A phenomenological study of psychiatric advanced practice nurses' role perceptions in the current healthcare structure

Abstract

The implementation of the nursing grade reform in Hong Kong Hospital Authority has introduced the position of advanced practice nurse as the working title in 2003. Recent published studies suggested that the definition and the scopes of practice for nurses in advance practice were context-specific in both general and psychiatric streams. The changes in the healthcare contexts provide opportunity for psychiatric nurses to develop advanced practice skills to meet the mental healthcare needs to the global populations. Although, a few Western studies revealed significant results in psychiatric advanced practice nurses' psychosocial intervention in managing clients with depression and psychological stress, and improving in-patient services, none was conducted in Hong Kong. Unclear role definition and delineation of an advanced practice nurse found in both local and overseas' studies further added the need to explore the psychiatric advanced practice nurses' role perceptions in local context. This study aimed to explore the lived experiences of existing psychiatric advanced practice nurses' role perceptions in the public hospitals using interpretative phenomenological research approach. Data were collected through individual interviews with thirteen out of around sixty psychiatric advanced practice nurses who were working in one of seven clusters of psychiatric hospitals under Hospital Authority, Hong Kong and were analyzed using the interpretative phenomenological analysis method. Three themes related to the experiences of psychiatric advanced practice nurses were discerned: (1) 'We are different' the participants felt themselves to be different in many ways, which can be attributed to administrative policies in the psychiatric stream, (2) 'Who am I?' the participants questioned their roles, which can be attributed to the unclear scope of their practice, and (3) 'I am who I am' the participants strove hard to meet their role obligations. The findings of this study showed that the psychiatric advanced practice nurses' perceptions on their roles, to a certain extent, were subjugated by the different administrative policy regarding the availability of clinical support given by nurse consultant between the general and psychiatric streams. Participants pointed out their needs for continuous development of psychiatric nursing skills and knowledge, and space for them to concentrate on clinical practice instead of spending time on managerial duties. In the current mental healthcare system, the impact of psychiatric advanced practice nurses needing to double their managerial duties which fall outside the prime clinical duties on professional patient care service should be further examined; and psychiatric advanced practice nurses' concerns for role delineation and career prospects should be addressed by the administrators. To meet the challenges that impact on psychiatric advanced practice nurses' roles, this study offered some implications for both psychiatric nurses and the administrators to facilitate the psychiatric advanced practice nurses' role enactment in mental health nursing practice, and has gained some insights into indigenous advanced nursing practice development of psychiatric nursing in Hong Kong. This study suggested that the success role enactment depends on the role-bearers' commitment to advance their clinical knowledge via self-arranged studies and reflection on clinical practice. Some psychiatric advanced practice nurses needing to perform the dual roles of clinician and manager raises question about the impacts on the development in clinical practice. To facilitate their focus on clinical field, administrators should provide the psychiatric advanced practice nurses with clinical support and space via creating a nurse consultant post in each specialty and assigning a managerial post in each unit. In addition, a clear pathway for career advancement for psychiatric nurses in public healthcare institutions should be developed.