Chapter 5: Global Perspectives on Advanced Nursing Practice Flashcards

1
Q

FACTORS CONTRIBUTING TO INTERNATIONAL GROWTH OF ADVANCED NURSING PRACTICE

A

Themes common throughout the world:

Escalating disease burden

Increased inpatient acuity and complexity of treatment

Impact of technological innovations and use of new therapeutic approaches

Increased emphasis on primary health care and community-based services

Growing request for and complexity of home care

General global shortage of health-care workers, including physicians, which is stimulating new consideration of skill-mix and task-shifting options

More demand for specialized services

Better-informed health-care consumers

Intensified call for options to increase access to health care and to address out-of-control health-care costs

The quest for quality

Nurses moving into the mainstream of higher education and demanding career choices

Call for professional advancement in nursing as a reason to remain in practice

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2
Q

THE INTERNATIONAL COUNCIL OF NURSES (ICN)

A

Transnational authority for advanced practice

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3
Q

ICN NETWORKS AND DOCUMENTS

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International Nurse Practitioner/Advanced Practice Nursing Network (INP/APNN) originated in 2000

The Scope of Practice, Standards and Competencies of the Advanced Practice Nurse (ICN, 2008a)

Nursing Care Continuum – Framework and Competencies (ICN, 2008b)

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4
Q

THE ICN DEFINITION APN

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… a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master’s degree is recommended for entry level.
(ICN, 2002)

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5
Q

TRANSNATIONAL AMBIGUITIES AND ISSUES

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Inability to define scope of practice nationally: poor role clarification

Proliferation of titles

Dominance of medicine in health care

Conflict of scope of practice with work of other health professionals

Mistrust between APRNs and other nurses

Variations in autonomy linked to differences in recognition, acceptance, and regulation

Disparate educational credentials

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6
Q

REGULATION, CREDENTIALING, AND STANDARD SETTING

A

The backbone to establishing advanced practice

Regulation often needs to catch up with innovation: be cautious and unrushed

Restrictive regulations may precede facilitative ones

Call for constant evaluation and revision of regulations, if needed

National nursing organizations are a major influence

Professional mobility will shape consensus for credentialing among countries

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7
Q

PRESCRIPTION OF MEDICINE AND THERAPEUTICS

A

Historically a common function outside a legal framework

In many areas, prescribing from a limited formulary is part of primary care practice

Less controversial than in the United States

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8
Q

AFRICA: BOTSWANA

A

Lack of specific regulations, qualifications, or routes for career advancement for the APRN

Focus on primary health-care services

Both a four-semester certificate program and a master’s FNP program exist

Discussion of articulating the certificate with master’s program at University of Botswana

Autonomy is commendable

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9
Q

AFRICA: REPUBLIC OF SOUTH AFRICA (RSA)

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ANP titled Family Nurse Practitioner (FNP)

2005 Nursing Act calls for assured competencies, but education is illusive

Postbasic preparation for FNPs does not require specialized education

Separate license to dispense medications

Employment mainly in primary care

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10
Q

AFRICA: WESTERN AFRICA

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Most nurses also prepared in midwifery

Recognized by a national certification exam and provide direct primary care services

All have post-entry education in a specialty

Advanced education not recognized for registration

Over 1,000 nurses hold the master’s degree

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11
Q

THE AMERICAS: CANADA

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Nurses are regulated at the provincial or territorial level

CNS and NP roles are utilized in all of Canada’s thirteen provinces and territories

However, the only role with governmental regulation and title protection is the NP

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12
Q

THE AMERICAS: CAYMAN ISLANDS

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NP-like roles evolved in response to the needs of the people, as well as within geographical circumstances

Since 1930, NP services progressed with the official employment of nurses experienced in midwifery and community health to provide PHC to Caymans, tourists, and refugees

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13
Q

THE AMERICAS: JAMAICA

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Master’s education for NP

Nurse anesthetists (NAs) are classified as NPs, although they predated the NP and do not require master’s preparation

Neither NA nor NP are regulated, nor have prescriptive authority

Specialty areas are family, pediatrics, and MH; pediatrics preparation has been discontinued

Most function in primary care settings

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14
Q

EASTERN MEDITERRANEAN (EMR)

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2001, WHO convened leadership group to give direction for ANP and prescribing in the area

Prescribing a range of essential drugs was determined to be within the scope of a general nurse

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15
Q

EMR: BAHRAIN

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Environment supports APNs in primary care

Basic 1-year education, called advanced practice, is available post-entry

The BSN is considered entry-level for nursing practice

No master’s education is available

Candidates for study are sent to the United States

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16
Q

EMR: IRAN

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14 master’s programs and 10 PhD programs in nursing, with 40 doctoral graduates reported

Advanced Specialists work autonomously in rural areas; in urban areas, they share responsibility with physicians

Physician supervision is not needed

Nurses, not only APNs, can open private practice

17
Q

EMR: ISRAEL

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2002, master’s degree in advanced practice

ANP blends the roles of NP and CNS

The APN role addresses the entire continuum of care from hospital to community practice, from individuals to groups

No regulatory recognition of APNs; no diagnosis or prescriptive authority possible

18
Q

EMR: OMAN

A

Considering community nursing and community nurse practitioner roles

There is resistance from physicians who prefer specialty-trained nurses

A lack of educators for the role and limited understanding of the nature of services

Unqualified nurses in remote areas are performing ANP functions

19
Q

EUROPE: THE EUROPEAN UNION

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Consists of 27 culturally and linguistically different member states.

APNs are rarely licensed, independent, and practice autonomously.

First NPs in UK in 1991, and from there to the rest of Europe.

Many European universities have established APN programs at the master’s level.

20
Q

EUROPE: FINLAND

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Physician shortage prompted APN acceptance

APN known as a Clinic Expert Nurse

Education is a master’s program, which prepares chiefly for secondary prevention: acutely ill and follow-up on chronic disease

21
Q

EUROPE: FRANCE

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Progress on APN roles is emerging, but progress is slow

Nurses are not considered a point of entry into the health-care system

Neither educational programs nor legislative support exists for APNs

Private practice nurses depend on a medical order to deliver care

22
Q

EUROPE: IRELAND

A

Regulatory recognition of ANP, including advanced midwife practitioner (AMP) role

Educational preparation at master’s level

Diagnosis and treatment, with physician collaboration

Title enabled by certification

Practice only possible within an approved and accredited post

23
Q

EUROPE: NETHERLANDS

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2,000 NPs working in Netherlands

Introduction of physician assistants (PAs) has not diminished numbers

Legislation provides prescriptive authority and title protection

Education is partially government subsidized, and mostly at the master’s level

Vast consumer acceptance

24
Q

EUROPE: SWEDEN

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Current need for community primary care and NPs

Prescriptive authority for nurses is in place for at least 10 years

Negotiated definition blends the APN with the district nurse role

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EUROPE: SWITZERLAND
A drive to APNs fueled by physician shortage Exploration of APN roles that resemble PAs A master’s degree in advanced practice exists Absence of a framework that addresses legal, policy, standards, and reimbursement issues
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EUROPE: UNITED KINGDOM
RCN Accredits NP educational programs 7 accredited university program, and the Association of Advanced Nursing Practice Educators now has 43 higher education institutions in its membership Practice includes diagnosis and prescription More than 10,000 nurses are Independent Prescribers (IPs); but not all IPs are APNs There is no government regulation of APNs
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SOUTHEAST ASIA: THAILAND
First educational program, 4 months postentry Intend to move education for APNs to the master’s level, but continue to acknowledge the 4-month certificate preparation Certification offered by the Thailand Nurse and Midwifery Council Many APNs are working beyond their defined scope of practice
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WESTERN PACIFIC: AUSTRALIA
NP is a protected title Most states/territories agree that the master’s degree is the basic requirement for practice Role is compromised by state/federal differences in scope of practice Competency standards exist between Australia and New Zealand In 2011, more than 400 NPs in practice
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WESTERN PACIFIC: BRUNEI
Proceeding forward in exploring advanced nursing practice Recommendation made for task force to promulgate criteria, standards, and regulations for ANP (2011) Debate focused on alignment of NP and specialist roles with nurse-midwives under the ANP umbrella
30
WESTERN PACIFIC: CHINA/HONG KONG
Hong Kong has still to find a champion for APN practice to catch a foothold in the health-care system Although there is evidence of strong practice, there has been very little progress on advanced practice No regulatory oversight exists, resulting in uneven educational and clinical development
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ISLANDS OF THE WESTERN PACIFIC
A variety of midlevel practitioners have provided health-care services for the populations of the Pacific island countries for more than 20 years
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WESTERN PACIFIC: FIJI
Fiji School of Nursing offers NP program with postgraduate 6-month internship Established scope of practice Published protocols, allowing prescriptive privileges Immediacy of health-care needs prohibits education at the master’s level Regional education well developed
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WESTERN PACIFIC: SAMOA
Nurse specialists are considered to be APNs Nurses prescribe in life-threatening situations, but broader prescriptive rights are being reviewed Mental health specialist nurses function independently and fairly autonomously
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WESTERN PACIFIC: NEW ZEALAND
Regulations include title protection, standards for educational programs, clinical competencies, and a description of role Master’s preparation or equivalent is required, 4-years’ experience in specialty, and presentation of a practice portfolio APNs are authorized to prescribe from an extensive formulary since 2005 As of May 2011, there were 96 NPs in NZ
35
WESTERN PACIFIC: PHILIPPINES
No public policy that defines or recognizes the APN or their practice An emphasis on post-entry specialty education Post-entry specialists are informally recognized by government with certification/program accreditation Many entry-level and master’s programs, and at least three doctoral programs exist
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WESTERN PACIFIC: SINGAPORE
A comprehensive master’s degree exists in advanced practice with no designated specialty; followed by an internship A second APN preparation exists in critical care APNs are placed on a government registry
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WESTERN PACIFIC: SOUTH KOREA
NP-like nursing roles have been in place in Korea since the 15th century Community health nurse practitioners are very prominent in rural areas Scope of practice includes diagnosis, prescriptive authority, and referral Qualifications include master’s-level education, certification, and experience in a chosen specialty
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WESTERN PACIFIC: TAIWAN
ANP focus is chiefly acute care Education is mostly in hospital training schools, but one master’s and one doctoral program do exist A certification with both theoretical and hands-on evaluations is being offered Official NP recognition and title protection accomplished in 2000
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global apn summary
The APN role surfaces from the needs and geography of the country These nursing roles are feasible, are sustainable, provide quality competent health care, and are growing Legislation and regulations are critical and necessary to legitimize the role, but they often lag behind practice Progression of the role is more an intricate maze or puzzle rather than a picture of coordinated forward motion International momentum is increasing, but it is fraught with frustration and role ambiguity APNs will be asked to provide evidence that they are cost-effective, valued, and sustainable