International Journal of Healthcare Simulation

Background:

The role of the Advanced Nurse Practitioner (ANP) within Scotland continues to expand and with the introduction of the transforming roles programme [1], this expansion is expected to continue exponentially. Within the USA it is commonplace for ANP to perform diagnostic lumbar punctures (DLP) however, this is a new development within the UK. Simulation-Based Mastery Learning (SBML) supports skill acquisition [2] and so within a Scottish District General hospital, a core group of ANPs took part in a SBML programme to perform DLPs. This programme was adapted and delivered by an ANP across all grades of Doctors. While literature exists around the role of the ANP and perceptions of the role in facilitating learning, there is little evidence exploring the role of ANPs as a facilitator of advanced clinical skills, traditionally taught by medical staff. Therefore, this study aimed to explore nursing and medical staff’s perceptions of ANPS performing and teaching DLPs.

Methods:

This study utilised an exploratory qualitative approach to conduct semi-structured interviews with eight participants (medical staff n=4, nursing staff n=4), within Acute Medical Services. Ethical approval was granted by an approved Further Education Institution, School of Health and Life Sciences Ethics Committee. Data was analysed using thematic analysis as described by Braun and Clarke [3].

Findings:

Three themes were developed through the thematic analysis. The themes were: improve the patient journey, ANPs integration and support within the multidisciplinary team, and ANPs as expert practitioners performing and teaching skills. The participants discussed a perceived reduction in patient anxiety leading to an increase in patient satisfaction. Participants discussed feeling that ANPs bridged the gap between nursing and medical staff which enhanced team working. All participants felt ANPs were best placed to perform DLP as ANPs had greater availability facilitating timely procedures for the patient. All participants discussed a potential for deskilling of medical staff. However, the medical staff participants felt that their skill acquisition could be enhanced by having access to an expert practitioner who can deliver mastery teaching and learning.

Conclusion:

This study suggests that ANPs have expertise to perform and teach clinical skills using a mastery skills programme. Further research should explore the benefits of using ANPs to deliver mastery skills to enhance skill acquisition across all professions. In addition, research to explore the patients’ perspective would be beneficial.

References

1. NES.scot.nhs.uk. 2022. Transforming NMAHP roles. NHS Education for Scotland. https://www.nes.scot.nhs.uk/our-work/transforming-nmahp-roles/ [Accessed on 29/06/2022].

2. Mehdipour–Rabori R, Bagherian B, Nematollahi M. Simulation-based mastery improves nursing skills in BSc nursing students: a quasi-experimental study. BMC Nursing. 2021;20(1):1–7.

3. Clarke V, Braun V. Thematic Analysis. In: Lyons E, Coyle A (eds.). Analysing Qualitative Data in Psychology, 2nd Edn., Sage Publications, London. 2016. pp. 84–103.