A Case Study of the Evolution of Ophthalmic Nurse Practitioner (as an instance of Advanced Practice Nursing) Roles in Palestine

This thesis investigated the evolution of the Ophthalmic Nurse Practitioner (ONP) role in Palestine. The study aimed to explore and explain how and why the ONP role developed and what were the contextual factors that both hindered and or facilitated this role development. It also aimed to explore the possibility of transferring similar roles to other health care settings in Palestine. A qualitative approach was used to answer the research questions based on the principles of constructivism with qualitative case study methodology to collect and analyze multiple sources of data. This qualitative research employed three data collection methods, a) focus group, b) individual interviews and c) reviewing and analyzing health care policy, historical and official documents. Advanced practice nursing roles development globally with emphasis on two countries (the USA and UK) was critical analyzed. This included rationale for role development in addition to contextual factors that facilitated and or hindered such development. Four themes emerged that explain why and how the ONP role developed as well as its impact. Three themes explained how and why ad hoc nursing roles developed in an accident and emergency setting. A conceptual framework was developed to guide the introduction of future roles within in the Palestinian health care system. The framework identifies the key conditions and pre-requisites for the potential introduction and development of APN in other health care settings in Palestine as well as factors which are able to frustrate and or facilitate such development. This study confirms the existing international body of knowledge that APN roles development is a complex phenomenon that is contextually based. The research provides operational information for the future introduction of APN roles in Palestine. This builds on previous work and takes debate in the field further to include countries with complex environmental and contextual settings. This contribution in itself provides the basis for further research to validate the proposed conceptual framework.