Case Study: Pioneer Nurse Practitioners & Advanced Practice Roles

This case study examines the experiences of pioneer nurse practitioners in establishing advanced practice roles. The study, involving 50 middle-aged women in Washington State who began as NPs between 1965 and 1979, utilizes interviews and focus groups to gather data, analyzed through grounded theory methods. The central theme, "Advancing Autonomy to Make a Difference," is manifested through six themes: Breaking Free, Molding the Clay, Encountering Obstacles, Surviving the Proving Ground, Staying Committed, and Building the Eldership. The findings highlight the importance of autonomy for NPs to practice to their full potential and the study provides insights into the evolution of advanced nursing practice and guidance for establishing similar roles in other countries. The analysis of the provided assignment solution assesses the believability and robustness of the original research report, covering aspects such as the clarity of writing, researcher qualifications, accuracy of the title and abstract, identification of the phenomenon studied, literature review, theoretical framework, philosophical approach, sampling method, participant suitability, data collection and analysis strategies, rigor, findings presentation, and referencing.

Nursing Assignment 1
Nursing Assignment
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Nursing Assignment 2
Believability of the Research
Is the report well written- concise, grammatically correct, avoids the use of jargon?
Yes, the study has been written in a concise and grammatically correct manner. Furthermore,
it is well laid out and organized. For instance, the report has a title, an abstract with
subheadings, methods, results, and conclusions. The results have also been presented in
themes and subthemes making it easy to read and understand. However, the report doesn’t
show whether there is an introduction or literature review (Brown and Draye, 2003).
Do the researcher’s qualifications/position indicate a degree of knowledge in this field?
Yes, the qualification of the researchers is also provided and is an indication of their degree
of knowledge in the field. Both authors are professors at the University of Washington,
School of Nursing. This shows that they are both experts in the school of nursing and their
attachment to the university shows that they also have experience in the research topic.
Is the title clear, accurate and unambiguous?
No, the title of the report is relatively ambiguous because it only shows the aim of the study
and doesn’t indicate the place and design of the study. According to O’brien et al. (2014), the
title of a study should be complete by showing the aim of the study, design, and nature of
participants.
Does the abstract offer a clear overview of the study, including the research problem,
sample, methodology, findings and recommendations?
Yes, the abstract shows a clear overview of the study and is subdivided into the purpose,
design, methods, findings, and conclusions. This outline fulfills the standard recommendation
of a research abstract by Ritchie et al. (2013).

Nursing Assignment 3
Robustness of the Research
Is the phenomenon to be studied clearly identified?
Yes, the phenomenon of the study has been identified which is to explore the experience of
the pioneer nurse practitioners in establishing advanced practice roles. This is consistent with
the aim or purpose of the study as well, which has also been identified (Brown and Draye,
2003).
Has a literature review been undertaken?
Yes, the descriptive study has undertaken a concise but clear literature review, even though
the study doesn’t have ‘a literature review’ title.
Does it meet the philosophical underpinnings of the study?
Yes, the report meets the philosophical foundations of the research because it highlights the
factors that affect the survival and growth of advanced nursing practice, and the most
appropriate way of addressing the challenges which are to examine the role of autonomy and
to collect wisdom from the previous experiences of those who initiated the nursing
practitioner roles (Duffield et al., 2009).
Does the review of the literature fulfil its objectives?
Yes, the literature review also meets its objectives which is to explore the experiences of the
pioneers in establishing and maintaining nurse practitioner roles in the current practice
environment. The authors accomplished this by providing justifications on the significance of
exploring the origins of advanced practice and previous evidence as to the importance of
nursing practitioner role in improving health care (Weitz et al., 2013). Additionally, the
literature review fulfills its objectives by showing the existing study gap which it endeavors
to fill (Hart, 2018).

Nursing Assignment 4
Has a conceptual or theoretical framework been identified?
No, the descriptive study does not identify a theoretical framework upon which is based. Gale
et al. (2013) observe that a theoretical framework strengthens research because an explicit
statement of the theoretical assumptions allows the audience to examine the study critically.
Furthermore, it acts as a link between the researchers to the current knowledge.
Has the philosophical approach been identified?
Yes, the philosophical approach is descriptive design and included focus groups and
interviews.
Why was the approach chosen?
The study doesn’t justify the reasons behind the choice of the approach. However, according
to Vaismoradi, Turunen, and Bondas (2013), a descriptive study is most appropriate when
observing and exploring the behavior of given subjects without influencing their feedbacks,
thus increasing the credibility of the findings. Moreover, the approach permits a multifaceted
approach to data collection and analysis, hence the reason for the use of focus groups and
interviews in data collection. The use of a variety of data collection approaches allows the use
of a large sample size which improves data validity and reliability (Noble and Smith, 2015).
Is the sampling method and sample size identified?
Yes, the sample size of the study is 50 nursing practitioners who were recruited using flyers.
The disclosure of the sample size is significant because it shows the number of subjects upon
which the findings were based and whether it was representative. Furthermore, the sample
size determines the generalizability of the outcomes (Leung, 2015).
Is the sampling method appropriate?

Nursing Assignment 5
However, the study doesn’t specify the sampling method except for the recruitment method
of the sample. This is likely to be a source of selection bias (Pannucci and Wilkins, 2010).
Were the participants suitable for informing research?
Yes, the participants were suitable for informing the research because only female nursing
practitioners (NP) who founded the role in the 1960s and 70s and were still in practice during
the study were included in the sample.
Were the participants fully informed about the nature of the research?
No, the participants were only informed of the nature of the research through flyers which
may not provide adequate information. This is likely to affect the sample size (Kho et al.,
2009) because most of the potential subjects may be reluctant to be involved in a study which
they are not fully aware of its objectives.
Was the autonomy/confidentiality of the participants guaranteed?
No, the study doesn’t expressly indicate whether the participants’ confidentiality was
guaranteed.
Were the participants protected from harm?
Yes, it can be assumed that the subjects were protected from harm because the report was
approved by the institution’s human subjects committee. Fabsitz et al. (2010) opines that
adequate and clearly understood information should be provided to the potential subjects of
the study to enable them to make decisions regarding their voluntary participation.
Are the data collection strategies described?

Nursing Assignment 6
Yes, data collection strategies have been identified and followed in the study, and these
include recruitment methods (use of flyers) and data collection methods (focus groups and
interviews).
Are the strategies used to analyse data fully described?
Yes, these include multiple steps of open coding, theoretical integration, and selective coding.
Did the researcher follow the steps of the data analysis method identified?
Yes, the results section indicates the summary of the findings which have been coded under
different themes and the selected quotations of the participants provided.
Was data saturation achieved?
Yes, data saturation has also been achieved in the study through the use of multiple data
collection methods (Fusch and Ness, 2015). For instance, the interviews were used to collect
data from the participants who could not make it for focus groups whereas the latter was also
used to obtain in-depth data for those that made it to the university (Brown and Draye, 2003).
Does the researcher discuss how rigour was assured?
Yes, the rigor of the study has been discussed in details. The use of both interviews and focus
groups increased the rigor of the research because they maximized the sample size and
quantity of data collected (Billups, 2014). Data collection and analysis was founded on
grounded theory methods which ensured that data collection methods like interviews and
focus groups were most appropriate.
Were credibility, dependability, transferability, and goodness discussed?
Yes, credibility, dependability, transferability, and goodness was discussed through the use of
non-participants NP pioneers to review the study, member checks, reflexive journals,

Nursing Assignment 7
extended engagement with the data and constant observations (Carcary, 2009). Moreover, the
dependability of the study was also achieved by having the NPs who were not involved in the
research to review and critique the theoretical process (Leung, 2015).
Are the findings presented appropriately?
Yes, the findings have appropriately been presented under different themes and sub-themes.
Additionally, some direct quotations of specific respondents have been provided. According
to the Leung (2015), the inclusion of direct quotes of participants is appropriate in qualitative
research because it improves the strength and validity of the outcomes.
Has the report been placed in the context of what was already known of the
phenomenon?
Yes, the study findings have been presented in the context of the currently known
phenomenon because they are compared with previous work.
Has the original purpose of the study been adequately addressed?
Yes, the initial objective of the study has been addressed adequately because experiences of
NP pioneers in their work setting and professional lives have been explored and presented
under six themes and several sub-themes (Brown and Draye, 2003).
Are the importance and implications of the findings identified?
Yes, the authors have also identified the importance and implication of the research. A proper
understanding of the detailed experiences of other advanced practice roles is crucial as it
provides more information on the independence of the profession. The findings of the study
are also relevant to the nursing profession in other countries developing advanced NP roles.
Are recommendations made to suggest how the research findings can be developed?

Nursing Assignment 8
Yes, the authors also make recommendations on how the study findings can be improved
further. They recommend an analysis of the corporate variables that foster or hinder NP
independence in the practice setting (Brown and Draye, 2003).
Were all the books, journals and other media alluded to in the study accurately
referenced?
Yes, the study used the APA referencing style, and all the references have been accurately
referenced. Feinstein (2008) noted that accurate referencing not only strengthens the
credibility of the author but also of the study. Moreover, correct referencing is essential in
research because it enables the reader to explore in more details specific concepts cited in the
study.

Nursing Assignment 9
References
Billups, F., 2014. The quest for rigor in qualitative studies: Strategies for institutional
researchers. The NERA Researcher, 52(1), pp.1-5.
Brown, M.A. and Draye, M.A., 2003. Experiences of pioneer nurse practitioners in
establishing advanced practice roles. Journal of Nursing Scholarship, 35(4), pp.391-397.#
Carcary, M., 2009. The Research Audit Trial--Enhancing Trustworthiness in Qualitative
Inquiry. Electronic Journal of Business Research Methods, 7(1).
Charmaz, K. and Belgrave, L., 2012. Qualitative interviewing and grounded theory
analysis. The SAGE handbook of interview research: The complexity of the craft, 2, pp.347-
365.
Duffield, C., Gardner, G., Chang, A.M. and Catling-Paull, C., 2009. Advanced nursing
practice: a global perspective. Collegian, 16(2), pp.55-62.
Fabsitz, R.R., McGuire, A., Sharp, R.R., Puggal, M., Beskow, L.M., Biesecker, L.G.,
Bookman, E., Burke, W., Burchard, E.G., Church, G. and Clayton, E.W., 2010. Ethical and
practical guidelines for reporting genetic research results to study participants: updated
guidelines from a National Heart, Lung, and Blood Institute working group. Circulation:
Genomic and Precision Medicine, 3(6), pp.574-580.
Feinstein, J., 2008. The Importance of Accurate References in Journals. Editors'
Bulletin, 4(3), pp.100-102.
Fusch, P.I. and Ness, L.R., 2015. Are we there yet? Data saturation in qualitative
research. The qualitative report, 20(9), pp.1408-1416.

Nursing Assignment 10
Gale, N.K., Heath, G., Cameron, E., Rashid, S. and Redwood, S., 2013. Using the framework
method for the analysis of qualitative data in multi-disciplinary health research. BMC
medical research methodology, 13(1), p.117.
Hart, C., 2018. Doing a Literature Review: Releasing the Research Imagination. Sage.
Kho, M.E., Duffett, M., Willison, D.J., Cook, D.J. and Brouwers, M.C., 2009. Written
informed consent and selection bias in observational studies using medical records:
systematic review. Bmj, 338, p.b866.
Leung, L., 2015. Validity, reliability, and generalizability in qualitative research. Journal of
family medicine and primary care, 4(3), p.324.
Noble, H. and Smith, J., 2015. Issues of validity and reliability in qualitative
research. Evidence-Based Nursing, pp.ebnurs-2015.
O’brien, B.C., Harris, I.B., Beckman, T.J., Reed, D.A. and Cook, D.A., 2014. Standards for
reporting qualitative research: a synthesis of recommendations. Academic Medicine, 89(9),
pp.1245-1251.
Pannucci, C.J. and Wilkins, E.G., 2010. Identifying and avoiding bias in research. Plastic
and reconstructive surgery, 126(2), p.619.
Ritchie, J., Lewis, J., Nicholls, C.M. and Ormston, R. eds., 2013. Qualitative research
practice: A guide for social science students and researchers. sage.
Vaismoradi, M., Turunen, H. and Bondas, T., 2013. Content analysis and thematic analysis:
Implications for conducting a qualitative descriptive study. Nursing & health sciences, 15(3),
pp.398-405.

Nursing Assignment 11
Weitz, T.A., Taylor, D., Desai, S., Upadhyay, U.D., Waldman, J., Battistelli, M.F. and Drey,
E.A., 2013. Safety of aspiration abortion performed by nurse practitioners, certified nurse
midwives, and physician assistants under a California legal waiver. American journal of
public health, 103(3), pp.454-461.