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Book review: A Theoretical Framework for Clinical Specialist Nursing: An example from diabetes

For many years the role of the clinical nurse specialist (CNS) has been defined, debated and redefined. This publication gives an in-depth analysis of the multi-faceted role and provides a theoretical framework to underpin all aspects of it.

The author investigates the historical background of the CNS role – which has its routes in North America over 70 years ago – and its subsequent emergence in the UK in the 1970s. The historical background is very interesting but the book also provides a contemporary treatment of the subject. For instance, discrepancies in academic attainment are discussed in detail with reference to the Knowledge and Skills Framework and Agenda for Change, as well as the education framework required to allow accreditation.

There is a thorough literature search that is enhanced by including results from several new studies, which involved over 50% of the nurse specialists working in diabetes care in the UK. These provide useful data regarding the concept of the role, the skills required and the many factors influencing role development and performance.

How the book unfolds
The first chapter of the book emphasises the need for clarification of the role and standardisation of academic achievement. The subsequent chapters seek not only to provide a theoretical framework but also to clarify the role’s definition so that it can be more successfully implemented in the future. These chapters follow a similar format to the academic model; they are underpinned by the theoretical framework of Hamric and Taylor (1989) and are thus interconnected.

Through a detailed debate of Hamric and Taylor’s framework, a thorough exploration of concepts is undertaken, looking at personal characteristics, role expectations and the stresses, strains and conflicts that emerge and impact upon role performance. Qualifications, skills and personal characteristics are carefully covered, as are the current academic attainments of the respondents from the new studies.

A detailed description of the development of the methods used to study the CNS role provides future researchers with useful guidance in selecting and applying methods appropriate to their research. This exploration continues by looking at the work and organisational factors involved, as well as the strengths and limitations of the instrument used for the studies.

The final chapter builds on this experience in the UK with a feasibility study of the implementation of the specialist nurse role in diabetes in the Greek healthcare system and this exemplifies the quality of the work undertaken by the author. Her deep understanding of the theoretical framework provided much insight into how such a new role could be established.

The work ends with some extremely useful appendices with examples of the questionnaires used throughout the studies.

Conclusion
The work is well set out with clear results and analysis and some interesting figures covering the inter-relationships in the CNS role. It is argued that a combination of clinical experience and advanced education is as important as a high level of characteristics and skills and that the CNS role requires certain personal attributes and competences. In addition, the author contends that there is a unique interaction and support required with administration, peers and other healthcare professionals.

Although the book is primarily intended for CNSs, it has a wide application not only for other advanced nurse practitioners but also for administrators, educators and students of all levels in preparation for specialist nursing and in support of those already in post. This excellent publication is an outstanding piece of academic work and extremely timely in the light of the many areas of change in primary and secondary care which face the profession at present.

A Theoretical Framework for Clinical Specialist Nursing: An example from diabetes
Author: Sofia Llahana
Publisher: Fivepin, Salisbury, Wiltshire
ISBN: 1903877369
Price: £17.95 (incl VAT)

For many years the role of the clinical nurse specialist (CNS) has been defined, debated and redefined. This publication gives an in-depth analysis of the multi-faceted role and provides a theoretical framework to underpin all aspects of it.

The author investigates the historical background of the CNS role – which has its routes in North America over 70 years ago – and its subsequent emergence in the UK in the 1970s. The historical background is very interesting but the book also provides a contemporary treatment of the subject. For instance, discrepancies in academic attainment are discussed in detail with reference to the Knowledge and Skills Framework and Agenda for Change, as well as the education framework required to allow accreditation.

There is a thorough literature search that is enhanced by including results from several new studies, which involved over 50% of the nurse specialists working in diabetes care in the UK. These provide useful data regarding the concept of the role, the skills required and the many factors influencing role development and performance.

How the book unfolds
The first chapter of the book emphasises the need for clarification of the role and standardisation of academic achievement. The subsequent chapters seek not only to provide a theoretical framework but also to clarify the role’s definition so that it can be more successfully implemented in the future. These chapters follow a similar format to the academic model; they are underpinned by the theoretical framework of Hamric and Taylor (1989) and are thus interconnected.

Through a detailed debate of Hamric and Taylor’s framework, a thorough exploration of concepts is undertaken, looking at personal characteristics, role expectations and the stresses, strains and conflicts that emerge and impact upon role performance. Qualifications, skills and personal characteristics are carefully covered, as are the current academic attainments of the respondents from the new studies.

A detailed description of the development of the methods used to study the CNS role provides future researchers with useful guidance in selecting and applying methods appropriate to their research. This exploration continues by looking at the work and organisational factors involved, as well as the strengths and limitations of the instrument used for the studies.

The final chapter builds on this experience in the UK with a feasibility study of the implementation of the specialist nurse role in diabetes in the Greek healthcare system and this exemplifies the quality of the work undertaken by the author. Her deep understanding of the theoretical framework provided much insight into how such a new role could be established.

The work ends with some extremely useful appendices with examples of the questionnaires used throughout the studies.

Conclusion
The work is well set out with clear results and analysis and some interesting figures covering the inter-relationships in the CNS role. It is argued that a combination of clinical experience and advanced education is as important as a high level of characteristics and skills and that the CNS role requires certain personal attributes and competences. In addition, the author contends that there is a unique interaction and support required with administration, peers and other healthcare professionals.

Although the book is primarily intended for CNSs, it has a wide application not only for other advanced nurse practitioners but also for administrators, educators and students of all levels in preparation for specialist nursing and in support of those already in post. This excellent publication is an outstanding piece of academic work and extremely timely in the light of the many areas of change in primary and secondary care which face the profession at present.

A Theoretical Framework for Clinical Specialist Nursing: An example from diabetes
Author: Sofia Llahana
Publisher: Fivepin, Salisbury, Wiltshire
ISBN: 1903877369
Price: £17.95 (incl VAT)

Hamric A, Taylor J (1989) Role Development of the CNS. In: A Hamric, J Spross, eds. The Clinical Nurse Specialist in Theory and Practice. Saunders, Philadelphia, PA

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