Development Of Advanced Nursing Practice Research Articles

Développement de la pratique infirmière avancée dans le système de santé du Bénin : une exploration contextuelle inspirée de l’Ethnonursing de Leininger et guidée par le modèle PEPPA

Introduction : La réforme du système de formation en sciences infirmières et obstétricales (SIO) au Bénin a permis de former des infirmiers de niveau maitrise académique dans le profil infirmière en pratique avancée (IPA). Cependant, malgré la reconnaissance de cette nouvelle formation sur le plan académique, le rôle de l’IPA dans le système de santé où ces infirmiers sont appelés à exercer dans une équipe multidisciplinaire au cœur d’une culture et de pratiques médicales et infirmières très diversifiées n’est pas encore clarifié. Objectifs : 1- Identifier les domaines d’intervention, les périmètres d’action, les rôles, les mandats et les activités possibles de l’IPA, ainsi que les facteurs favorables et défavorables au développement de la pratique infirmière avancée (PIA) dans le système de santé du Bénin; 2- Déterminer les éléments constitutifs d’un cadre formel et réglementaire d’exercice de la PIA au Bénin. Méthodes : Cette recherche qualitative basée sur la théorie de l’universalité et de la diversité des soins de Leininger (1991) s’appuiera sur le modèle PEPPA (Participatory, Evidence-Based, Patient-Focused Process for Advanced Practice Nursing) proposé par Bryant-Lukosius et Dicenso (2004) pour la séquence des étapes de développement, d’implantation et d’évaluation d’un nouveau rôle d’IPA. Des entrevues individuelles semi-dirigées et groupes focalisés auprès des infirmiers et sages-femmes de nationalité béninoise titulaires d’une maitrise en SIO seront réalisés. Des questionnaires auto-administrés et un recueil de textes permettront de collecter des données auprès du personnel de santé et des responsables des structures et services de soins cliniques. Discussion et retombées anticipées : Cette étude permettra d’identifier les balises qui soutiendront l’implantation du rôle de l’IPA dans le système de santé du Bénin, clarifiant ses domaines d’intervention, ses périmètres d’action, ses mandats et activités possibles, ainsi que le contexte nécessaire pour son implantation.

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

The past, present and future of advanced nursing practice

Kelly Swaby, Julie Reynolds and Gerri Mortimore explore the historical, professional and national developments that have influenced advanced nursing practice in England This article considers the past, present and future development of advanced nursing practice. It traces the historical, professional and national developments that have impacted on advanced nursing practice in England. Current influence and future opportunities and challenges are explored, providing a comprehensive overview of advanced nursing practice in England.

Role of the advanced practice nurse in the management of patients with coronary artery disease

Cardiovascular disease is the leading cause of death in the world and the second leading cause of death in France. Patients with coronary artery disease have a high risk of recurrence. Nevertheless, by acting on health determinants and secondary prevention, it is possible to reduce the risks. With the development of advanced nursing practice, a new professional with specific skills can take charge of and accompany people with this pathology. This player works in an interdisciplinary manner to provide holistic and optimal patient care.

Focused development of advanced practice nurse roles for specific patient groups in a Swiss university hospital

Background: To cover future health care needs of the population, new care models are necessary. The development of advanced nursing practice (ANP) offers the opportunity to meet these challenges with novel services. At the Inselspital, Bern University Hospital, ANP services and corresponding advanced practice nurse (APN) roles have been developed since 2011. Purpose: The aim is to develop innovative and evidence based ANP services to supplement health care for specific patient groups and their family members with the goal to improve safety and achieve better outcomes. Methods: Project-based ANP services are developed in close collaboration of clinical departments and the Nursing Development Unit (NDU) of the Directorate of Nursing. Structure, process and outcome data are collected for evaluation. Findings: Currently, five ANP services are established and running, eight more are in the developmental phase. Most services address the long term care of patients with chronic illnesses and their family members. Ten APNs work between 10 % and 80 %, three are leading an ANP-team. APNs work over 50 % in direct clinical practice, primarily in counselling. An ANP network connects APNs and NDU, promoting synergy and exchange. Conclusions: The available resources often constitute a challenge for the development of ANP services. Vital for the long-term success are an adequate extent of the position, the support by department directorate, the conceptual framework that is implemented across the whole hospital, and the development within project structures.

Different Places, Different Ideas: Reimagining Practice in American Psychiatric Nursing After World War II.

In 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

Different Places, Different Ideas: Reimagining Practice in American Psychiatric Nursing After World War II

AbstractIn 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.

To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. Case study. A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice.

What History can Teach us Today, Looking at the Development of Advanced Nursing Practice and Clinical Nurse Specialism

Clinical nurse specialism is an important and integral part of nursing in the 21st century but when did it start? Since the time of Florence Nightingale, nursing has grown and developed as a profession. Part of this growth, particularly in relation to professional development, has resulted in nurses focusing on, or specialising in, particular areas of nursing care and the development of clinical nurse specialism and advanced practice. The USA led the way in this field, followed closely by the UK and the rest of Europe, Australia and Asia. This has led to a proliferation of nurses working in specialised areas and advancing nursing practice.

Advanced or advancing nursing practice: what is the future direction for nursing?

Advanced nursing practice roles have emerged over the last 25 years in response to two major challenges: first, the significant reduction in available doctors; and, second, the rise in numbers of patients with complex health needs. It is suggested that, with a major drive to respond to the first problem, with its emphasis on the development of medical skills, the development of advanced nursing practice (which has the potential to have a significant impact on the second challenge of the rise in long-term conditions) has very much taken second place. Moreover, advanced nursing practice roles have become so medically focused that not only is advanced nursing practice not evident, but neither are the recognised sub-roles that are fundamental to advancing practice. These include innovation, education, research and clinical leadership. This article argues that in the current climate it is essential that advanced nurse practitioners not only demonstrate advanced practice, but also actively embrace the concept of 'advancing' nursing practice as the dominant feature of new roles.

The content of the work of clinical nurse specialists described by use of daily activity diaries

Evaluate the usefulness of the role of clinical nurse specialists and the content of their work by mapping their activities. The clinical work of advanced practice nursing differs in different countries, and a clear picture is lacking on what exactly advanced practice nurses do. Prospective exploratory study. The setting of the study was the largest hospital in Iceland where over half of the country's active nursing workforce are employed, including the only clinical nurse specialists. Of 19 clinical nurse specialists working at the hospital, 15 participated. Data were collected over seven days with a structured activity diary that lists 65 activities, classified into six roles and three domains. In 17 instances, the 'role activities' and 'domain activities' overlap and form 17 categories of practice. The clinical nurse specialists coded their activities at 15-minutes interval and could code up to four activities simultaneously. Daily, the clinical nurse specialists evaluated their clinical nurse specialist background. The roles that occupied the greatest proportion of the clinical nurse specialists' time were education, expert practice and 'other' activities, while the smallest proportions were in counselling, research and practice development. The domain they worked in most was the institutional domain, followed by the client/family domain and the clinical outcome management domain. All of the clinical nurse specialists reported working on two activities simultaneously, 11 of them on three activities and six on four activities. They self-assessed their background as clinical nurse specialists as being very useful. The activity diary is a useful tool for assessing the content of practice. Clinical nurse specialists spend too much time on activities related to the institution. Nurse managers are advised to provide clinical nurse specialists with ample time to develop the direct practice role in the client/family domain. The development of advanced nursing practice requires that clinical nurse specialists take an active and visible part in direct patient care.

The Doctor of Nursing Practice: A national workforce perspective

In 2004, the American Association of Colleges of Nursing (AACN) adopted a position statement concerning the future of advanced practice nursing education. A target date of 2015 was articulated as the point by which master’s preparation for advanced practice nurses would be replaced by doctoral level education. Seismic shifts in the realities surrounding nursing education and practice have occurred since the proposal to require a Doctor of Nursing Practice (DNP) degree for entry into advanced practice nursing was proposed. Unprecedented economic challenges have resulted in significant budget downturns for all sectors, including higher education. The consequent cutbacks, furloughs, and restructuring in educational operations of all types have placed enormous demands on faculty, staff, and students across the country. In addition, the growing incidence and earlier onset of chronic disease, a rapidly aging population, health care reform agendas, a shortage of primary care practitioners, and projected severe shortages of nursing faculty have raised fundamental questions about the capacity of nursing education to produce the numbers of advanced practice nurses needed. This article addresses the changing realities and growing concerns associated with the future of advanced practice nursing. Recommendations to ensure continuing development of advanced nursing practice that serves the interests and needs of the public now and in the future are presented within the context of a national workforce perspective.

Entwicklung der Rolle der Advanced Practice Nurse in der stationären Langzeitpflege älterer Menschen in der Schweiz

Due to the imminent demographic surge of older people, many suffering from multiple chronic diseases and age-related health problems, the demand for professional nursing care will increase massively over the coming decades. However, the demand for qualified nursing personnel in long-term healthcare is already outpacing the supply. Without a change of course, this can only lead to a crisis of quality. Experiences, e.g. from the U.S., have shown that masters-prepared Advanced Practice Nurses (APN) facilitate quality improvement in the long-term care of elderly people. With their focus on interdisciplinary collaboration and clinical results, they support the development of the institutions they work with and of gerontological nursing in general. This article describes the development of Advanced Nursing Practice in three gerontological long-term care facilities in Switzerland's German speaking region on the basis of practice development projects advancing the assessment and management of pain. APNs' defined competencies serve as a framework to evaluate the implementation of their roles: working in clinical leadership projects, they support interdisciplinary collaboration, focusing on direct clinical practice, the development of evidence-based nursing care, and the expert guidance of nurses. The role of APN in stationary long-term care in Switzerland has considerable potential for development.

The Development of Advanced Nursing Practice Globally

To examine the development of advanced nursing practice globally. Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data.A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Confirms the development of advanced practice in nursing is a global trend. APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.

Thinking and writing at Masters level: a reflective passage

This article identifies key characteristics of Masters level writing and the underpinning relationship of these characteristics to reflective thought. Classical models of reflective writing are reviewed and their focus on reflection as a progressive process is debated. A linear model of reflection is proposed and its application to reflective writing for Masters level assessments is examined. The classical authors tend to present reflection as a process in which the outcomes of reflection becomes deeper at advanced levels. While this is an appropriate application of the concept of reflection for the traditional academic essay, it might not always be so appropriate for other more applied aspects of thinking and writing particularly in the development of advanced nursing practice. A linear model of reflective writing which offers a more pragmatic perspective on reflection is developed.

Advanced nursing practice: policy, education and role development

This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Moving Towards Harmony: Exemplars of Advanced Nursing Practice for British Columbia

Moving Towards Harmony: Exemplars of Advanced Nursing Practice for British Columbia

Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

The development of advanced nursing practice: 2.

The first part of this article discussed the development of the advanced nursing practitioner role. In this article the author describes how she interpreted the role in an initiative at Evesham Community Hospital by integrating clinical practice, management, research and education elements into her nursing role.

The development of advanced nursing practice: 1.

The PREPP report became a reality in April 1995. This article, the first of two parts, analyses the role of the advanced nursing practitioner and outlines some of the changes in nursing that have led to the need to reorganise clinical practice.