EXPLORING THE CLINICAL PRACTICE OF NURSE PRACTITIONERS (EXPANDED ROLE, JUDGMENT, PHENOMENOLOGY).
Contributors: University of California, San Francisco.
Published: 1985
Number of pages: 297
Subjects: Health Sciences, Nursing.
Description: Both the acceptance and competence of nurse practitioners have been demonstrated in extensive studies of the medical aspects of this expanded nursing role. The less measurable aspects of clinical expertise and disciplinary distinctions have been difficult to capture because of their complexity and contextual nature. The purpose of this study is to provide a contextualized account of the actual clinical practice of experienced nurse practitioners. This study employs Patricia Benner's (1983, 1984) research on the nature of clinical nursing expertise as a model.

This study uses hermeneutical phenomenology to describe the knowledge embedded in the clinical practice of nurse practitioners. The sample consisted of 22 experienced nurse practitioners in 4 hospital-based ambulatory care settings. Data collection consisted of small group interviews with nurse practitioners, participant observation of patient visits, individual interviews of nurse practitioners, and a brief demographic questionnaire. A major feature of this research approach is the maintenance of the situational context. The unit of analysis is specific clinical episodes. A total of 199 clinical situations comprised the text. Narrative accounts of clinical situations, transcribed interviews, and field notes were systematically analyzed using an interpretive approach. Selected interpretations were later validated with participants.

This study extends and expands Benner's research (1983, 1984) and contributes to knowledge development in nursing in the following ways: (1) the validity of the domains of nursing practice is supported for nurses practicing in expanded roles in ambulatory care; (2) an additional domain of nursing practice is described for ambulatory care and additional competencies are identified; (3) understanding of the aspects of practical knowledge is enhanced by description of exemplars and themes from the clinical practice of nurse practitioners; and (4) the concept of coaching is broadened and applied to common health and illness concerns encountered in ambulatory care nursing practice. Study findings suggest that nurse practitioners can provide health care management for the majority of patients' complaints with physician consultation. The typical style of nurse practitioner practice described in this study is characterized by judicious use of high technology and promotion of safety and acceptability of care through careful monitoring and teaching which may reduce complications and frequency of hospitalization.
Notes: Source: Dissertation Abstracts International, Volume: 46-11, Section: B, page: 3780.

Thesis (D.N.S.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1985.

School code: 0034.