Community-Based Advanced Practice Nursing (APN): The Road to Vision 2020

Abstract

Malaysia is a heterogenous, multi-ethnic society with a population of 30 million, of which 74% reside in urban areas. Since gaining independence, the main priority of health policy makers is to provide and enhance the delivery of health care for the disadvantaged communities, namely the rural populations: women, children and the disabled. The Ministry of Health is the main healthcare provider in Malaysia. There has been much development in the healthcare system of Malaysia from the time of independence; starting from the development of the two-tier system and its subsequent transformation to a three-tier system, as well as the extension of healthcare delivery into rural areas in Sabah and Sarawak through the implementation of mobile teams and the Flying Doctor Service (FDS). The improvement in health status of the general population, particularly in rural settings is remarkable and in line with the Tenth Malaysian Plan on the road to Vision 2020. However, the current shift in disease burden from communicable to chronic non-communicable conditions continues to undermine these efforts. As a result, deficiencies in healthcare delivery and the health status of populations still exist, albeit more rampant in rural populations. We propose the implementation of Advanced Practice Nursing (APN) in the community as a solution to bridge gaps in health care provision in rural areas in line with Vision 2020. An advanced practice nurse is a specialty-specific registered nurse with an expert knowledge base and clinical competencies for extended practice. Modelled on Australian and Norwegian systems, advanced practice nurses are recruited directly from rural communities, with a better understanding of the population, and access to the local cultural norms, such as traditional healers. APN training is still in its infancy in many developing countries. Evidence from other similar models has proven that the care provided by specialised nurses results in higher patient satisfaction, greater access to health care, improved outcomes and cost effectiveness. APN compliment the care provided by physicians; reducing doctors’ workload, patient waiting times and providing care in the convenience of the patients’ homes. To succeed in improving health care outcomes by APN, the utilisation of evidence based practice, audits, guidelines, and escalation of specialist care at hospitals and continuous medical education are essential.