能会更好地利用护理技能来满足未满足的健康需求。主要发现是什么？新西兰一般实践中护士的角色是根据个人对需求响应护理实践的概念，通过目标驱动的协商来确定的。个人从占据他人护理理念定义的工作空间发展到定义包含自己专业信念、价值观和期望的工作场所。协商取决于是否有机会接触到榜样、与导师和决策者进行有计划的对话，以及是否有支持安全实践的机会。强有力的临床和组织治理以及个人的积极自我效能感是有效协商的促成因素。该研究将在何处以及对哪些人群产生影响？创建空间理论可以为推进一般实践护士角色以满足社区健康需求的组织和个人努力提供信息。一般实践组织可以提供安全、有支持的环境，以进行有效的协商；初级保健领导者可以通过让护士参与关键决策，培养他们的强大治理和自我效能感，从而促进这一点。护士本人可以将该理论作为一个框架，支持他们对如何积极协商自己的专业角色进行批判性思考。
作者使用 COREQ 报告方法遵守了相关的 EQUATOR 指南。
目前在一般实践中工作的研究人员和参与者参与了这项研究的开展。通过理论抽样和恒定性比较，参与者的意见有助于塑造研究设计。
这篇论文对更广泛的全球临床社区有何贡献？了解卫生专业人员协商其角色的过程对于支持他们应对全球所有卫生部门日益增加的复杂性挑战非常重要。
