Exploring A Complex Process: A Study Using Constructivist Grounded Theory Principles to Explore The Introduction of Roles with Advanced Practice Nurse titles in A Tertiary Hospital In Oman

Abstract

Background: Introducing the Advanced Practice Nurse (APN) roles in contemporary healthcare systems has become a global trend in response to increased healthcare systems demands and decreasing medical workforces. Despite these nursing roles promising improvements in healthcare systems, the evidence demonstrates that their implementation and utilisation in practice is more challenging. There is also a lack of evidence from the Middle East, Arab, Gulf Cooperation Council (GCC) countries, and Oman in particular, regarding the implementation and utilisation of the APN role, with no studies at all that focused on Oman. The study aimed to explore and uncover nurses with APN titles’ experiences in relation to the implementation of their role in an Omani context. Methods: The study utilised the principles of Charmaz’s Constructivist Grounded Theory (CGT). Data was collected using in-depth face-to-face audio-recorded interviews with an initial purposive sampling of 5 nurses with APN titles (APNs). The initial analysis enabled theoretical sampling of 35 more individuals, with APNs, general nurses, head nurses, physicians, APN leavers and senior hospital managers from one tertiary hospital in Oman. In addition, document analysis was utilised to gather and explore further relevant data and contextualise the data gathered during the interviews. Data were collected and analysed concurrently using different levels of coding (initial, focused and theoretical coding), constant comparative analysis, and memo writing. Findings: Four interrelated categories that explained the APNs and their role stakeholders’ experiences of the roles implementation and utilisation emerged; ‘The Competing, Overlapping and Contradictory Role Agendas’, ‘From experience to expectation’, ‘Entering a new world’ and ‘Establishing themselves in an APN role’. Discussion: In this study the participants’ narratives suggested that the APN role was implemented in a complex organisational context and involved multiple agendas, challenges and demands. These competing agendas led to a deliberately broad role description that allowed for flexibility and ambiguity in response to the needs of the Omani healthcare system. This flexible and ambiguous role could fit the multiple role agendas and was adaptable to new ways of working. This flexibility was also integral to the development of the role in the organisation. The findings indicate that the multiple role agendas required the APNs to show they were self-directed, could handle their role challenges and could take their development into their own hands despite their lack of preparation and a clear role description. Therefore, the APNs had to use multi-levelled negotiations in order to establish their role and influence the perceptions of other role stakeholders towards their role. Conclusion: The data in this research sought to illuminate the processes by which successful transition into roles with APN titles occurs in Oman and to provide novel insights into the experiences of the APNs from an Omani perspective. It is hoped that these insights and the recommendations listed can inform interventions and guide future role development in Oman and beyond.

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Hannah Cooke (Supervisor) & Shaun Speed (Supervisor)