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Voices from the wilderness : an interpretive study describing the role and practice of outpost nurses Tarlier, Denise Susan


Outpost nurses are expected to function as both primary care providers and in a community health nursing role, to provide comprehensive primary health care in Canada's underserved northern and remote communities. However, little information exists informing us as to whether or how outpost nurses meet this expectation. The purpose of this study was to discover how experienced outpost nurses perceive and enact their role, and to explore the practical knowledge and clinical wisdom revealed in participants' practice narratives. Nine experienced outpost nurses participated in this study by sharing their stories of clinical practice. Data analysis was conducted in accordance with Benner's (1984; 1994) model of interpretive phenomenology, a research methodology that effectively preserved the unique context of outpost nursing practice. Four main themes emerged from the data and were interpreted within the context of practice: (a) primary care competencies are fundamental to outpost nursing practice, (b) nurses evolve into the outpost nursing role by learning community health competencies and adapting to context-specific practice issues, (c) experienced outpost nurses build and maintain responsive relationships with communities, and (d) experienced outpost nurses become comfortable with the autonomy and responsibility of practice. Paradigm and exemplary cases served to ground the interpretation in the data. The domains and competencies of outpost nursing practice thus revealed were then related to domains and competencies of nursing and nurse practitioner practice, using adaptations of frameworks developed by Benner (1984) and Brykczynski (1989), resulting in a preliminary conceptual framework of outpost nursing practice. A better understanding of the outpost nursing role has implications for outpost nursing practice and education and may provide direction for future research. Insight into the outpost nursing role may contribute to our understanding of evolving nursing roles, such as nurse practitioner and advanced practice nurse, which are currently the focus of much discord within the nursing profession in Canada. Ultimately, giving 'voice' to the nurses who live and work in remote northern communities may help to make visible the nature of their practice, and clarify how their role may best contribute to improving the health status of northern communities.

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