Tan, Valerie Ann (2021) Practice Nurses' role extension and diagnostic work in long-term conditions: a qualitative metasynthesis and interview study. Masters thesis, Keele University.

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Abstract

Background
Role extension is common in primary care in the UK, with assessment, diagnosis and management of some conditions by role extended nurses well established. Practice nurses (PNs) are now considered fundamental to the care of patients with long-term conditions (LTCs). Healthcare policy demands that their role further extend to be inclusive of a greater level of complex care including assessment and diagnosis. Many LTCs have objective diagnostic criteria against which an unequivocally diagnosis can be made. The diagnosis of OA, a prevalent LTC, can be more complex with poor recognition and suboptimal treatment common. OA is often comorbid with other LTCs. Given their pivotal role in LTC care, PNs may be well placed to address poor recognition of OA, facilitating treatment optimisation and potentially improving patient outcomes. However, PN views on role extension in this context are unknown.

Methods
Empirical qualitative research evidence regarding PN perspectives of role extension and diagnosis of LTCs including OA in primary care was identified and synthesised using the process of meta-synthesis. Perspectives of PNs (n=18) were explored through semi-structured interviews using a topic guide. Data was analysed thematically using the principles of constant comparison. A LTC public and patient involvement and engagement (PPIE) group were involved in several stages of the research process.

Results
The meta-synthesis identified factors that can facilitate or hinder the successful implementation of extended roles. No literature regarding PN perspectives of their role in diagnosis was identified. Twenty-four PNs provided written consent to participate. No new themes were noted after eighteen interviews which were conducted face-to-face or via telephone. Six main themes were identified: understanding role extension; role boundaries; competent, confident and comfortable; factors that influence role extension; the impact of evolving role boundaries; and the nurse role in diagnosis. Role extension was described as something new, context dependent and relevant to the norm for that individual. The need for clear professional boundaries was explicit, yet nursing roles remain poorly defined affecting understanding and acceptability of extended roles. Problems in creating nationally agreed definitions were evident and clarity at the practice level was deemed more realistic and achievable. Strong interprofessional relationships and integrated care was important in the context of support. Support was considered essential for role extension and provision was reliant upon the ability to recognise and work within boundaries. Whilst role extension usually requires formal training, the importance of experiential learning and need to be comfortable in a role was clear. Three main drivers for change were recognised: the system, GP and nurse. Participants had variable understanding of the term OA and misconceptions were noted.

Conclusion
NHS England talk of the need to increase the flexibility and capacity of the primary care workforce if we are to ‘future proof’ the NHS against the challenges to come. Role extension is seen as pivotal to this process. Whist PNs accept the need for role extension, implementation is not without its problems. This thesis identifies and discusses key facilitators and barriers to role extension in the context of the PN in primary care.

Item Type: Thesis (Masters)
Subjects: H Social Sciences > HV Social pathology. Social and public welfare
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Contributors: Chew-Graham, C (Thesis advisor)
Jinks, C (Thesis advisor)
Finney, A (Thesis advisor)
Depositing User: Lisa Bailey
Date Deposited: 24 Mar 2021 12:23
Last Modified: 24 Mar 2021 12:23
URI: https://eprints.keele.ac.uk/id/eprint/9303

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