Global Context on Advanced Practice for Nurses - Essay Example

Evidence for Advanced Practice Critical Review Student’s Name Institution of Affiliation Evidence for Advanced Practice Critical Review Introduction In the recent world, there have been numerous changes in the healthcare needs of individuals and those of the society. As a result, the health care sector is faced with numerous challenges that include increased costs, professionals’ shortages, highly aging population, the availability of new technologies, and increasing challenges to health care access. For the advanced practice nurses, the presented dynamic healthcare system results to opportunities and challenges. The challenges and opportunities facing advanced practice nurses are attributed the various factors influencing healthcare which include legislation, politics, global events, and insurance companies among others. In order to provide quality healthcare to patients, the demand is to encourage collaborative and innovative clinical practice for leaders in healthcare. Additionally, advanced practice nurses are expected to remain vigilant in their advocacy for legislation such that there is continued promotion of advanced practice nursing[Ham14]. In the presence of advanced practice, nurses manage to expand their expertise and knowledge base. This way, the advanced practice nurses manage to differentiate themselves from associate or baccalaureate degree nurses as well as other health professionals. More specifically, the nurses in advanced practice are expected to respond to such evolution using their position that requires them to meet the health needs of all citizens. The nurse in advanced practice nursing should respond to dynamic change through the establishment of nursing knowledge, contributing to sustainable and effective health system, and advancing the nursing profession. In order to deliver great outcomes, advanced practice nurses have to change their professional roles to reflect universal political and socio-economic trends and issues. Additionally, advanced practice nursing have to emphasis cost effectiveness and manage to promote interdisciplinary work. However, all countries cannot work under the same goals in advanced nursing. For the developing nations, much attention is in diseases arising from lifestyles like cardio-vascular disease while developing nations concentrate on the burden on diseases like tuberculosis and HIV/AIDS. The identification of such priorities is essential in guiding the syllabus for nurses and developing policies for national health institution[Adr]. In this section, advanced practice is evaluated in terms of the global context, conceptualization of advanced practice, and recommendation for advanced practice Global Context on Advanced Practice Global context of advanced practice nursing, there has been notable advances in the establishment of educational programs for preparing nurses for their direct roles in advanced nursing. The intention here is to optimize the contribution of nursing to healthcare by delivering to them advanced roles[Ham14]. For any person willing to partake advanced practice nursing, there are numerous available choices that are equally valuable. The choices available for nurses moving towards advanced practice are dependent upon the factor of the country in which they are intended to operate. Some of the available advanced practices are advanced practice registered nurse or APRN; Certified Nurse Anesthetists or CRNAs; certified nurse-midwives or CNMS; Clinical Nurse Specialists or CNSs and Certified Nurse Practitioners or CNPs[Adr]. Although these are different branches within the advanced practice nursing profession, they all share their focus on direct care to individual consumers of healthcare. Consequently, nursing experts view advanced practice nursing with regards to the domain in which they operate. Additionally, experts have to consider that advanced practice nurses are engaged in actions that go further than the fine submission of technological complex practice. The key competencies for education and practice scope in each of the countries or domains are defined by assorted professional associations. Advanced Practice Nursing Regulations in United States and Canada In the United States, the state laws and regulations have the responsibility of defining the licensure criteria for each designated nursing practice and the practice scope associated to each[Bar09]. These state laws guarantee consumer safety as they look into the alignment of education, licensure, accreditation, and certification. In addition to the state rules and regulation, each of the advanced practice role has its own established standards and competency requirement[Adr]. In Canada, the Canadian advanced practice nursing has two distinct practice roles that are the clinical nurse specialist and the nurse practitioner. In the 1970’s, the clinical nurse specialists first emerged owing to growing complexity of consumer base. As a result the role of advance nurses to provide clinical guidance and leadership to other staff in nursing hence managing care and endorsing evidence based practice. However, clinical nurse specialist roles did not last especially in the 1980s and 1990’s until the 21st century when the role of nurse specialists revived especially given that the demand for quality care was on the rise and it is expected that the role of the nurse specialist will recuperate[Vol05]. Eventually, in Canada, the advanced practice nursing was associated with some nurses who offered nursing care to patients in areas where such care was unavailable especially owing to remoteness and their rural nature. The nurse practitioners gained formal recognition in the 1970s after recognition by policy-maker to emphasize the mode of providing healthcare services to populations in isolation[Vol05]. In this regard, education systems were started but due to the presence of physicians oversupply, lack of enabling legislation, and remuneration issues, the interests in having this program up and running waned until the introduction of health care reform in the 1990s. This healthcare reform came with the increased need to access integrating care hence elevating the demand for primary health care. Conceptualization of Advanced Practice Nursing Registered nurses in nursing spectrum represent a wide range of professionals from novice to experts. However, advanced practice registered nurses acquire specialized knowledge in selected areas. In order to understand the individual practice within a given specialty area, one has to focus on the specialty scope and conventional documents[Adr]. Advanced practice conceptualization is important for students as well as the nurses who are in advanced practicing. For the novices, advanced practice is guided frequently by rules and guidelines to solve common problems and have work accomplished. However, for expert Advanced Practice nurses or APNs, no rules may be consulted to solve problems but new methodologies are improvised to resolve problems and add to the existing knowledge base through problem solutions. Despite their years of experience though, APNs depend on common processes and language for their communications with colleagues about patient care. APNs also use common language to acknowledge points where they have to clarify clinical situations to persons who are not conversant with the patient[Ham14]. The use of a common language and conceptual communication structure to direct and assess practice, policy, education, theory and research in advanced nursing is essential for relevant progress within the discipline. With a well laid framework and guideline within advanced nursing, it is easy to identify, evaluate and incorporate any changes arising from continued evolution. For any nation’s health care system, having a strong foundation in advanced practice nursing offers a strong foundation which is crucial for the development. Additionally, having a framework and guidelines to direct advanced practice education, research, theory and practice, advanced practice nurses have the responsibility to offer and manage quality care for patients. This is possible given the presence of specialized knowledge and practical application of such knowledge such that it positively influences the outcomes of patient care. According Nevin [Nev06]to advanced practice concept may be a useful tool in assisting practitioners to improve the quality of health care they offer to patient positive and high quality health care outcomes. Apart from receiving expert knowledge, advanced practitioners also gain complex skills for use in their decision making and competencies in expanded clinical practice. This is possible since advanced practice nursing offers opportunities in master’s degree which is a recommended entry level requirement[Rue09]. As an advanced practice nurse practitioner, there is need to have a framework within which to define one’s scope, requirements and education level. Such limits are essential especially in distinguishing confusing terms like advanced practitioner, specialist, or expert when used interchangeably. One of the main aspects distinguishing advanced practitioners from any other advanced specialists or experts is the fact that they think, see, and experience clinical practice differently[Nev06]. Some of the attributes of an advanced practitioner are evident in refined provision of quality service milieu and focus on patients both of which are advocated through ground-breaking and establishing new roles that are responsive to the dynamic demand and needs within the healthcare system[Don07]. With such attributes in mind, advanced practice nursing is viewed as a modern practice of nursing where advanced skills coupled with consumer needs are used to offer optimal healthcare quality despite financial constrictions that face modern healthcare today. Although the attainment of core concepts of advanced practice is gradual owing to numerous challenges the reality is embracing advancement clinically suggests ongoing performance, learning and evaluation which are clear indicators of efforts to remain relevant, competent and guarantee optimal response to the needs of patients or clients. Advanced Practice in Education and Research In the real sense, advanced practice nursing has the responsibility to challenge ritualistic boundaries in practice and professional role which is why its presence is attributed to a monumental shift in nursing care delivery[Vol05]. To change from ritualistic practice to advanced practice, nurses are expected to be equipped with professional competence to respond to efficiently to increased political, lifestyle, and economic pressures as well augmented globalization[Rue09]. With such changes, nursing practice is faced with confusion as there is no clarity on what nurses are expected to offer and how to measure the accuracy of their activities. As a result, nurses’ experience inhibited development of the conventional and professional status of nursing. When operating under circumstances of confusion, nurses do not understand lack proper job satisfaction and the advanced nursing practitioner fails to fulfill the core concepts of advanced practice like relationship between them and the patient, expert practice level, provision of effective consumer response, and development of designated roles. Consequently, the definition of a clear and accurate framework within which to operate is an essential move for promoting precise and easy to evaluate and identify practice. With the advancement in nursing profession within the past 50 years, patients are presenting more critical illnesses while nurses are expected to deal with them in the most effective way[Dis07]. As a result, nations including United States are shifting from focus on secondary to focus on primary care. This move presents challenges in terms of treatment which then focuses on treatment through prevention and health maintenance. This strain, as revealed by Distler [Dis07] is compounded by lack of clinically competent nurses and budget constraints. In order to keep up with the increasing need for competent nurse practitioners, nursing schools were compelled to revise their approach to education[Seb00]. Embracing changes in nursing education took consideration of fact like old and young students enrolling in various nursing programs. In terms of learning, some terms like problem-based learning, student-centered learning, critical thinking, and evidence-based practice came into play[Dis07]. Today, advanced Practice nursing is a great career choice since it offer opportunities to learn new knowledge including technology oriented diagnosis and treatment, generic research responsible for unraveling pathophysiology complexity, and information storage, gathering and sharing. For graduate APNs, nursing theories offer substantial foundation for practice, while research reveals scientific evidence for best practice. Additionally, APN introduce fresh ideas and interventions to consumers into the market through their research utilization skills. Recommendations of Advanced nursing Practice Within the current need for advanced practice nursing care, several recommendations are provide to promote advanced practice are provided. To begin with, advanced practice nursing conceptualization should be streamlined. According to Ruel & Motyka [Rue09], the concept of advanced practice nursing has not identified a core definition which then has contributed to poor external enhancement of legitimacy and recognition. Additionally, the lack of a proper definition has seen confusion in the understanding of advanced practice nurse or APN roles, competencies and sub-roles which have minimized the enhancement of internal cohesion. In the presence of a clear and accurate definition of advanced practice, nurses will understand their roles and focus on evidence-based advanced practice. The result will be to encourage a foundation upon which precise measurements of nursing performance will be taken. According to Nevin [Nev06], the main attributes of an operational advanced practice definition include: relationship; practice level; context specialization; roles designation; and reliable response the needs of consumers. Further, advanced practice nursing is essential in enabling nurses to establish dual-faceted relationships with patient which then is a strong pillar for evidence-based nursing practice. Advanced Practice Nursing and Evidence –based Practice or EBP Apart from the need to improve nursing through advanced practice, evidence-based practice is also a requirement for high quality patient care outcomes. In nursing, evidence-based practice also closes the gap between practice and research outcomes. Sebastian, et al. [Seb00] highlight that the gap between practice and EBP outcomes is as a result of lack of advanced skills in leadership which then results to slow or no incorporation of the established findings into practice. Additionally, Dontje [Don07] highlights that the incorporation of evidence from research findings into practice takes about 17 years or is never at all incorporated into practice. With the presence of advanced practice nurses, findings from research can be translated into practice provided the nurse practitioners understand the evidence-based practice or EBP and the many ways available to integrate such findings within the practice settings. Dontje [Don07] argues that clinical expertise and patient values coupled with current research evidence are enough to formulate legitimate interventions. This way, the care practices developed will be valid since the available information is reliable hence promoting evidence-based clinical decisions. Clinical decisions based on evidence should consider variables such as: 1. Personalizing evidence to represent patient conditions 2. Nursing models of care to accentuate the significance of using EBP in patient-focused model. Such a practice propagates quality care within an environment that is supportive and encourages decision making. Through advanced practice introduction into healthcare system, clinical reasoning and practices, and leadership are expected to promote the implementation of evidence based practice. Consequently, the focus of the nurses will be on intended interventions to get to the desired outcomes for patients while managing or decreasing utilization of resources[Adv14]. Additionally, incorporating evidence based strategies within clinical settings implies that patients from diverse backgrounds and settings will be evaluated and information gathered that will be essential in the improving of health outcomes related to their background. Additionally, the involved advanced practice nurses are expected to be familiar with research knowledge synthesizing; analyzing of data from medical records; conventions held internationally, locally and nationally; pathophysiology; risk data and quality improvement; and analyzing of cost effectiveness. Further, advanced practice nurses should also be familiar with clinical expertise; preferences of patients; and benchmarking. This way, nurses will manage to embrace processes that develop evidence-based approaches that are clinically relevant to the clinical settings available. References Ham14: , (Hamric, Hanson, Tracy, & O'Grady, 2014), Adr: , (Adrian, 2005), Bar09: , (Barker, 2009), Vol05: , (Vollman & Martin-Misener, 2005), Nev06: , (2006), Rue09: , (Ruel & Motyka, 2009), Nev06: , (Nevin, 2006), Don07: , (Dontje, 2007), Dis07: , (Distler, 2007), Dis07: , (2007), Seb00: , (Sebastian, et al., 2000), Rue09: , (2009), Seb00: , (2000), Don07: , (2007), Adv14: , (AdvanceWeb, 2014), Read More