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Clinical nurse specialists define advanced nursing practice and describe their practice in relation to client health outcomes Cox, Katherine Margaret


Advanced nursing practice (ANP) is a term well utilized in the literature and in nursing discussions, yet is not clearly understood. Recently, nursing authors have been strongly supporting the need to develop a clear definition of ANP. The current focus on outcome measures throughout health care has prompted efforts to examine discipline specific, as well as broad influences on client health outcomes (CHO). The need for nurses in ANP to be able to articulate their practice in relation to CHO has been heightened during the last few years. This is due to factors such as the examination of various nursing roles during times of decreasing health care resources inherent in health reform. The purpose of this study was to explore and describe how Clinical Nurse Specialists (CNSs) define ANP and describe their practice in relation to CHO. An exploratory- descriptive qualitative methodology was used for this study. Data were collected through semi-structured, audio-taped interviews with 6 female and 1 male CNSs who had a master's degree and had been in their role for a mean of 6.3 years. From the thematic analysis of the data, three broad categories or descriptors that were common to participants were identified and developed. Together these three broad categories represent participant attempts to define ANP and describe their practice in relation to CHO. The first category relates to difficulties in clearly defining ANP. The second category relates to descriptors of ANP. The third category relates to possible relationship between ANP and CHO. These findings revealed that ANP is a term that is broad and vague in nature and not amenable to a clear and concise definition. Furthermore, it was found that it may not be possible to articulate a direct relationship between ANP and CHO in an interdisciplinary collaborative practice environment. The implications for graduate education, policy and administration as well as research are identified in light of research findings.

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