The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles. Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles. Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices. Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred. The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear.

Introduction This study qualitatively explores perceptions of women who have experienced abortion care. It explores women’s journey through abortion from confirmation of pregnancy to post-abortion. Aim The study seeks to understand the implications of these perceptions for policy and practice. Main Outcome Measures A qualitative study involving in-depth semi-structured interviews with 17 women, aged between 22 and 57 years, who had undergone legal induced abortion in the UK when they were 16 years or older. Participants were not recruited under the age of 16 because of the ethical and legal complexities of interviewing minors. Additionally, 16 years was deemed to be the most appropriate age as this is the legal age of consent in the UK. Methods Participants were recruited from 12 community contraception and sexual health clinics in two NHS trusts, one in England and one in Wales. Participant recruitment was set at a minimum of 12 and participants were recruited on a “first come first served basis” (i.e., the first 12 who contacted the researcher). The number of participants was raised to seventeen as this was the number deemed to be the most suitable for data saturation in this particular qualitative research. Results Women in this study understood abortion as highly taboo and a potentially personally stigmatizing event. These perceptions continued to affect disclosure to others, long after the abortion, and affected women’s perceptions of the response of others, including society in general, significant others, and health professionals. Conclusion Women’s experiences of abortion may be influenced by perceived negative social attitudes. Health professionals and abortion service providers might combat the perceived isolation of women undergoing abortion by attending not only to clinical/technical aspects of the procedure but also to women’s psychological/emotional sensitivities surrounding the event.

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Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future.

R . ( 2 0 0 1 ) Journal of Advanced Nursing 34(5), 629±638 The primary and secondary care interface: the educational needs of nursing staff for the provision of seamless care Aim. To identify nurses' perceived de®cits in the knowledge and skills required to provide effective seamless care, so that appropriate training could be provided. Background. A clear understanding of nursing staff roles, skills and resources is paramount to work at the primary/secondary care interface. Nursing staff require an educational model that will provide a clear understanding of how their roles coalesce with other healthcare professionals. There is little evidence that examines the educational needs of nurses related to changing care boundaries. Design/Methods. The study used methodological triangulation to explore these issues within current practice. Focus groups were used to generate items for inclusion in the questionnaire. Questionnaire design was based on an importanceperformance analysis. This procedure has been effective in developing health care marketing strategies. A strati®ed random sample of nursing staff (n 722) from the participating trusts received the questionnaire, eliciting a response rate of 172 (23á8%). Results. Factor analysis provided a list of seven training categories in order of training need priority: information technology, awareness of roles, communications within seamless care, working across boundaries, professional issues, practicerelated issues, delivery of patient/client care issues. There were no differences in nurses' training needs across NHS trusts. However, differences were highlighted for staff located in primary or secondary settings or working across the interface. Conclusions. Despite there being a vast range of training issues the majority of nurses appear to have a clear idea of their training needs for the provision of seamless care. A training programme required which targets the speci®c needs of nursing staff working at different positions across the primary/secondary care interface.