|Year : 2023 | Volume
| Issue : 1 | Page : 1-9
Identifying structure, process and outcome factors of the clinical specialist nurse: A scoping review study
Saied Hashemi1, Leila Karimi2, Seyed Tayeb Moradian3, Abbas Ebadi3, Amir Vahedian-Azimi4, Jamileh Mokhtari-Nouri5
1 Student's Research Committee, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
4 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
5 Medicine, Quran and Hadith Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
|Date of Submission||21-Sep-2021|
|Date of Decision||27-Nov-2021|
|Date of Acceptance||17-Apr-2022|
|Date of Web Publication||27-Jan-2023|
Medicine, Quran and Hadith Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: In order to achieve the major goals of transformation in the health care system, organizing and developing the existing potential properly play a pivotal role. The objective is to conduct a scoping review to describe available extent of literatures about scattered structure, process, and outcome factors of the clinical specialist nurse and redesign those as three cohesive and interconnected factors. Materials and Methods: A scoping review of studies was conducted from 1970 to June 20, 2020, focusing on the structure, process, and outcome factors of the clinical specialist nurse from six databases. Results: Forty-six studies were carried out. Structure (individual characteristics, intra-organizational, and governance factors), process (professional interactions, and roles and duties of a specialist nurse), and outcome (patient and family, nurse, and organizational outcomes) factors were identified. Conclusions: With the correct knowledge of the factors, it is possible to achieve the desired therapeutic, organizational, and professional results of nursing by providing the necessary fields in the structure, process, and outcomes. The identification of structures, processes, and outcomes that influence clinical nurse's role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and guarantee the delivery of high-quality care.
Keywords: Clinical nurse specialist, outcome, process, structure
|How to cite this article:|
Hashemi S, Karimi L, Moradian ST, Ebadi A, Vahedian-Azimi A, Mokhtari-Nouri J. Identifying structure, process and outcome factors of the clinical specialist nurse: A scoping review study. Iranian J Nursing Midwifery Res 2023;28:1-9
|How to cite this URL:|
Hashemi S, Karimi L, Moradian ST, Ebadi A, Vahedian-Azimi A, Mokhtari-Nouri J. Identifying structure, process and outcome factors of the clinical specialist nurse: A scoping review study. Iranian J Nursing Midwifery Res [serial online] 2023 [cited 2023 Mar 20];28:1-9. Available from: https://www.ijnmrjournal.net/text.asp?2023/28/1/1/368505
| Introduction|| |
Through time, the health care system has undergone significant changes due to demographic and cultural diversities, technological advances, changes in disease patterns, and community expectations of how health care services provided. Due to this, many decision-makers in the health care system have forced countries to develop specialized nursing roles to meet the needs of society and improving the quality of care.
A clinical specialist nurse, known as a registered nurse with a master's or doctoral degree who uses knowledge, skills, evidence, and scientific research as a trainer, researcher, consultant, and leader, provides safe, high-quality, and cost-effective care for the patients.,
The results of a systematic review study of Donald et al. entitled “the Impact of nurses' specialist on long-term care” showed that the use of specialist nurses has associated with increasing quality of health care, job, and family satisfaction. Descriptive study of Lamb entitled “ability of the leadership role of nurses specialist” showed that the specialist nurses have a high level of leadership power and with this ability, they provide better conditions in terms of care and quality services for the patients. However, after more than 60 years of activity of the clinical specialist nurse as one of the four types of specialist nurses, and as a part of the health care system, the performance of specialist nurses in organizations is still different in spite of their determined role. Despite the efforts made by the community of specialist nurses to increase the understanding of others and differentiate this role from other nurses, in some cases, this role in the health care system is used incorrectly and contradictory.
Studies show that using the role of the clinical specialist nurse correctly in the health care system has led to a reduction in patient mortality and improving the quality of care., Therefore, by employing a clinical specialist nurse, followed by improving the quality of care, mortality can be greatly reduced, but assessing the care is necessary to improve the quality of care. Assessing the quality of care shows how health programs are implemented and identifies program deficiencies so that problems can be addressed.
There are several models for evaluating the quality of care; the most widely used model in measuring and evaluating the quality of care is evaluation of services in terms of structure, process, and outcome and was introduced in 1980 by Donabedian. According to this model, the assessment path of care quality starts from the structure, then moves towards the process, and finally ends in the outcome. Structure means describing the physical, organizational, and other characteristics of the care delivery system, process means the method and how to provide care, and outcome means the impact of services on the health status of patients and people.
Some studies examined only the structural and process factors, some the outcome of the role of the clinical specialist nurse, and one study has briefly been referred to structural, process, and outcome factors. Therefore, our objective was to conduct a scoping review to describe available extent literatures about scattered structure, process, and outcomes factors of clinical specialist nurse and redesign those as three cohesive and interconnected factors.
| Materials and Methods|| |
Scoping studies are used to review related articles to identify extent of a concept. The scoping review study was conducted from 1970 to June 20, 2020, which deals with a wide range of articles related to the intended goals and on the role of the clinical specialist nurse based on the provided framework by the Joannah Briggs institute, created by Arksey and Omalley.
Research strategy was set up based on the Joannah Briggs institute framework. The research strategy consists of three steps: In the first step, a limited study was performed at the Scopus database to find keywords by analyzing the words in the title and abstract of the retrieved articles. In the second step, the study was performed based on the specified keywords, and in the third step, the list of sources of the retrieved articles was also investigated.
The following databases have been used to search for published articles: Persian databases such as MagIran, Iran Medex, and SID, and English articles such as Scopus, PubMed, and Web of science. All related Persian and English accessible articles that have a good score in quality appraisal (≥60% for each appraisal tool of total score) were considered as inclusion criteria. Duplicate titles and non-related titles to clinical specialist nurse were also excluded from the study [Figure 1].
To choose from articles, first, the survey of articles was done by three researchers separately, and then the obtained titles were examined and consensus was reached. After removing duplicates and irrelevant articles, the titles and then the abstracts of the articles were reviewed by two researchers based on the relevance to the research question and then the articles with inclusion criteria screened for the next step [Figure 1]. Finally, the full text of the remaining articles was reviewed according to inclusion criteria.
The quality of final selected articles was evaluated separately by three researchers. CASP tool was used to evaluate qualitative articles, STROB tool was used for quantitative articles, and PRISMA tool was used to evaluate meta-analysis and systematic articles., For qualitative articles, a score of 6 or higher of CASP (total score 10) was considered as good. STROBE tool (total score 22) was selected for quantitative articles, and a score of 15 or higher was regarded as good. For a systematic review, a score 18 or higher of PRISMA (total score 27) was assumed good [Table 1]. In cases of disagreement, discussion was continued until a final agreement between the three researchers was reached.
After reviewing 6 databases, a total of 22,719 abstracts were gathered. Duplicate articles were removed and 15,435 articles were remained. After screening the titles and abstract, only 115 articles were related to the research question in which the full text of them was reviewed. After reviewing the full-text of articles according to the inclusion and exclusion criteria, finally 46 articles were selected for the final review [Figure 1].
An adapted form of the Joannah Briggs Institute was used for data extraction, which was related to scoping studies. After reviewing and comparing the findings of each article, the initial themes were formed, then all the themes were reviewed and discussed among the members of research teams; any changes also were applied as needed.
Researchers tried to act in an unbiased way to analyze the retrieved data of articles. Ethics committee of Bagiyatallah University of Medical Sciences approved this study (Project code: IR.BMSU.REC.REC.1399.288).
| Results|| |
Summary of themes
Based on the extracted codes, three factors including structure (individual characteristics, intra-organizational, and governance factors), process (professional interactions, roles, and responsibilities of the specialist nurse), and outcome (patient and family, nurse, and organizational) were selected. The themes were explained as follows:
These factors determine the necessary conditions to promote the role of the nurse toward clinical specialist nurse. Sub-categories of individual characteristics includes: evidence-based practice (15-time), clinical judgment (2-time), Decision-making power (4-time), problem-solving ability (3-time), moral characteristics, empathy, responsibility (6-time), professional competence (Knowledge, attitude, professional and specialized skills, and technical ability) (12-time), systematic thinking (1-time), job commitment (1-time), work experience (5-time), having certificate of a clinical specialist nurse (7-time), having at least a master's degree (18-time), independent performance (2-time), critical thinking (3-time) and having a multifaceted nature of education, research, management, leadership, and clinical (4-time).
Sub-categories of intra-organizational factors include scientific promotion and specialized knowledge (4-time), explanation the scope of activities in the specialized and managerial field (complex decision-making power, moral, department management, team and health, and safety and quality assurance) (6-time), approval of specialized nursing courses by organizations for professional competence (7-time), budgeting (10-time), having experienced professors in various fields (4-time), specifying the structure and standards of education (7-time), editing specialized educational curriculum (12-time), explaining and clarifying the role of specialist nurse (15-time), determining facilitating factors and barriers (6-time), having an organizational chart (manpower) (7-time), need for expertise according to the context and culture (5-time), understanding the importance and role of clinical specialist nurse by officials (5-time), and provision of nurse welfare facilities (private room, meeting place for specialist nurse) (1-time). Sub-categories of governance factors include determining the rules and regulations (9-time), support of government institutions (11-time), and determining the educational requirements and creating a culture of the importance of the role (6-time).
Process factors have been expressed through practice, participation, and working relationships of team members, including doctors and other nurses. Sub-categories of professional interactions are communication with the patient and his family (21-time), education to the patient and their family (10-time), communication with other members of treatment team (28-time), communication with team members for independent prescription (2-time), submission integrated and coordinated care with treatment team (4-time), cooperation and gaining trust for effectiveness (2-time), partnership with team to solve the problem (3-time), and participation in meetings and conferences with team members (5-time).
Sub-categories of “duties of a clinical specialist nurses” are management and leadership roles (19-time), supervision to provide a calm and respectful environment and treatment (7-time), support and recognition of new nurses (4-time), implementation and use of scientific evidence in the clinic (6-time), the role of care depending on the patient's needs (3-time), the role of diagnosis, treatment and prevention (6-time), community needs assessment (1-time), the role of education, research and clinical (18-time), Policy making (1-time), the responsibility of clinical specialist nurse for action taken (4-time), training of general nurses and medical staff (12-time), and gaining new and up-to-date experiences in care (6-time).
These factors explain the effects of employing a clinical specialist nurse according to the results of treatment measures. The sub-categories of “Patient and family outcomes” are as follows: increasing patient satisfaction (9-time), prevention of patient readmission to hospital (4-time), reducing mortality (5-time), complication prevention and control (5-time), reduction of staying time in hospital (5-time), improving the quality of services and clinical care of nurse (15-time), encouragement and involving patient to self-care (increase treatment adherence)(5-time), meeting the patient's physical and environmental needs (2-time), reducing the patient's medical expenses (19-time), availability of care and clinical specialist nurse (6-time), training and emotional support of patients and their families (9-time), and decreasing anxiety (3-time).
The sub-categories of “nurse outcomes” include increasing job satisfaction (5-time), professional, specialized qualification promotion (4-time), and the formation (employment) of clinical specialist nurse (2-time).
The sub-categories of “organizational outcomes” are as follows: increasing the credibility of organization and attracting nurses (1-time), preventing leaving the job (2-time), reducing organizational costs (7-time), promoting organization (5-time), and improving organizational performances (2-time).
| Discussion|| |
Due to the complexity of the process of playing the role of a clinical specialist nurse, identifying and recognizing the factors are of particular importance; therefore, this study was conducted to describe available extent of literatures about scattered structure, process, and outcome factors of clinical specialist nurse and redesign those as three cohesive and interconnected factors; then, the authors applied results of this study to provide more evidence supporting the structure, process, and outcome factors to clarify the role of clinical specialist nurse. One of the strengths of the current study is the process of searching for articles without considering the time period, reviewing abstracts and titles of articles, and evaluating the quality of articles by three researchers separately. All authors also endorsed the extracted themes and the number of times that were repeated in the articles. Weaknesses of the study include the omission of non-English and non-Persian articles and the impossibility of properly evaluating narrative review articles due to the lack of qualitative evaluation tools. Moreover, the authors did not search in some databases like EMBASE, Cochrane, and CINAHL due to lack of access to those sites.
One of the subcategories was individual characteristics as having a degree/license of specialist nurse, recognizing the role of specialist nurse, systemic thinking, evidence-based performance, management, and leadership, that is consistent with our study findings; moreover; the results of the included studies showed that due to the complex situation and extensive changes in health care services, clinical specialist nurse should be able to update their knowledge, professional skills, and technical abilities by continuing to study at the postgraduate level, which are important and the main pillars of the personal characteristics of a clinical specialist nurse because a clinical specialist nurse plays a pivotal role in the delivery of evidence-based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries.,
Another subcategory is an organizational factor which defines the scope of activity of clinical specialist nurse and clarifies the role of the nurse. Based on the current study, even though they have the necessary characteristics to play the role of a clinical specialist nurse, these persons should be supported by the organization and the organization should create educational and organizational structures with a correct understanding of the role of clinical specialist nurse, training specialized nurses, removing existing barriers by using relevant educational curriculum, and experienced professors fitted to the context and culture of the country. Some authors believed that redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes have a key role in successfully establishment of the clinical specialist nurse role and could sufficiently differentiate from other nursing roles.
Final subcategory is governing factor, to the best of the authors' knowledge, for the first time, this concept has been introduced as a separate subcategory in current study; although review of the literatures demonstrated, the factor in other studies has differently labeled as determining laws and regulations and the support of government institutions.
Professional interactions, roles, and responsibilities of clinical specialist nurse are the subcategories of process factor that is consistent with the study of Kilpatrick et al. (2016) which expresses interactive factors such as communication and acquaintance of clinical specialist nurse with other members of treatment team, cooperation, and gaining trust for effectiveness and partnership with treatment team to solve the problem, and the role of management and leadership, but do not mention the interactions of clinical specialist nurse and treatment team with the patient and the patient's family to provide integrated and coherent care. However, recently, it is stated that a small variability was found in the comparison of using from a clinical specialist nurse in core competency in the spheres of patient, nursing, organization, and scholarship.
Another noteworthy issue that has been neglected is the knowledge of a clinical specialist nurse about his/her roles and responsibilities as a manager, leader, researcher, clinical educator than general nurses, providing care according to the need and accepting responsibility before evidence-based treatment for the patient in order to establish these interactions, because Poulton believes how to care by treatment team as a process leads to the realization of more than a quarter of the effectiveness of occupational therapy; one of the most guiding studies for better performing the roles and responsibilities is Contandriopoulos and their colleagues study that demonstrated five themes which includes planning, role definition, practice model, collaboration, and team support.
Patient and their family, nurse, and organization outcomes were extracted, which refers to the importance of the role of clinical specialist nurse in organizational outcome that is consistent with other quantitative and qualitative studies., However, in aforementioned studies, only the effect of the role of clinical specialist nurse on the patient is considered and its influence on preventing from leaving the job of medical staff and consequently improving performance and reducing costs of the organization has not been considered. The outcomes that bring about job satisfaction, formation, and promotion of professional and specialized qualifications for nurses are not discussed. Some authors declared that current guidelines should form the foundation for such evaluations of clinical specialist nurse roles; the proposed role-specific considerations which clarifies application of standard guidelines sections to such evaluation of clinical specialist nurse could strengthen the quality and comprehensiveness of future evaluations of these roles., One of the main limitations of the present study was lack of access to the EMbase website and lack of access to interviews with specialist nurses abroad.
| Conclusion|| |
Considering the involving factors in structure, process, and outcome area of clinical specialist nurse role can guarantee the key to successful establishment of the clinical specialist nurse role and sufficiently differentiate it from other nursing roles, having lasting effect on the patient life, their family, the organization, and even the clinical specialist nurse. Moreover, with the correct knowledge of aforementioned factors, it is possible to achieve the desired therapeutic, organizational, and professional results of nursing by providing the necessary fields in the structure, process, and outcome that may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and support the delivery of high-quality care.
Thanks to guidance and advice from the “Clinical Research Development Unit of Baqiyatallah Hospital”.
Financial support and sponsorship
Baqiyatallah University of Medical Sciences
Conflicts of interest
Nothing to declare.
| References|| |
Ahmadian S, Mokhtari J. A review of the evolution and challenges in nursing role development. Iran J Med Ethics Hist Med 2017;9:48-60.
Fagerström L. The impact of advanced practice nursing in healthcare: Recipe for developing countries. Ann Neurosci 2012;19:1. doi: 10.5214/ans. 0972.7531.180401.
Hall S, Thompson J, Phair T, Davies AN. Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team. BMJ Support Palliat Care 2020;10:111-3.
Sanchez K, Winnie K, de Haas-Rowland N. Establishing the clinical nurse specialist identity by transforming structures, processes, and outcomes. Clin Nurse Spec 2019;33:117-22.
Lamb A, Martin-Misener R, Bryant-Lukosius D, Latimer M. Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nurs Open 2018;5:400-13.
Donald F, Martin-Misener R, Carter N, Donald EE, Kaasalainen S, Wickson-Griffiths A, et al
. A systematic review of the effectiveness of advanced practice nurses in long-term care. J Adv Nurs 2013;69:2148-61.
Mohr LD, Coke LA. Distinguishing the clinical nurse specialist from other graduate nursing roles. Clin Nurse Spec 2018;32:139-51.
Saunders MM. Clinical nurse specialists' perceptions of work patterns, outcomes, desires, and emerging trends. J Nurs Adm 2015;45:212-7.
Whitehead L, Ghosh M, Walker DK, Bloxsome D, Vafeas C, Wilkinson A. The relationship between specialty nurse certification and patient, nurse and organizational outcomes: A systematic review. Int J Nurs Stud 2019;93:1-11.
Levac D, Colquhoun H, O'Brien KK. Scoping studies: Advancing the methodology. Implement Sci 2010;5:69. doi: 10.1186/1748-5908-5-69.
Nelson KM, Helfrich C, Sun H, Hebert PL, Liu C-F, Dolan E, et al
. Implementation of the patient-centered medical home in the veterans health administration: Associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med 2014;174:1350-8.
Jahani Shourab N, Ghaffari Sardasht F, Jafarnejad F, Esmaili H. Assessment of prenatal care process based on donabedian model in Mashhad health centers. Iran J Obstet Gynecol Infertil 2013;16:7-17.
Donabedian A. Advantages and limitations of explicit criteria for assessing the quality of health care. Milbank Mem Fund Q Health Soc 1981;59:99-106.
Zhang X, Meng K, Chen S. Competency framework for specialist critical care nurses: A modified Delphi study. Nurs Crit Care 2020;25:45-52.
Fallon N, Cassidy I, Doody O. Irish respiratory clinical nurse specialists' experiences of their role: A qualitative exploration. Clin Nurse Spec 2018;32:240-8.
Peters M, Godfrey C, McInerney P, Soares C, Khalil H, Parker D. The Joanna Briggs Institute reviewers' manual 2015: Methodology for JBI scoping reviews. 2015.
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology 2005;8:19-32.
Casp. Critical Appraisal Skills Programme (CASP).(Qualitative checklist) 2018.
Programme CAS. CASP Cohort Study Checklist. Critical Appraisal Skills Programme. UK: Oxford; 2018.
Massaroli A, Martini JG, Moya JLM, Pereira MS, Tipple AFV, Maestri E. Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil. Rev Lato-Am Enfermagem 2019;27:e3134. doi: 10.1590/1518-8345.2620.3134.
Jølstad AL, Røsnæs ER, Severinsson E, Lyberg A. A paradigm shift in nurse specialist clinical supervision—implementation of a competence program. SAGE Open Nurs 2019;5:2377960819844366. doi: 10.1177/2377960819844366.
Irajpour A, Khorasani P, Bagheri M, Eshaghian A, Ziaee ES, Saberi Z, et al
. The framework for developing nursing specialist roles in the health care system of Iran. Nurs Outlook 2020;68:45-54.
Bruce JC, Baumann J, Schmollgruber S. Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study. J Adv Nurs 2019;75:2969-79.
Valizadeh L, Zamanzadeh V, Rassouli M, Ghahramanian A, Archibald MM, Asghari E. A qualitative study of specialized clinical nurses' perceptions of good care in practice. Clin Nurse Spec 2018;32:260-7.
Mayhew C, Strudwick G, Waddell J. Clinical nurse specialists' perceptions of a mental health patient portal. Clin Nurse Spec 2018;32:313-22.
Latham K, Nyatanga B. Community palliative care clinical nurse specialists as independent prescribers: Part 2. Br J Community Nurs 2018;23:126-33.
King AI, Boyd ML, Dagley L, Raphael DL. Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives. J Clin Nurs 2018;27:807-18.
Casey M, O'Connor L, Nicholson E, Smith R, O'Brien D, O'Leary D, et al
. The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners. J Adv Nurs 2017;73:3007-16.
Martins A, Aldiss S, Gibson F. Specialist nurse key worker in children's cancer care: Professionals' perspectives on the core characteristics of the role. Eur J Oncol Nurs 2016;24:70-8.
Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The future of the clinical nurse specialist role in Finland. J Nurs Scholarsh 2015;47:78-86.
Hellqvist C, Berterö C. Support supplied by Parkinson's disease specialist nurses to Parkinson's disease patients and their spouses. Appl Nurs Res 2015;28:86-91.
Whittaker E, Kernohan WG, McLaughlin D. Learning, development, and support needs of community palliative care clinical nurse specialists. Int J Palliat Nurs 2014;20:425-33.
Boström E, Isaksson U, Lundman B, Graneheim UH, Hörnsten Å. Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes. Patient Educ Couns 2014;94:187-92.
Onishi M, Kanda K. Expected roles and utilization of specialist nurses in Japan: The nurse administrators' perspective. J Nurs Manag 2010;18:311-8.
Gibson F, Bamford O. Focus group interviews to examine the role and development of the clinical nurse specialist. J Nurs Manag 2001;9:331-42.
Carroll S. Role of the breast care clinical nurse specialist in facilitating decision-making for treatment choice: A practice profile. Eur J Oncol Nurs 1998;2:34-42.
Doody O, Slevin E, Taggart L. Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland. J Clin Nurs 2017;26:2964-75.
Husband J, Kennedy C. Exploring the role of community palliative care nurse specialists as educators. Int journal of Palliat Nurs 2006;12:277-84.
Kobleder A, Mayer H, Gehrig L, Senn B. “Promoting continuity of care”—Specialist nurses' role experiences in gynaecological oncology: A qualitative study. J Clin Nurs 2017;26:4890-8.
Cook O, McIntyre M, Recoche K, Lee S. A clearer pathway—The future of the gynaecological oncology specialist nurse role. Collegian 2020;27:388-95.
Willard C, Luker K. Working with the team: Strategies employed by hospital cancer nurse specialists to implement their role. J Clin Nurs 2007;16:716-24.
Lopatina E, Donald F, DiCenso A, Martin-Misener R, Kilpatrick K, Bryant-Lukosius D, et al
. Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review. Int J Nurs Stud 2017;72:71-82.
Wallace I, Barratt H, Harvey S, Raine R. The impact of clinical nurse specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study. Eur J Oncol Nurs 2019;43:101674. doi: 10.1016/j.ejon. 2019.101674.
Sundler AJ, Blomberg K, Bisholt B, Eklund A, Windahl J, Larsson M. Experiences of supervision during clinical education among specialised nursing students in Sweden: A cross-sectional study. Nurse Educ Today 2019;79:20-4.
Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Structural and process factors that influence clinical nurse specialist role implementation. Clin Nurse Spec 2016;30:89-100.
Fulton JS, Mayo AM, Walker JA, Urden LD. Core practice outcomes for clinical nurse specialists: A revalidation study. J Prof Nurs 2016;32:271-82.
Colwill JP, O'Rourke C, Booher L, Soat M, Solomon D, Albert NM. Capture of knowledge work of clinical nurse specialists using a role tracking tool. Clin Nurse Spec 2014;28:323-31.
Wickham S. What are the roles of clinical nurses and midwife specialists? Br J Nurs 2013;22:867-75.
Kilpatrick K, DiCenso A, Bryant-Lukosius D, Ritchie JA, Martin-Misener R, Carter N. Practice patterns and perceived impact of clinical nurse specialist roles in Canada: Results of a national survey. Int J Nurs Stud 2013;50:1524-36.
Kim MY. Effects of oncology clinical nurse specialists' interventions on nursing-sensitive outcomes in South Korea. Clin J Oncol Nurs 2011;15:E66-74.
Chang KPK, Wong KST. The nurse specialist role in Hong Kong: Perceptions of nurse specialists, doctors and staff nurses. J Adv Nurs 2001;36:32-40.
Comiskey C, Coyne I, Lalor J, Begley C. A national cross-sectional study measuring predictors for improved service user outcomes across clinical nurse or midwife specialist, advanced nurse practitioner and control sites. J Adv Nurs 2014;70:1128-37.
Doody O, Slevin E, Taggart L. Activities of intellectual disability clinical nurse specialists in Ireland. Clin Nurse Spec 2017;31:89-96.
Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Relationship between clinical nurse specialist role implementation, satisfaction, and intent to stay. Clin Nurse Spec 2016;30:159-66.
Lawler J, Leary A, Walden E, Stanisstreet D, Punshon G. The workload of the diabetes specialist nurse workforce in the UK. Journal of Diabetes Nursing 2020;23:112.
Kitajima M, Miyata C, Tamura K, Kinoshita A, Arai H. Factors associated with the job satisfaction of certified nurses and nurse specialists in cancer care in Japan: Analysis based on the basic plan to promote cancer control programs. PLoS One 2020;15:e0232336. doi: 10.1371/journal.pone. 0232336.
Fukuda T, Sakurai H, Kashiwagi M. Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes. PLoS One 2020;15:e0228458. doi: 10.1371/journal.pone. 0228458.
Ryskina KL, Lam C, Jung H-Y. Association between clinician specialization in nursing home care and nursing home clinical quality scores. J Am Med Dir Assoc 2019;20:1007-12.e2.
Cook O, McIntyre M, Recoche K. Exploration of the role of specialist nurses in the care of women with gynaecological cancer: A systematic review. J Clin Nurs 2015;24:683-95.
Forbes A, While A, Dyson L, Grocott T, Griffiths P. Impact of clinical nurse specialists in multiple sclerosis–synthesis of the evidence. J Adv Nurs 2003;42:442-62.
Hussain Rawther SC, Pai MS, Fernandes DJ, Mathew S, Chakrabarty J, Devi ES. Specialist nurse initiated interventions in breast cancer care: A systematic review of randomised controlled trials. J Clin Nurs 2020;29:2161-80.
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013;15:398-405.
DiCenso A, Bryant-Lukosius D, Martin-Misener R, Donald F, Abelson J, Bourgeault I, et al
. Factors enabling advanced practice nursing role integration in Canada. Nurs Leadersh (Toronto, Ont) 2010;23:211-38.
DiCenso A, Martin-Misener R, Bryant-Lukosius D, Bourgeault I, Kilpatrick K, Donald F, et al
. Advanced practice nursing in Canada: Overview of a decision support synthesis. Nurs Leadersh (Toronto, Ont) 2010;23:15-34.
Wei W, Niu Y, Ge X. Core competencies for nurses in chinese intensive care units: A cross-sectional study. Nurs Crit Care 2019;24:276-82.
Heale R, Rietze L, Hill L, Roles S. Development of nurse practitioner competencies for advance care planning. J Hosp Palliat Nurs 2018;20:166-71.
Jokiniemi K, Hølge-Hazelton B, Kristofersson GK, Frederiksen K, Kilpatrick K, Mikkonen S. Core competencies of clinical nurse specialists: A comparison across three Nordic countries. J Clin Nurs 2021;30:3601-10.
Poulton BC, West MA. Effective multidisciplinary teamwork in primary health care. J Adv Nurs 1993;18:918-25.
Contandriopoulos D, Brousselle A, Dubois C-A, Perroux M, Beaulieu M-D, Brault I, et al
. A process-based framework to guide nurse practitioners integration into primary healthcare teams: Results from a logic analysis. BMC Health Serv Res 2015;15:1-11.
Bryant-Lukosius D, Carter N, Reid K, Donald F, Martin-Misener R, Kilpatrick K, et al
. The clinical effectiveness and cost-effectiveness of clinical nurse specialist-led hospital to home transitional care: A systematic review. J Eval Clin Pract 2015;21:763-81.