title: Fluid role boundaries: exploring the contribution of the advanced nurse practitioner to multi-professional palliative care.
abstract: OBJECTIVE
  To evaluate the introduction of Advanced Nurse Practitioners in a specialist, multi-professional palliative care context. The objective is to explore the core domains and competencies of the advanced nurse practitioner role in a multi-professional palliative care context.
  
  
  BACKGROUND
  New models of health care and service delivery are emerging alongside expanded levels of autonomy, skills and decision-making for nurses and midwives. This has resulted in some confusion in the health service community internationally about the professional role and scope of the advanced nurse practitioner.
  
  
  METHODS
  A qualitative evaluation study (n = 21).
  
  
  METHODS
  Three phases of data collection were conducted over 10 months. Twenty-one participants took part from a specialist palliative care unit in one health board in a U.K. region spanning ANPs (n = 2) multi-professional staff (n = 14) and patients/carers (n = 5). Data collection methods included individual and focus group interviews with key stakeholders and observation of the advanced nurse practitioners at work and their reflexive diaries.
  
  
  RESULTS
  The findings of this evaluation demonstrate that if the advanced nurse practitioner role can flourish it has the potential to shape 'new identities', re-construct the boundaries of nursing roles and emphasise the relationship based elements of excellent nursing work.
  
  
  CONCLUSIONS
  The advanced nurse practitioner has the potential to enhance specialist palliative care service delivery through fluid role boundaries. The context in which advanced nurse practitioner roles are developed is important as acceptance of the role is linked to the co-construction of a different nursing identity. Our findings support the need to define, defend and name the work of advanced nursing roles.
  
  
  CONCLUSIONS
  The advanced nurse practitioner roles were regarded as providing a unique contribution to service delivery and were characterised by fluid role boundaries which crossed the traditional disciplinary boundaries between nursing and medicine.
authors.affiliation: Department of Nursing and Midwifery, University of Limerick, Ireland.
authors.forename: Catriona
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: NHS Lothian/Edinburgh Napier University, Edinburgh, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Brooks Young
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nicol
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Campbell
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Gray Brunton
mesh_terms: D002983:Clinical Competence; D017144:Focus Groups; D064946:Hospice and Palliative Care Nursing / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners; D024802:Nurse's Role; D010348:Patient Care Team; D013222:State Medicine; D006113:United Kingdom; D000078329:Workforce
keywords: Advanced Nurse Practitioners (ANPs); nursing identity; person-centred care; qualitative research; role boundaries