Advanced Practice and the Orthopaedic Nurse: An Interpretive Study

Abstract

Advanced nursing practice is a broad topic that is often misunderstood. Related terms are used interchangeably, which tends to engender a degree of confusion over what constitutes advanced practice. The relationship of advanced practice to expert and specialty practice is unclear. Health care is increasingly becoming more complex. There are greater expectations placed upon the nurse practising in this context. Therefore the role of the nurse must reflect the increasing complexity that exists within a contemporary health system. Advanced practice provides an opportunity to debate and acknowledge how nursing practice must reflect modern trends. This study will assist in conceptualising advanced practice in terms of the nature and scope of advanced orthopaedic nurse practice. This study aimed to uncover the meaning of the lived experiences of advanced orthopaedic nurse practitioners, thereby engaging orthopaedic nurses within the debate. The methodology employed in this study was Hermeneutic Phenomenology, informed by Heidegger and van Manen. Seven expert orthopaedic nurse practitioners were asked to describe an experience in which they believed they performed at an advanced level. Concepts and themes emerged from the narratives. Themes included: having knowledge, being in and outside the role, being an advocate and being in control. Controversy and confusion dominates the debate over what constitutes advanced practice, both here and overseas. This study highlighted that advance practice is part of a continuum that describes specialist, expert and advanced practice. It is also an important concept in contemporary nursing practice. However ongoing clarification and consistency in terminology would assist immeasurably in identifying standards of advanced practice. Once this is achieved, the impact of advanced practice on patient care can be ascertained.