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J Adv Nurs. 2014 May;70(5):1128-37. doi: 10.1111/jan.12273. Epub 2013 Oct 22.

A national cross-sectional study measuring predictors for improved service user outcomes across clinical nurse or midwife specialist, advanced nurse practitioner and control sites.

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School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.



The aim was to identify key patient outcomes and to compare these outcomes across services that employed clinical specialists (either nurse or midwife) or advanced nurse practitioners with matched, non post-holding services.


In nursing and evaluation research, it is recognized that, further patient outcome studies, which measure and evaluate the impact of the new advanced roles, are urgently needed.


A cross-sectional study design with a comparison group was implemented across Ireland.


A total of 279 surveys were completed by service users in 41 services in 2009/10. Key outcomes were identified, then chosen as primary outcomes and assessed for differences across post-holding and the matched comparison sites. To identify the priority of importance of the key outcomes, a logistic regression model was computed with difference in overall care observed (yes or no) as the dependent variable, and gender, age grouping and the key outcomes as the independent predictors.


Analysis revealed that the key outcomes were, on anxieties, dignity and respect, time waited, confidence in the clinician and the clinician making a positive difference. Results of the logistic modelling of the key outcome on noticing any difference in the care given by the clinical specialists or advanced nurse practitioners compared with the care from others revealed that the single most important predictor was being treated with respect.


Further studies evaluating advanced health professions roles measuring these six key outcomes, at a minimum, will ensure that service users' main concerns are being accounted for.


advanced practice; cross-sectional; evaluation research; midwifery; nursing; patient perspective

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