title: A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.
abstract: OBJECTIVE
  To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK.
  
  
  BACKGROUND
  Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community.
  
  
  METHODS
  Case study.
  
  
  METHODS
  A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers.
  
  
  RESULTS
  Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice.
  
  
  CONCLUSIONS
  These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education.
  
  
  CONCLUSIONS
  Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice.
authors.affiliation: School of Health Sciences, University of Surrey, Guildford, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Raleigh
authors.affiliation: School of Health & Education, Middlesex University, The Burroughs, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Allan
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods*; D002983:Clinical Competence; D004739:England; D006801:Humans; D009722:Nurse Practitioners / Q000193:education*; D010808:Physical Examination / Q000451:nursing*; D036301:Qualitative Research
keywords: advanced practice; boundary working; community nurses; diagnostic skills; physical assessment skills