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Background: The shortage of doctors and their unequal distribution serve as challenges to advancing primary healthcare (PHC) and achieving effective universal healthcare coverage in Brazil. In an effort to use nurses' potential more efficiently, the country is investigating the introduction of the advanced practice nurse (APN) into PHC. This paper presents a situational analysis of the practices of Brazilian nurses based on the following components: regulation, practice, and education.Methods: This is a national multi-method study with triangulated data from a documentary study, a scoping review, and an exploratory study. The regulation component involved the analysis of official normative documents on the regulation of nursing education and nurses' scope of practice. The practice component aimed to identify the practices performed by nurses in Brazilian PHC based on primary studies. The education component intended to identify the practices taught in nursing training based on a survey and interviews with directors of undergraduate nursing programs.Results: Federal legislation in Brazil authorizes nursing graduates to perform a set of advanced practices as part of the PHC nurse's daily routine. They can request and interpret complementary tests and prescribe medication. However, in the local context, municipalities define the scope of this assistance based on technical norms or nursing protocols. Furthermore, this study indicates that undergraduate nursing programs do not fully prepare students to adequately execute these tasks.Conclusions: In the context of Brazilian PHC, advanced practices have already been implemented and respond to main healthcare demands. Therefore, it is unnecessary to introduce the APN as a new professional category. Upon detecting deficiencies in the training process, the current education model should undergo reforms that seek to incorporate the skills compatible with the regulated advanced practices and in-service training for practicing nurses. Regarding the introduction of APN along international lines, this article presents recommendations that may support the operationalization of a Brazilian APN model. [ABSTRACT FROM AUTHOR]

Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. Results: consensus for Core Competencies was established. Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment. [ABSTRACT FROM AUTHOR]

Objective: the aim of this paper is to describe and analyze the literature on nursing models applied to clinical practice. Materials and method: integrative literature review regarding the nursing models applied to clinical practice, under the Ganong proposal, with an observation window of 20 years that included the review of 17 databases by using the search tool Descubridor. Results: the review of 44 documents showed that nearly half of them were papers based on a reflective analysis or a literature review. Most of the studies were descriptive. Most of the papers were published in the last decade and in English. The content identified four categories including the general applications of conceptual models in the nursing practice; why they should be implemented; How to implement the models; and finally, who should undertake the leader role in this implementation. Conclusions: the conceptual models applied to clinical practice are useful, important and they allowed innovation in the nursing practice. The use of conceptual models help nurses to meet the expectations of society with professional autonomy and with a better service. They contribute to the development of nursing knowledge and can generate solid contributions to innovate care in response to user needs. The use of models should be strengthen in nursing research in order to qualify continuously the nursing practice in its different roles. [ABSTRACT FROM AUTHOR]

Objective This paper focuses on the role of the Non-Medical Surgical Assistant (NMSA) in Australia. Registered Nurses predominately perform this role. This paper will articulate a position to: * validate this role as an Advanced Practice Nursing (APN) role in Australia through regulation and governance by the Nursing and Midwifery Board of Australia (NMBA) who sit under the umbrella of the Australian Health Practitioner Regulation Agency (AHPRA); * lobby AHPRA to recognise, regulate and protect the title of Advanced Practice Nursing (APN) roles other than the Nurse Practitioner (NP) in Australia; and * as a result of sanctioned regulation, facilitate APN (including NP) to seek appropriate remuneration for undertaking this role in the private sector in Australia. Setting The Australian Healthcare system. Subjects Clinicians performing the role of the NMSA in Australia. Primary Argument The NMSA is well established with clear mechanisms for governance internationally. This role has been practiced in Australia for more than 20 years, and while clinicians function under the guise of advanced practice, the role is not clearly defined, standardised or regulated. This is partially attributed to lack of sanctioned governance from AHPRA. Conclusion While the AHPRA via the NMBA are reluctant to formally recognise and regulate this role, the overwhelming majority of clinicians in Australia are nurses. Without regulation it is difficult to quantify the role as APN. Lack of governance excludes NMSA (including the NP) from access to the Medicare Benefits Schedule and private health funds for intraoperative reimbursement thereby rendering a potentially cost-effective role unsustainable to many clinicians. [ABSTRACT FROM AUTHOR]

Background: To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. Methods: Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015–August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. Results: Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2–16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. Conclusions: The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec. [ABSTRACT FROM AUTHOR]

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing. [ABSTRACT FROM AUTHOR]