Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors.

BACKGROUND: Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. AIM: To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. METHODS: The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. FINDINGS: The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. CONCLUSION: The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.

Clinical application research: a hermeneutical approach to the appropriation of caring science.

Clinical caring science researchers contribute, by means of various participatory research efforts, to bring clinical practice closer to the ideals of caring. These research efforts have in the main been developed from classical action research rooted in critical theory. In this article, the authors launch an alternative research approach called clinical application research, the basis of which can be traced to the interpretative paradigm, or hermeneutics. The basic cornerstones of this research approach are ontology, context, and appropriation as well as understanding, interpretation, and application. Using an example from ongoing clinical research, the authors demonstrate the utility of this approach. Their aim in this article is to contribute to the development of methods within clinical research.

The role of significant others in the care of women with breast cancer.

This study seeks to gain knowledge of how significant others experience the nursing care of women with breast cancer and what their own caring needs might be. The overall research design is a clinical application research within the hermeneutic tradition. Thirty-seven significant others have contributed their own narratives about the care on the basis of open, structured questions. The narratives have been submitted to an analysis of contents. The result shows that significant others have no given place in nursing care. Their place in nursing care is to look on, be present or be ignored. No matter what their place is, the significant others feel a need for caring conversations and information in an ethical manner. The faith and trust of significant others, the sharing, sense of communion and the information about woman's illness strengthen the significant others' own vitality. Their inmost desire concerns the sensitiveness of caregivers with regard to the woman's as well as the significant others' personal needs. If space is allowed and this desire meets with response, significant others can constitute a source of strength in the care of the woman suffering from breast cancer.