Education for advanced nursing practice: an evolving framework

This paper presents and critiques a framework for advanced health care practice. The framework is a set of professional attributes which underpin the delivery of an inter-disciplinary postgraduate course in the United Kingdom (UK). It enables students to review and develop knowledge and skills required to lead and advance nursing and health care practice. The framework is reviewed in relation to UK policy discussion on advanced or higher levels of practice. Brief comparisons are made with international concepts and literature on advanced nursing practice. The potential contribution of this framework to nursing practice and education is discussed. In particular, the framework provides a degree of clarity and coherence in specifying the nature and scope of advanced and higher level practice in the UK.     

Advanced practice nursing: A principle-based concept analysis

Purpose: To analyze and clarify the conceptual basis of advanced practice nursing to determine the state of the knowledge from the perspective of four overarching principles derived from the philosophy of science: epistemological, pragmatic, linguistic, and logical.
Data sources: Written discourse regarding advanced practice nursing from refereed journals published between 2000 and 2007.
Conclusions: Conceptualization of a core definition of advanced practice nursing will enhance external legitimacy and recognition; understanding advanced practice nurse (APN) roles, sub-roles, and competencies will enhance internal cohesion. The outcome of this concept analysis is a greater understanding of the conceptual basis of advanced practice nursing and a current best estimate of the probable truth surrounding advanced practice nursing.
Implications for practice: A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions.     

A framework for the introduction and evaluation of advanced practice nursing roles

AIM: This paper describes a participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA framework). BACKGROUND: Despite the growing demand for advanced practice nurses, there are limited data to guide the successful implementation and optimal utilization of these roles. The participatory, evidence-based, patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing (PEPPA) framework is an adaptation of two existing frameworks and is designed to overcome role implementation barriers through knowledge and understanding of APN roles and environments. The principles of participatory action research directed the construction of the new framework. CONCLUSIONS: The process for implementing and evaluating APN roles is as complex and dynamic as the roles themselves. The PEPPA framework is shaped by the underlying principles and values consistent with APN, namely, a focus on addressing patient health needs through the delivery of coordinated care and collaborative relationships among health care providers and systems. Engaging environmental stakeholders as participants in the process provides opportunity to identify the need and shared goals for a clearly defined APN role. The process promotes increased understanding of APN roles and optimal use of the broad range of APN knowledge, skills, and expertise in all role domains and scope of practice. The steps for planning and implementation are designed to create environments to support APN role development and long-term integration within health care systems. The goal-directed and outcome-based process also provides the basis for prospective ongoing evaluation and improvement of both the role and delivery of health care services.     

The emerging role of advanced nursing practice in acute pain management throughout Canada

The purpose of this study was to describe the role qualifications and responsibilities related to advanced nursing practice in acute pain management across Canada. The Canadian Nurses Association national framework on advanced nursing practice was used as a guide to identify role components for nurses within this specialty. A self-administered questionnaire of fixed choice and open-ended questions was mailed to nurses in acute pain management throughout Canada. Respondents identified their primary role responsibilities as clinical, educational, and administrative. Role challenges included lack of administrative/colleague support, complexity of pain problems, role definition, and acceptance. Key areas of positive outcomes involved the patient as well as interdisciplinary and nursing teams. Nurses described the ability to provide continuity of care, patient and staff education, and leadership in pain management as important and rewarding. The role of advanced nursing practice in acute pain management throughout Canada is evolving. The affect of this role promises to enhance the quality of pain management for healthcare professionals and their patients.     

A conceptual framework for advanced practice: an action research project operationalizing an advanced practitioner/consultant nurse role

• ? A preliminary conceptual framework for an advanced practice/consultant nurse role is presented which links the role to its context and outcomes.
• ? The conceptual framework was developed in the process of analysing data from a 3-year action research study involving the operationalization of an advanced practice/consultant nurse role in a Nursing Development Unit.
• ? The skills and knowledge base of consultancy, underpinned by a strong nursing foundation, augmented by strong leadership and combined with the educator and researcher functions, are presented as the attributes of the advanced practitioner/consultant nurse.
• ? The facilitation of a transformational culture is highlighted as central to the skills and processes used within the role.
• ? Implications for the preparation and accreditation of the advanced practitioner/ consultant nurse are highlighted.

     

Strategic directions and actions for advanced practice nursing in China

There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs) improve health care and outcomes. The China Medical Board (CMB) China Nursing Network (CCNN) began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities. This paper presents the discussion, recommendations and action plans developed at the inaugural planning meeting on June 26, 2015 at Fudan University in Shanghai. The recommendations are: Develop standards for advanced nursing practice; Develop Master's level curricula based on the standards; Commence pilot projects across a number of University affiliated hospitals; and Prepare clinical tutors and faculty. The strategic directions and actions are: Develop a clinical career ladder system; Expand the nursing role from hospital to community; and Build a specialty nurse accreditation system.     

Delineating advanced practice nursing in New Zealand: a national survey

Background

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning.

Aims

To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles.

Method

Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons.

Results

Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership.

Conclusions

Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles.

Implications for nursing policy

By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development.     

Sustained impact of an academic-practice partnership

Academic-practice partnerships foster innovation and transition to nursing practice in healthcare systems. The purpose of this paper is to describe the impact of a public-private academic-practice partnership for Doctor of Nursing Practice (DNP) education designed to transform a large healthcare system's nursing workforce and model of care. The conceptual framework is organized around Rogers's (2003) principles of diffusion of innovation in organizations. A logic model illuminates how inputs, activities, outputs and outcomes resulted in sustained impact for graduates, the college and the healthcare organization. Partnership outcomes include education of baccalaureate and master's-prepared employed nurses (n = 95) in a DNP program for advanced practice nursing (APN) roles in the healthcare system; dissemination of scholarship; and revision of the healthcare system's research approval process. Sustained impact includes advancement of DNP-prepared graduates to complex leadership and practice roles; development of new programs and advanced practice roles based on scholarly project findings; expansion of population-specific patient programs; and extension of continuum- and access-to-care models in the healthcare organization. Recommendations include continuing development of academic-practice partnerships for transition to practice and advancement of roles and levels of champions to achieve sustained impact of academic-practice partnerships in healthcare organizations.     

Dancing to our own tune: understandings of advanced nursing practice in British Columbia

There has been ongoing confusion about the meaning of advanced nursing practice (ANP) and the nature of ANP roles in Canada and elsewhere. A broad range of roles and titles have been adopted throughout Canada in an attempt to delineate specialized and/or advanced roles within nursing. One key objective in a recent three-phase study of ANP in British Columbia was to clarify the role and understanding of advanced nursing practice and related roles within the larger healthcare system. Our intent in this paper is to describe the understandings of ANP that emerged in Phase I of this recent study and to compare registered nurses' understandings of ANP to the characteristics and competencies identified by the Canadian Nurses Association (2002) framework. (Note: The term "nurse," as used in this paper, refers to "registered nurse.") We conclude by identifying future directions for development of advanced practice roles.     

A genetics course for advanced clinical nursing practice

PURPOSE: To describe a genetics course for advanced clinical nursing practice. BACKGROUND: The Human Genome Project is yielding new discoveries in genetics. The sheer volume of new information threatens to overwhelm healthcare providers as they must find ways to interpret and use these discoveries. DESCRIPTION OF PROJECT: The course was developed in recognition of the fact that graduate nursing students in advanced practice programs need to understand and apply genetic information in the care of their patients. The course builds on core competencies identified by the National Coalition for Health Professional Education in Genetics and the International Society of Nurses in Genetics. OUTCOMES: Students demonstrate that they can access, evaluate, and synthesize current information on a genetic condition and develop a comprehensive plan of care for patients with the selected condition. INTERPRETATION/CONCLUSION: Students learn basic and applied genetic concepts and skills. They are able to utilize resources appropriately to identify patient care needs and develop strategies for meeting those needs. IMPLICATIONS FOR NURSING PRACTICE: The need to remain current in understanding emerging technologies and genetic information will continue to grow as scientific discoveries are made that affect greater numbers of the public. Nurses in advanced practice are in a position to support patients and their families as they deal with the significance of these discoveries for their current and future health.     

Advanced nursing practice: policy, education and role development

Aims and objectives. 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. Background. 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. Conclusion. 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. Relevance to clinical practice. 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.     

Achieving maximal utilization of an advanced practice council.

In the James A. Haley Veterans' Hospital, it became increasingly apparent to those in advanced practice roles that a forum was needed to provide a supportive milieu in which nursing staff in expanded and advanced practice roles could come together and discuss the clinical needs of patients and nursing practice issues. Using a dynamic theoretical framework based upon the identification of need for such a forum, an Advanced Practice Council was established to: (1) enhance an understanding of the advanced practice role; (2) promote consultation, support, and networking among Council members; (3) facilitate and refine communication systems; (4) share new ideas; (5) collaborate for research; (6) contrast methods of practice; and (7) increase consultation services. The current activities of this group focus around role clarification and utilization. Peer review of advanced practice roles, for example, has been explored by the council and is in the stages of implementation. Future activities include examining the effects of expanded roles on staff practice and patient care, expanding standards of clinical nursing practice, and facilitating the autonomy of nursing practice through a privileging process.     

Review of advanced nursing practice: the international literature and developing the generic features

Aim. The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its’ generic features. Background. This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. Methods. An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re‐read and indexed as to develop seven thematic units that formed the generic features of the ANP. Findings. The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision‐making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. Conclusion. Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. Relevance to clinical practice. Clarifying the confusion surrounding advanced nursing practice and gaining an in‐depth understanding of its’ generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.     

The advanced practice nurse in gastroenterology serving as patient educator.

The role of the advanced practice nurse is evolving in the specialty of gastroenterology, requiring flexibility and an openness to change on the part of the practitioner. The gastroenterology advanced practice nurse performs history and physical assessments, orders diagnostic studies, determines medical and nursing diagnoses, prescribes and evaluates pharmacologic and other therapeutic regimens, manages followup care, and evaluates patient outcomes. The advance practice nurse also provides patient, family, and group education and screening programs. Collaboration with other healthcare professionals; serving as a mentor and as a consultant; participating in continuing education, research and quality management; and providing professional leadership underscore the professional aspects of advance practice nurse activities. The focus of this article is the educational role of the advanced practice nurse. The body of knowledge applicable to the educational role is discussed, in addition to contributory professional activities.     

Developing the scope of practice and education for advanced practice nurses in Finland

Background:  The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals.
Aim:  To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care.
Methods:  The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46).
Findings:  The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development.
Conclusions:  The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.     

Director of nursing and midwifery leadership: informed through the lens of critical social science

solman a . (2010) Journal of Nursing Management 18, 472–476
Director of nursing and midwifery leadership: informed through the lens of critical social science Aims Highlight the use of critical social science theories, practice development principles and a situational leadership framework within transformational leadership to inform Directors of Nursing and Midwifery (DoNM) practices as leaders. Background Healthcare is constantly changing, unpredictable, strives for quality service and cost containment, which can result in stress and crisis for healthcare workers. DoNM leadership is critical to supporting and leading staff through these complex times within healthcare. Key issues Understanding theories, frameworks and their application to real-world practice can assist in supporting individuals and teams to navigate through the changing healthcare environment. Conclusion Blending critical social science theories with practice development principles and the situational leadership framework can assist the DoNM to enact transformational leadership to support the development of individuals and teams to meet the complex healthcare needs of patients within the clinical setting. Implications for nurse management This article contributes through the practical application of critical social science theories, practice development principles and situational leadership framework within transformational leadership as an approach for enacting DoNM leadership. To further understand and develop in the role of the contemporary DoNM in leadership, these directors are encouraged to publish their work.     

A transdisciplinary approach to developing a web-based nursing experiential log system for advanced practice nursing clinical experiences

This article describes a transdisciplinary project between the computer information systems department and the graduate nursing department of a higher education institution. The project is the planning, development, and implementation of a Web-based nursing experiential log system for advanced practice nursing clinical experiences, which was funded by a Nursing Education Practice and Retention grant from the Health Resources and Services Administration. The article explains the concept and benefits of the transdisciplinary nature of the project. The design team, project leadership, and roles within the team are reviewed, including the role of end-user faculty in the design process. The article describes the focus and scope of the Web-based experiential log system database that is used to document and track advanced practice nursing student clinical experiences, as well as a summary of the design process used to develop the log system and the specific functionality of the database system. The implementation process, including end-user training, pilot implementation, and modifications, lessons learned, and future directions of the project are addressed. The article concludes with the benefits to the clinical experience and graduate nursing program that have been noted since the implementation of the system.     

Reflections on leadership in advanced and consultant radiographic practice within the UK

IntroductionThis Educational Perspective provides an overview of how leadership fits into advanced and consultant radiographic roles within the UK setting. It draws on research in the area as well as reviewing some of the wider healthcare literature beyond the medical radiation sciences. The reflections outlined suggest how leadership at these levels may look and differ in practice.DiscussionLeadership should be seen as fundamental to practice and not necessarily a discreet element to either role, but one that supports all other areas. The proportion of the role that leadership takes up, along with the degree of influence, increases from advanced to consultant practice. Consideration over conflict with management and leadership within roles is also important. Ultimately leadership is about relationships with people, for which interpersonal skills are required, along with establishing networks, supported by training and development to maximise effectiveness.ConclusionA clearer understanding of leadership is needed to help conceptualise and measure its impact at advanced and consultant levels of practice. The content is intended to provide an opportunity for reflection and discussion around the topic, serving as a development tool in practice.