Monday, 23 May 2016

Advanced practice nurses: it’s time to strongly support

According to International Council of Nurses, an advanced nursing practitioner is a specialist who has acquired the expert knowledge, the capabilities of making complex decisions and the necessary clinical competencies for expanded practice.

The concept emerged in the US, in the 70s, in the areas of obstetrics and anaesthesia and, thereafter, the development of the nursing profession has focused on what has been renamed Advanced Nursing Practice (ANP). It’s a graduate training that provides an overview for the care of complex patients, for the involvement of people in managing their own diseases and, in short, for everything that regards innovation, evidence and research aimed at improving the care offered to people.

On this matter, I would like not to discuss the arguments among the corporate competencies, and instead focus a bit more on what these advanced practice nurses can contribute in a future healthcare model that counts with more integration of services, more clinical leadership of family doctors (and geriatricians when necessary), more response capacity from nurses and more coordination between health services and social services. A health system in which specialists only see the complex chronic patients and elderly patients under a consultancy regime, provided that the multidisciplinary team responsible for the patient’s action plan, sees fit.

In the following graph, we can notice the area of shared competence between doctors and nurses and I have chosen, as examples, 8 areas of hybrid territory, where it’s obvious that the contribution of an advance practice nurse may be more appropriate than that of a doctor, due to a more global vision of the needs of people.
  1. Health prevention and promotion. Both for healthy people and for people with risk factors, leadership and nursing work is paramount.
  2. Shared clinical decision. The support of nurses can be decisive in creating a climate of understanding and communication materials adjusted to the cultural level of each patient.
  3. Nurse demand management. There are experiences with very positive evaluations.
  4. Adherence to treatment; in addition to preventing poly-medication for the elderly, and their involvement, along with doctors in the deprescription processes.
  5. Training, control and ongoing care for chronic patients. The nurse becomes the key member of the professional team when the patients develop various illnesses and the needs for services multiply.
  6. Support for geriatricians in the comprehensive assessments. The nurse is the benchmark for the geriatric work and becomes the bridge between health care and social care in the case of  frail elderly patients with complex needs.
  7. Indications and management of urinary catheters, but also in treatment of urine bacteria in elderly patients.
  8. End of life processes. Involvement in the multidisciplinary team and technical leadership in managing symptoms, appropriate for each person and situation.
Recalling last week’s post, I deem it appropriate to point out that when society needs, more than ever, an integrated care service, we can’t allow the nursing work to slide down. Therefore, nurses advanced training must be strengthened and we must support the idea that nurses have the ability to lead many aspects of the clinical processes with complex health and social needs, given their proximity to the way of seeing things of each patient.

Thank you, Catalina Padilla, Assistance Coordinator of Nurse Methodology of Consorci Sanitari Integral, for having provided the necessary documentation to write this post.

Jord Varela


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