An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.

AIM: This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. BACKGROUND: Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. DESIGN: An ethnographic approach was used to explore the advanced nurse practitioner role. METHODS: Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. RESULTS: The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. CONCLUSION: Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes.

Developing sustainable nursing and allied health professional research capacity.

BACKGROUND: Research provides the evidence on which to base effective, safe clinical services. Engaging healthcare staff in research improves healthcare. However, clinical staff may not want to leave clinical practice to develop their research experience. Gaining postdoctoral research experience is a difficult step to make and opportunities are limited. AIM: To describe an approach to developing sustainable research capacity by supporting nurses and allied health professionals to develop their postdoctoral research skills while remaining in clinical practice. DISCUSSION: An approach to developing nursing, midwifery and allied health professionals (NMAHPs)'s postdoctoral research skills was devised and implemented in an acute NHS hospital in England. This collaborative approach involved negotiating strategic support from senior managers and incorporated an action-learning framework to develop and fund a research project addressing a clinical priority. CONCLUSION: A 'whole organisation' approach is needed to develop postdoctoral nurse and NMAHP researchers that requires a reflexive model with strategic, organisational and individual support encompassing action learning and corporate buy-in from senior managers. IMPLICATIONS FOR PRACTICE: Taking such an approach can enable nurses to remain in practice while developing NMAHP-led research. This shows its usefulness to senior managers and enables nurses to have the knowledge and confidence to support others to develop their research skills.

Assessment of injury severity in patients with major trauma.

Major trauma centres provide specialised care for patients who have experienced serious traumatic injury. This article provides information about major trauma centres and outlines the assessment tools used in this setting. Since patients in major trauma centres will be transferred to other settings, including inpatient wards and primary care, this article is relevant for both nurses working in major trauma centres and in these areas. Traumatic injuries require rapid assessment to ensure the patient receives prompt, adequate and appropriate treatment. A range of assessment tools are available to assist nurses in major trauma centres and emergency care to assess the severity of a patient's injury. The most commonly used tools are triage, Catastrophic Haemorrhage Airway to Exposure assessment, pain assessment and the Glasgow Coma Scale. This article summarises the use of these assessment tools in these settings, and discusses the use of the Injury Severity Score (ISS) to determine the severity of patient injuries.