Shortcuts in knowledge mobilization: An ethnographic study of advanced nurse practitioner discharge decision‐making in the emergency department

King, Rachel, Sanders, Tom and Tod, Angela (2021) Shortcuts in knowledge mobilization: An ethnographic study of advanced nurse practitioner discharge decision‐making in the emergency department. Journal of Advanced Nursing. ISSN 0309-2402 (In Press)

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Official URL: https://doi.org/10.1111/jan.14834

Abstract

Aim
To understand how advanced nurse practitioners use knowledge to inform their discharge decision‐making in the emergency department.

Background
Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department.

Design
An ethnographic study was undertaken in an emergency department in the North of England.

Method
Data were collected by observation (n = 5) and semi‐structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes.

Findings
In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision‐making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge.

Discussion
Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring.

Conclusion
Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision‐making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department.

Impact
The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision‐making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence‐based discharge decision‐making.

Item Type: Article
Additional Information: Funding information: The research was funded by the NIHR CLAHRC Yorkshire and Humber, www.clahrc‐yh.nihr.ac.uk. The views expressed are those of the author, and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Uncontrolled Keywords: advanced nurse practitioners, boundary blurring, ethnography, knowledge mobilization, qualitative research, shortcuts
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
L400 Social Policy
L500 Social Work
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Elena Carlaw
Date Deposited: 31 Mar 2021 13:49
Last Modified: 31 Mar 2021 14:00
URI: http://nrl.northumbria.ac.uk/id/eprint/45847

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