背景:全球范围内正在探索的扩展角色是高级临床医师(ACP)。在英国,这是专职医疗专业人员的扩展角色,护士和助产士在一系列的设置。
目的:本文主要研究三个问题:1)ACP在英格兰的作用是什么?2)执行该作用的障碍和促进因素是什么?3)ACP对英格兰卫生服务的贡献是什么?
方法:定性,探索性研究,探讨ACP在一系列临床环境中的作用。
方法:我们招募了63名利益相关者,包括34名护士,在ACP角色或ACP教育中工作。有目的的雪球抽样技术确定了符合纳入标准的参与者。
方法:在2020年进行一对一的半结构化访谈,逐字记录和转录,匿名化和主题分析。
结果:ACP在英格兰的作用是在广泛的临床背景下进行的。在英国,“高级临床医生”不是受保护的头衔。在英格兰,对ACP角色的理解和部署存在高度的可变性和模糊性。实施过程的促进者包括培训和教育,临床监督和组织支持。对角色缺乏保护和经验差异是障碍。雇主支持促进了ACP角色的发展,然而,在支持有限的地方,在个人或组织层面,这是一个障碍。我们的研究强调了ACP角色有益于患者预后和劳动力发展的广泛方式。
结论:本研究概述了ACP对卫生服务的贡献,发挥这一作用的促成因素、关键障碍和促进者。工作表明,ACP可以为服务重新设计做出积极贡献,劳动力发展和患者结果,在接受的同时,还有很多工作要做,以确保所有专业和临床环境中的受保护地位和均等。
BACKGROUND: An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings.
OBJECTIVE: This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England?
METHODS: A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings.
METHODS: We recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria.
METHODS: One-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed.
RESULTS: The ACP role in England was undertaken in a broad range of clinical contexts. In England \'advanced clinical practitioner\' was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development.
CONCLUSIONS: This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts.