Confusion prevails in defining 'advanced' nursing practice

The Australian nursing profession has accepted the challenge to support and encourage advanced nursing practice role development. A critical review of national and international literature highlights that there is no singular definition or understanding of 'advanced' nursing practice. Instead difficulty with nomenclature and clarification of levels of nursing are perpetuated by unclear distinction between 'advanced', 'specialist' and 'expert' nursing practice. This paper presents the findings of a review of the literature and posits that ambiguity and lack of consistency in defining 'advanced' nursing practice is hampering the progression of the profession towards the development of consistent advanced practice roles in Australia. It is proposed that a universally accepted definition would provide a vehicle for future Australian role development so that all advanced practice roles have a common genesis and national consistency results.     

A critical engagement with the concept of advancing nursing practice

AIM: This paper aims to elucidate the concept of advancing nursing practice by engaging critically with developments in policy in the UK and ongoing debates in the international literature. BACKGROUND: Advancing practice to the outer edges of nursing's scope of practice is a challenge for the profession both in the UK and elsewhere. However, defining what advancing nursing practice is and what it might become remains problematic. EVALUATION: Critical analysis of published papers and policy documents pertaining to the concept of advancing nursing practice. KEY ISSUE: Advancing nursing practice as a concept offers enormous potential for nurses and has been the subject of numerous debates over the last 25 years. Previous history of advanced practice offers no imperative practice and informs us little about the future roles of advanced nurse practitioners. CONCLUSION: Current understanding about the role of advanced nurse practitioner and the nature of advanced practice remains unclear. Measuring the impact and outcome of the complex advanced practice nursing roles remains a challenge. IMPLICATIONS FOR NURSING MANAGEMENT: While it is difficult to articulate succinctly what constitutes advancing nursing practice, defining the activities nurses engage in, the skills and competencies involved and the qualities and attributes required help reduce the ambiguities of the role.     

Creating a framework for clinical nursing practice to advance in the West Midlands region

The West Midlands Regional Health Authority identified a lack of opportuni-ties for nurses to develop advanced clinical practice through a recognized pro-gramme at Postgraduate diploma/ Masters degree level. Education for clinical practice must be equally grounded in theory and practice. Advanced clinical practice requires more than just skills acquisition, it has a much wider remit incorporating elements of clinical expertise and higher level decision making, research awareness, teaching and role modelling, informing policy making and leading in the provision of patient care within individual Trusts. This initiative has encouraged universities, trusts and provider units to work together to identify and prepare students and staff for their changes in role, and to review existing boundaries for practice which will enable new approaches to team work and the provision of holistic patient care.     

Exploring new advanced practice roles in community nursing: a critique

Attempts to 'modernize' the English National Health Service (NHS) have included significant workforce re-design, including the development of new, advanced roles in nursing. There is a wealth of evidence documenting and evaluating such roles in hospital and, to a lesser extent, in community settings. This paper builds on this work, drawing on recent post structural and sociological analyzes to theorize these roles, locating them within broader social and cultural changes taking place in healthcare and exploring how understandings of new roles in community nursing are in the process of being constructed. Building on a literature review, the paper draws out what an analysis of new advanced nursing roles in the community reveals about competing conceptualizations of the nursing mandate, the ambivalence and ambiguity that practitioners experience in shaping 'new' identities (the shaping of subjectivities), and the often implicit ideological positions that underpin such developments.     

The development of a conceptual framework for advancing cancer nursing practice in Europe

Continued professional development through formal education programmes is essential for improving the quality of care provided to patients with cancer. This paper describes a European Oncology Nursing Society project concerned with advanced cancer nursing education. While the development of an education programme for advanced cancer nursing practice in Europe proves difficult at this time, this project has provided the opportunity to examine some of the key elements of advanced cancer nursing work. In turn, the information gained has enabled the development of a conceptual framework for advancing cancer nursing practice in Europe to be constructed.     

Advanced practice nursing roles: development, implementation and evaluation

AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals.     

我院专科护理管理体系的建立与实践

目的 探索专科护理管理体系的建立与实践的方法与效果.方法 建立健全组织体系,加强专业护士培训,制订科学流程,完善质量控制体系、持续改进护理方法、执行会诊制度等.结果 提高了护理质量合格率和病人满意度,护理不良事件发生率降低,重点护理技术开展增多,差异均具有统计学意义(P<0.01或P<0.05).结论 专科护理管...     

护理硕士专业学位研究生临床实践培养的研究进展

临床实践在护理硕士专业学位研究生的培养过程中占据重要地位,文章对目前国外护理硕士专业学位研究生临床实践培养的目标、实践时间、内容及场所、教学方法、考核方式等进行阐述及分析,探讨目前我国护理硕士专业学位研究生临床实践培养中亟待解决的问题,为护理硕士专业学位研究生临床实践培养提供参考.     

Profile of advanced nursing practice in Spain: A cross‐sectional study

In this study, we described the profile of advanced nursing practice in Spain. A cross‐sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence‐based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study.     

护理硕士专业学位研究生临床实践的现状与进展

临床实践是培养护理硕士专业学位研究生的重要环节,本文通过分析比较国内外专业型护理硕士的临床实践模式特点,发现我国护理硕士专业学位研究生临床实践培养中存在的问题,旨在为构建并完善我国护理硕士专业学位研究生临床实践模式提供依据.     

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.     

临床护理专家研究者角色分析及建议

临床护理专家（CNS）承担了多种角色,现就CNS作为研究者的发展历史、实践范围以及面临的挑战和问题进行综述,并结合我国目前的护理研究现状对我国CNS开展护理研究提出建议。     

New nursing roles: the experience of Scotland's consultant nurse/midwives

AIM: To describe career pathways of consultant nurses/midwives and identify postholders views on key factors in role initiation, development and progression to inform future development and appointment of nurse/midwife consultants in National Health Service Scotland. BACKGROUND: Nurse/midwife consultants represent the highest levels of clinical practice. Given the Scottish Executive Health Department's aim to treble numbers conditions and circumstances that enable them to flourish must be identified. METHOD: A postal survey was undertaken of all nurse/midwife consultants in post (n = 16). RESULTS: Key themes emerged around factors that consultant nurse/midwives considered important including mentorship, autonomy and clinical credibility. Barriers to role delivery included lack of understanding of roles and the wide scope of some posts. Considerable variation in support, conditions of service and line management arrangements was found. CONCLUSIONS: Development of a recognized career pathway and a consistent approach to employment and support of postholders is recommended.