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Role Development > Chapter 5: Global Perspectives on Advanced Nursing Practice > Flashcards

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

A

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

A

… 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

A

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)

A

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

A

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

A

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

A

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

A

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)

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

25
Q

EUROPE: SWITZERLAND

A

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

26
Q

EUROPE: UNITED KINGDOM

A

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

27
Q

SOUTHEAST ASIA: THAILAND

A

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

28
Q

WESTERN PACIFIC: AUSTRALIA

A

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

29
Q

WESTERN PACIFIC: BRUNEI

A

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
Q

WESTERN PACIFIC: CHINA/HONG KONG

A

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

31
Q

ISLANDS OF THE WESTERN PACIFIC

A

A variety of midlevel practitioners have provided health-care services for the populations of the Pacific island countries for more than 20 years

32
Q

WESTERN PACIFIC: FIJI

A

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

33
Q

WESTERN PACIFIC: SAMOA

A

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

34
Q

WESTERN PACIFIC: NEW ZEALAND

A

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
Q

WESTERN PACIFIC: PHILIPPINES

A

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

36
Q

WESTERN PACIFIC: SINGAPORE

A

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

37
Q

WESTERN PACIFIC: SOUTH KOREA

A

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

38
Q

WESTERN PACIFIC: TAIWAN

A

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

39
Q

global apn summary

A

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

Role Development (17 decks)

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