title: Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.
abstract: OBJECTIVE
  This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong.
  
  
  BACKGROUND
  Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice.
  
  
  METHODS
  A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted.
  
  
  RESULTS
  The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics.
  
  
  CONCLUSIONS
  The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong. annshiu@cuhk.edu.hk
authors: Ann T Y
authors: AT
authors: Shiu
authors: Diana T F
authors: DT
authors: Lee
authors: Janita P C
authors: JP
authors: Chau
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing / Q000458:organization & administration* / Q000639:trends; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D003920:Diabetes Mellitus / Q000451:nursing; D055317:Evidence-Based Practice / Q000458:organization & administration; D005242:Fecal Incontinence / Q000451:nursing; D005260:Female; D006723:Hong Kong; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D024802:Nurse's Role; D015401:Nursing Administration Research; D019982:Organizational Case Studies; D015279:Organizational Culture; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D036301:Qualitative Research; D014549:Urinary Incontinence / Q000451:nursing; D014947:Wounds and Injuries / Q000451:nursing