Understanding the role of the advanced paediatric nurse practitioner from the perspectives of service users and service providers within NHS Scotland: a Gadamerian hermeneutic approach.

Introduction:The Scottish Government prioritises improving capacity and capability in child health(Scottish Government, 2006; 2008; 2017) and aims to develop a skilled workforce capable ofadapting to changing health and social care needs (Scottish Government, 2010). Advancedpaediatric nurse practitioners (APNPs) are central to the Scottish Government's (2017)strategy to address the evolving health and care demands of children, young people, and theirfamilies in Scotland.Aim of study: This research aims to develop an understanding and meaning of the APNP rolefrom a whole Systems perspective of service providers and service users.Method: Using a Gadamerian philosophical hermeneutic (Gadamer, 2012) lens, a purposefulsample of 8 APNPs, 8 ‘others’, members of the multidisciplinary team who work alongsideAPNPs, and 5 parents participated in conversational interviews with the researcher abouttheir experience, understanding and meaning of the advanced paediatric nurse practitionerrole (n = 21 conversations) in NHS Scotland. The research process was guided by using theresearch method of Fleming et al., (2003).Results: The findings from the conversations are presented in three chapters and constitutea hermeneutic narrative that represents emergent themes from each participant group. Theemergent themes for APNPS were Taking a chance, Professional Identity, Communication andFamily Centredness; For ’Others’ were Professional Identity, Bridging the gap, andInconsistency; And finally for Parents were Bridging the gap, Communication skills and ClinicalCompetence, and Caring Behaviour. A fusion of horizon chapter offers a critical discussion onthese emergent themes within the context of contemporary literature.Conclusion: This thesis makes a unique contribution to knowledge as the first study inScotland, and the wider UK, to explore the APNP role from these three perspectives: APNPs,‘others’ as professional colleagues, and parents. By integrating these voices, the researchdemonstrates that relational essence embodied in communication, empathy, and caringbehaviours is as vital as clinical competence in shaping new role development. The studyprovides narrative evidence from multiple stakeholders, offering a holistic understanding ofhow APNPs are perceived and legitimised in practice. Most significantly, it illuminates theparent perspective for the first time, revealing their appreciation of APNPs’ ability to bridgethe gap between nursing and medicine, their clinical expertise, and the caring behavioursrooted in prior nursing experience. These insights extend existing conceptualisations of theAPNP role and provide a foundation for supporting future workforce planning, education, andpolicy development in advanced paediatric nursing practice.