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Objetivo: o objetivo deste artigo é descrever a primeira fase de um projeto que teve como finalidade geral desenvolver um conjunto de competências de práticas avançadas de enfermagem baseadas em consenso aplicáveis em países da América Latina e, usando tais competências, produzir um protótipo curricular de práticas avançadas de enfermagem a serem adaptadas em países da América Latina. O projeto foi enquadrado em uma abordagem baseada em competências para o ensino de práticas avançadas de enfermagem. Os objetivos específicos da primeira fase do projeto descritos neste artigo foram: 1) identificar um conjunto de competências em enfermagem para práticas avançadas que serviriam como modelo para as Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina e 2) estabelecer um consenso sobre Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina. Método: as competências de enfermeiros de práticas avançadas foram derivadas de uma revisão abrangente das competências publicadas e informaram o desenvolvimento de uma pesquisa projetada para avaliar a relevância das competências de enfermeiros de práticas avançadas nos países da América Latina. A pesquisa foi distribuída entre enfermeiros líderes e enfermeiros educadores. Os dados foram analisados por meio de estatística descritiva. Resultados: foi estabelecido um consenso sobre Competências Essenciais. Conclusão: apresentam-se as Competências Essenciais de Enfermeiros de Práticas Avançadas que podem fornecer um quadro estruturado para construir programas educacionais alinhados com as necessidades do ambiente regional. 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. Objetivo: el objetivo de este documento es describir la primera fase de un proyecto, cuyo objetivo general es desarrollar un conjunto basado en consenso de competencias de práctica avanzada de enfermería aplicables en los países de América Latina y utilizando las competencias, producir una enfermera con práctica avanzada de prototipo curricular para la adaptación en países latinoamericanos. El proyecto se encuadró en un enfoque basado en competencias para la educación de enfermería de práctica avanzada. Los objetivos específicos de la primera fase del proyecto descritos en este documento fueron: 1) identificar un conjunto de competencias potenciales de enfermería de práctica avanzada que servirían como un modelo para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos y 2) establecer consenso para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos. Método: las competencias de práctica avanzada de enfermería se derivaron de una revisión exhaustiva de las competencias publicadas e informaron el desarrollo de una encuesta diseñada para evaluar la relevancia de las competencias de práctica avanzada de la enfermera en los países de América Latina. La encuesta fue distribuida a enfermeras líderes y enfermeras educadoras. Los datos fueron analizados utilizando estadística descriptiva. Resultados: se estableció el consenso para las Competencias Básicas. Conclusión: se presentan las Competencias Básicas de Enfermería de Práctica Avanzada que pueden proporcionar un marco estructurado para construir programas educativos alineados con las necesidades del entorno regional.

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.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.consensus for Core Competencies was established.the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment.o objetivo deste artigo é descrever a primeira fase de um projeto que teve como finalidade geral desenvolver um conjunto de competências de práticas avançadas de enfermagem baseadas em consenso aplicáveis em países da América Latina e, usando tais competências, produzir um protótipo curricular de práticas avançadas de enfermagem a serem adaptadas em países da América Latina. O projeto foi enquadrado em uma abordagem baseada em competências para o ensino de práticas avançadas de enfermagem. Os objetivos específicos da primeira fase do projeto descritos neste artigo foram: 1) identificar um conjunto de competências em enfermagem para práticas avançadas que serviriam como modelo para as Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina e 2) estabelecer um consenso sobre Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina.as competências de enfermeiros de práticas avançadas foram derivadas de uma revisão abrangente das competências publicadas e informaram o desenvolvimento de uma pesquisa projetada para avaliar a relevância das competências de enfermeiros de práticas avançadas nos países da América Latina. A pesquisa foi distribuída entre enfermeiros líderes e enfermeiros educadores. Os dados foram analisados por meio de estatística descritiva.foi estabelecido um consenso sobre Competências Essenciais.apresentam-se as Competências Essenciais de Enfermeiros de Práticas Avançadas que podem fornecer um quadro estruturado para construir programas educacionais alinhados com as necessidades do ambiente regional.el objetivo de este documento es describir la primera fase de un proyecto, cuyo objetivo general es desarrollar un conjunto basado en consenso de competencias de práctica avanzada de enfermería aplicables en los países de América Latina y utilizando las competencias, producir una enfermera con práctica avanzada de prototipo curricular para la adaptación en países latinoamericanos. El proyecto se encuadró en un enfoque basado en competencias para la educación de enfermería de práctica avanzada. Los objetivos específicos de la primera fase del proyecto descritos en este documento fueron: 1) identificar un conjunto de competencias potenciales de enfermería de práctica avanzada que servirían como un modelo para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos y 2) establecer consenso para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos.las competencias de práctica avanzada de enfermería se derivaron de una revisión exhaustiva de las competencias publicadas e informaron el desarrollo de una encuesta diseñada para evaluar la relevancia de las competencias de práctica avanzada de la enfermera en los países de América Latina. La encuesta fue distribuida a enfermeras líderes y enfermeras educadoras. Los datos fueron analizados utilizando estadística descriptiva.se estableció el consenso para las Competencias Básicas.se presentan las Competencias Básicas de Enfermería de Práctica Avanzada que pueden proporcionar un marco estructurado para construir programas educativos alineados con las necesidades del entorno regional.

Nurses have an educational background particularly suited to the growing challenges of the 21st century, characterized by an accelerated demographic transition, accompanied by a scenario of triple disease burden: 1) the unsurpassed agenda for infectious diseases; 2) the increase in deaths attributable to external causes; and 3) the predominance of chronic noncommunicable diseases. Advanced Practice Nurses (APN) already have regulations well-established in many countries such as Australia, Belgium, Canada, the USA, Finland, France, Ireland, Japan, Poland, the United Kingdom, and the Czech Republic, among others. This paper aimed to point out and to reflect on Advanced Practice Nursing and the expansion of the role of nurses in Primary Health Care (PHC) in the Americas. In the same year the Nursing Now Campaign was launched, Pan American Health Organization (PAHO) and World Health Organization (WHO) prepared the document Expanding the Role of Nurses in PHC which calls on governments and nurses from countries in the Americas to implement APN training for PHC and Nurses from Central and South America who already have specialization programs, residency, academic master's and doctoral degrees. Expansion is intended to provide greater coverage and assistance to users of the health system, take advantage of nurses' intellectual capacity, and retain good professionals in the profession. This is a crucial moment for nursing worldwide. However, it is imperative to ensure the voice and impact of nursing continues to reverberate long after the end of 2021. In this paper, a debate on the strengths and challenges for the expansion of the APN role in PHC in the Americas is discribed.

The aim of this study was to synthesize available data on current educational provision related to preparation for the advanced clinical practice role.A mixed methods rapid review of the literature.A search of Ovid Medline and Ovid EMBASE for English language papers published 2006-2018 resulted in 38 publications, which met the criteria for inclusion.Using Tricco's seven-stage process, following an identification of relevant papers and data extraction, a data-based convergent synthesis was used to convert quantitative papers into qualitative data prior to completing a narrative synthesis.The four themes identified from data synthesis were consolidation; theory to practice gap; competency and mentoring. A lack of preparedness for new advanced clinical practitioners completing an educational programme was noted with a need identified for a clinically focussed consolidation period to enable practitioners to develop their skills under supervision in the clinical environment.As the needs for different models of health care evolve with the expansion of advanced practice, appropriate education and clinical supervision are important aspects in the delivery of programmes that allow individuals to be competent and confident practitioners providing safe and effective health care.There is a paucity of papers on educational preparedness of advanced clinical practitioners. Our findings demonstrate a lack of preparedness and the need for a clinically focussed consolidation period with good role models and mentors following completion of a Master's programme. Employers and higher education institutions need to ensure a protected period of time is available for newly qualified advanced clinical practitioners to allow consolidation of clinical practice.目的: 本研究的目的是对当前涉及高级临床实践角色准备的相关可用教育准备数据进行总结。 设计: 采用混合研究法,对文献进行快速评价。 资料来源: 对Ovid Medline和Ovid EMBASE上2006年至2018年发表的英文论文进行了检索,结果有38篇符合纳入标准。 综述方法: 采用Tricco的七阶段流程,在确定相关论文和提取数据后,采用基于数据的汇集式总结方法将定量论文转化为定性数据,然后,完成叙述性总结。 结果: 从数据总结中确定的四个主题是:巩固;理论与实践之间的差距;能力与指导。有人指出,新的高级临床医师在完成教育方案这一方面准备不足,需要有一个专注临床的巩固期,使他们能够在临床环境的监督下发展自己的技能。 结论: 随着高级实践范围的扩展,对不同医护服务模式的需求也在不断变化,适当的教育和临床监督是提供方案的重要方面,如此才足以使个人能够胜任且自信地提供安全、有效的医护服务。 影响: 关于高级临床医师教育准备方面的论文很少。我们的调查结果表明,在完成硕士课程后,缺乏准备,而且,存在对专注临床的巩固期与良好的榜样和导师的需求。用人单位和高等教育机构需要确保为新获得资格的高级临床医师提供一段保护期,以便对临床实践进行巩固。.

Many OECD countries have undergone reforms over the past decade to introduce advanced roles for nurses in primary care to improve access to care, quality of care and/or to reduce costs. This working paper provides an analysis of these nurse role developments and reforms in 37 OECD and EU countries. Four main trends emerge: 1) the development in several countries of specific advanced practice nursing roles at the interface between the traditional nursing and medical professions; 2) the introduction of various new, supplementary nursing roles, often focused on the management of chronic conditions; 3) the rise in educational programmes to train nurses to the required skills and competencies; and 4) the adoption of new laws and regulations in a number of countries since 2010 to allow certain categories of nurses to prescribe pharmaceuticals (including in Estonia, Finland, France, Netherlands, Poland and Spain).

Aim:\ud To explore the collaborative nature of an international research project with other advanced practice nurse researchers and critically analyse the process.\ud \ud Background:\ud Research within the nursing community is recognized internationally as important to ensure that nurses participate in cutting-edge health care and promote evidence-based practices, yet there is little detail found in literature on how a successful collaborative relationship is initiated and conducted in advanced practice research.\ud \ud Design:\ud Discussion paper: The purpose of this paper is to discuss the process of collaboration on a research study among advanced practice nurses from four countries who are members of an international organization.\ud \ud Implications for Nursing:\ud The collaborative process in international nursing research can be challenging and rewarding. It is important to remember that there is a relationship between the complexity of the study and the time required to complete it. Keys to success include following established guidelines.\ud \ud Conclusion:\ud This project was a valuable experience in developing collaborative relationships as well as creating partnerships for future research to build on the knowledge gained. The authors' linkages to universities facilitated their participation in the research and completion of the ethical review processes. The use of social media and university resources was indispensable.

Aim. This paper serves as the outline for a simulation that nurse educators can use to better prepare graduate students for the clinical setting and ensure the student's essential competencies prior to clinical practicum. Background. Educators often struggle with whether nurse practitioner students are sufficiently prepared for their clinical practicum once they have successfully completed the didactic component of their coursework. Method. This paper addresses the methods by which one institution uses standardized patients in a simulation laboratory to better prepare the graduate students for their first clinical practicum. The implications of using clinical simulation to enhance both student and faculty learning are addressed. Results. Simulation done prior to a student's clinical practicum prepares the student for patient cases in the clinical setting. Conclusion. Clinical simulation can enhance the knowledge, skills, and attitudes that nurse practitioner students need in the clinical setting.

Advanced practice nursing has evolved over the years to become recognized today as an important and growing trend among healthcare systems worldwide. To understand the development and current status of advanced practice nursing within a Canadian context, it is important to explore its historical roots and influences. The purpose of this paper is to provide a historical overview of the major influences on the development of advanced practice nursing roles that exist in Canada today, those roles being the nurse practitioner and the clinical nurse specialist. Using a scoping review and qualitative interviews, data were summarized according to three distinct time periods related to the development of advanced practice nursing. They are the early beginnings; the first formal wave, between the mid 1960s and mid 1980s; and the second wave, beginning in the late 1980s and continuing to the present. This paper highlights how advanced practice nursing roles have evolved over the years to meet emerging needs within the Canadian healthcare system. A number of influential factors have both facilitated and hindered the development of the roles, despite strong evidence to support their effectiveness. Given the progress over the past few decades, the future of advanced practice nursing within the Canadian healthcare system is promising.

chang a.m., gardner g.e., duffield c. & ramis m.-a. (2010) A Delphi study to validate an Advanced Practice Nursing tool. Journal of Advanced Nursing 66(10), 2320–2330. Abstract Aim. This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background. Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method. An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results. After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion. The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.

Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence-based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical-academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical-academic partnership.

Objective The objective of this scoping review is to identify the outcomes reported from objective structured clinical examinations in advanced practice registered nurse education and to describe their characteristics. Introduction Graduate medical education has used objective structured clinical examinations to assess student health professionals since 1975. Nursing programs have adopted objective structured clinical examinations to assess evidence-based practice and clinical competency of advance practice nursing students, but little is known about the outcomes that are being reported. Inclusion criteria This review will consider evidence on the outcomes and other characteristics of objective structured clinical examinations for students enrolled in graduate-level advanced practice nurse education programs (ie, nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists). All types of evidence will be considered, including quantitative and qualitative studies, systematic reviews, as well as text and opinion papers. Methods This review will be conducted in accordance with the JBI methodology for scoping reviews. A literature search will be conducted in PubMed, CINAHL, MEDLINE, Nursing and Allied Health, Scopus, and Google Scholar. Sources that are published in English or that could be translated into English will be considered for inclusion. No date limit will be applied. Study selection and data extraction will be conducted by three independent reviewers. Any disagreements will be resolved through discussion. The scoping review findings will be presented in a narrative style and reported using diagrams and extraction tables.

Aim: This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background: Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method: An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results: After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion: The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Advanced midwifery practice is a controversial notion in midwifery, particularly at present in Australia. The proposed changes in legislation around access to the publicly funded Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 2009-2010 have meant that the issue of advanced midwifery practice has again taken prominence. Linking midwifery access to MBS and PBS to a safety and quality framework that includes an 'advanced midwifery credentialling framework' is particularly challenging. The Haxton and Fahy paper in the December 2009 edition of Women and Birth is timely as it enables a reflection upon these issues and encourages debate and discussion about exactly what is midwifery, what are we educating our students for and is working to the full scope of practice practising at advanced level? This paper seeks to address some of these questions and open up the topic for further debate. © 2009 Australian College of Midwives.

The aim of this paper is to examine the purpose and growth of the development of general, advanced and specialist competency standards in nursing and midwifery in Australia. The definitions, content, types, utility and acceptability of competencies are reviewed. This paper also reports the results of a recent survey of nurses and midwives about the uses of competency standards. Challenges in identifying and assessing the impact of competency standards on practice and professional development; reasons for their proliferation and associated shortcomings such as their lack of cultural sensitivity and inability to reflect the complexity of nursing care are also explored. The rationale for this paper is that charting these issues and identifying gaps in the field will assist the further development and refinement of competency frameworks for Australian nursing. The paper concludes by recommending that future research in this area should focus on: (1) formal analysis of the validity and suitability of competency standards in relation to the purposes for which they are designed; (2) the mapping of competency domains, elements and performance criteria to identify similarities and differences in order to provide insight into the nature of both specialist and advanced practice nursing; and (3) a systematic review of the competency literature to ascertain the level of evidence that exists to support the use of competencies in terms of standard setting, safe practice and enhancement of patient outcomes. Crown Copyright © 2008.

Hypertension is a leading cause of cardiovascular disease (CVD) and affects nearly one in two adults in the United States when defined as a blood pressure of at least 130/80 mm Hg or on antihypertensive medication (Virani et al., 2021, Circulation, 143, e254). Long-standing disparities in hypertension awareness, treatment, and control among racial and ethnic populations exist in the United States. High-quality evidence exists for how to prevent and control hypertension and for the role nurses can play in this effort. In response to the 2020 Surgeon General's Call to Action to Control Hypertension, nursing leaders from 11 national organizations identified the critical roles and actions of nursing in improving hypertension control and cardiovascular health, focusing on evidence-based nursing interventions and available resources.To develop a unified "Call to Action for Nurses" to improve control of hypertension and cardiovascular health and provide information and resources to execute this call.This paper outlines roles that registered nurses, advanced practice nurses, schools of nursing, professional nursing organizations, quality improvement nurses, and nursing researchers can play to control hypertension and prevent CVD in the United States. It describes evidence-based interventions to improve cardiovascular health and outlines actions to bring hypertension and CVD to the forefront as a national priority for nursing.Evidence-based interventions exist for nurses to lead efforts to prevent and control hypertension, thus preventing much CVD. Nurses can take actions in their communities, their healthcare setting, and their organization to translate these interventions into real-world practice settings.

AIMS: To characterize the future Psychiatric Mental Health (PMH) Advanced Practice Registered Nurse (APRN) workforce in light of the high demand for psychiatric providers in all aspects of mental health service delivery. Over the past 20 years, there has been significant growth of the PMH APRN workforce, a provider group capable of addressing mental health provider shortages. However, continued growth may be limited by anticipated retirements and traditional volume of graduations from PMH nurse practitioner (NP) programs. Optimum utilization of PMH APRNs in service delivery systems and State workforce planning may also be impeded by their frequent mischaracterized in federal reports and mental health workforce studies. METHODS: Based on a review of the literature, this discussion paper evaluates trends related to PMH NP programs and graduates, anticipated retirements of current PMH ARPNs, facilitators and barriers to increasing the PMH APRN workforce, and opportunities and threats to workforce development. RESULTS: The PMH APRN workforce faces significant challenges owing to barriers and facilitators to growth of the specialty. These factors conspire to limit the supply of PMH APRNs at a time when they are needed to compensate for declining numbers of providers in the United States, particularly practicing psychiatrists. CONCLUSION: Recommendations are forwarded as to how best shape the educational pipeline to meet the current and emerging needs of American citizens for quality mental health care.

PURPOSE: The Doctor of Nursing Practice (DNP) programs have grown exponentially for the last 10 years across the United States. However, the intra-professional collaboration among DNP and PhD scholars is not clearly demonstrated in the literature as it relates to frequency, training models, and the outcomes of these collaborations on translation. The purposes of this paper are to: (1) examine the role for DNP nurses in symptom science research and (2) describe training models to cultivate the PhD-DNP collaboration to strengthen the translation of discoveries from nursing research, to facilitate implementation of discoveries, and to improve clinical practice of nurses. METHODS: A targeted review of the literature was conducted to identify, (1) the role of the DNP, (2) examples of PhD-DNP collaborations, (3) training models that support collaborations, and (4) the outcomes of these intra-professional collaborations. RESULTS: Two articles reported on PhD-DNP collaboration within a university setting; however, they did not address how the partnership was modeled. One additional article described an academic-hospital partnership model aimed at MSN-prepared advanced practice nurses (APRN) by which outcomes were measured. No examples were found outside of academic settings. The National Institute of Nursing Research (NINR) has established the Symptom Science Center (SSC) with an interest in training the next generation of symptom scientists. By developing a training curriculum through the NINR SSC, DNP-prepared students and practitioners can be exposed to the research enterprise and potentially develop early partnerships with PhD-prepared students and scholars that lead to research translation. CONCLUSION: The NINR Department of Intramural Research (DIR) and National Institutes of Health Clinical Center are dedicated to building stronger ties between PhD- and DNP-prepared scientists. The SSC can serve as an optimal platform to promote the collaboration of PhD and DNP nurses to advance symptom science translation. CLINICAL RELEVANCE: Nurses have a remarkable role in early detection of disease progression. Training opportunities to cultivate the PhD-DNP collaboration have significant relevance for expediting the translation of nursing science to nursing practice.

Discussion around the scope of practice of all nurse practitioners (NPs) in Australia was a component of the recent review of NPs’ eligibility to have broader access to the Medical Benefits Schedule (MBS). This review process has been prolonged and, while the MBS review officially concluded on the 30 June 2020, no information regarding decisions about expanded NP access to the MBS for patient rebates had been disclosed at the time of publication. It is anticipated that the MBS review will contribute little change to NP access to the MBS. The MBS is the primary funding process for private-sector medical services in Australia and is a barrier to the scope of practice of Australian NPs. Specifically, in the perioperative setting the lack of access to the ‘assistance at operations’ MBS item numbers limits the NP’s scope of practice as it leaves the private sector surgical patient out-of-pocket when an NP provides surgical assisting services. This discussion paper considers the international non-medical surgical assistant experience and relates this to the Australian context exploring the complexities associated with the term advanced practice nursing, regulation of the NP compared to other clinicians, and the matters of funding and protectionism in the perioperative space.

ObjectivesThe implementation of advanced practice nursing (APN) programmes in sub-Saharan Africa (SSA) has been difficult due to lack of SSA-specific curriculum frameworks or benchmarks to guide institutions in developing and implementing APN programmes. A few APN programmes in SSA were benchmarked on western philosophy and materials, making local ownership and sustainability challenging. This paper presents an SSA-specific concept-based APN (Child Health Nurse Practitioner, CHNP) curriculum framework developed to guide institutions in developing relevant and responsive APN curricula in order to qualify CHNP and contribute to a decreased incidence of preventable deaths of children in the SSA region.DesignA sequential multimethod study design consisting of a scoping review, Delphi study, development of a framework by a curriculum team, and evaluation of the curriculum framework by faculty from 15 universities in SSA.SettingThis study included universities from East, West, Central and Southern Africa.ParticipantsThe study included international multidisciplinary health professionals and curriculum development experts from 15 universities in 10 SSA countries.ResultsA concept-based Advanced CHNP curriculum framework was developed. The faculty who evaluated the curriculum framework for applicability within their institutions and the SSA context unanimously stated that the framework is detailed, evidenced-based and could be adapted for other APN specialty areas.ConclusionThe Child Health Nurse Practitioner curriculum framework is comprehensive, context-specific and has the potential to respond to the special child healthcare needs of SSA. It is adaptable for other APN specialty programmes in SSA. Nursing leaders should lobby for funding and advocate for the introduction of the CHNP programme as a collaborative process between government, clinical services, communities and educational institutions.

CONTEXT. La Infermera de Pràctica Avançada és una figura que avança de manera diferent en cada país. Actualment encara falta estudiar sobre quin paper i quines funcions pot realitzar dins del cribratge precoç prenatal. OBJECTIU. Descriure quines són les competències que la Infermera de Pràctica Avançada pot desenvolupar en l’àmbit del cribratge prenatal per comparar la legislació espanyola amb la legislació d’altres països europeus. METODOLOGIA. La pregunta d’investigació és: La figura de la Infermera de Pràctica Avançada, experta en el cribratge precoç prenatal, està més desenvolupada en altres països d’Europa que no pas a Espanya?. Es realitza una revisió exploratòria a les bases de dades PubMed, Science Direct i Web of Science. Els estudis s’han publicat els últims 10 anys i tots parlen del cribratge prenatal. L’avaluació del rigor científic s’ha analitzat mitjançant les escales de CASPe i QARI. Els resultats s’han classificat segons el país europeu, el professional sanitari i s’han organitzat segons tres temàtiques, en funció de la informació aportada per cada article: rol en el cribratge prenatal, ecografia obstètrica i coneixements genètics. RESULTATS. En cada país europeu, les tasques realitzades per les infermeres/llevadores són similars però no iguals. No hi ha una legislació que defineixi quines competències han de tenir dins del cribratge. A Europa, la Infermera de Pràctica Avançada encara li falta agafar reconeixement, però els Estats Units, és un país on aquest concepte es troba més desenvolupat, ja que hi ha tasques que ja són reconegudes com habilitats avançades. CONCLUSIÓ. Les llevadores són les principals responsables del cribratge en la majoria de països europeus. Les tasques són similars, tot i que hi ha algun país on la infermera, amb formació prèvia, està capacitada per realitzar altres funcions. La falta de competències genètiques, produeix un baix domini dels conceptes necessaris per oferir informació i assessorament prenatal. CONTEXTO: La Enfermera de Práctica Avanzada es una figura que avanza de forma diferente en cada país. Todavía falta estudiar sobre qué papel y qué funciones puede realizar dentro del cribado precoz prenatal. OBJETIVO: Describir cuáles son las competencias que la Enfermera de Práctica Avanzada puede desarrollar en el ámbito del cribado prenatal para comparar la legislación española con la legislación de otros países europeos. METODOLOGÍA: La pregunta de investigación es: La figura de la Enfermera de Práctica Avanzada, experta en el cribado precoz prenatal, está más desarrollada en otros países de Europa que en España?. Se realiza una revisión exploratoria en las bases de datos PubMed, Science Direct y Web of Science. Los estudios se han publicados los últimos 10 años y todos hablan del cribado prenatal. La evaluación del rigor científico ha analizado mediante las escalas de CASPe y QARI. Los resultados se han clasificado según el país europeo, el profesional sanitario y se han organizado según tres temáticas, en función de la información aportada por cada artículo: rol en el cribado prenatal, ecografía obstétrica y conocimientos genéticos. RESULTADOS: En cada país europeo, las tareas realizadas por las enfermeras / matronas son similares pero no iguales. No hay una legislación que defina qué competencias deben tener dentro del cribado. En Europa, la Enfermera de Práctica Avanzada todavía le falta coger reconocimiento, pero los Estados Unidos, es un país donde este concepto se encuentra más desarrollado, ya que hay tareas que ya son reconocidas como habilidades avanzadas. CONCLUSIÓN: Las matronas son las principales responsables del cribado en la mayoría de países europeos. Las tareas son similares, aunque hay algún país donde la enfermera, con formación previa, está capacitada para realizar otras funciones. La falta de competencias genéticas, produce un bajo dominio de los conceptos necesarios para ofrecer información y asesoramiento prenatal. CONTEXT: The Advanced Practice Nurse is a figure that advances differently in each country. There is still a long way to go to study what role and what functions it can perform within prenatal early screening. OBJECTIVE: To describe the competencies that the Advanced Practice Nurse can develop in the field of prenatal screening to compare Spanish legislation with the legislation of other European countries. METHODOLOGY: The research question is: Is the figure of the Advanced Practice Nurse, an expert in early prenatal screening, more developed in other European countries than in Spain?. An exploratory review is performed on the PubMed, Science Direct, and Web of Science databases. The studies have been published for the last 10 years and all of them talk about prenatal screening. The assessment of scientific rigor has been analyzed using the CASPe and QARI scales. The results were classified according to the European country, the health professional and were organized according to three themes, based on the information provided by each article: role in prenatal screening, obstetric ultrasound and genetic knowledge. RESULTS: In each European country, the tasks performed by nurses / midwives are similar but not the same. There is no legislation that defines what competencies they should have within screening. In Europe, the Advanced Practice Nurse still needs recognition, but the United States is a country where this concept is more developed, as there are tasks that are already recognized as advanced skills. CONCLUSION: Midwives are the main culprits in screening in most European countries. The tasks are similar, although there are some countries where the nurse, with prior training, is trained to perform other functions. The lack of genetic skills produces a low mastery of the concepts needed to provide prenatal information and counseling.

Aims and objectivesThe role of professional doctorates is receiving increased attention internationally. As part of building the rigour and scholarship of these programmes, we assessed projects undertaken as part of a doctor of nursing practice (DNP) programme at Johns Hopkins University. Recommendations for programme development in professional doctorates are provided.BackgroundPast research has described the methodologic limitations and dissemination of DNP projects. However, few studies have provided recommendations for strengthening these projects and alternative strategies for achieving scale in larger student cohorts.DesignA descriptive study reported in accordance with STROBE guidelines.MethodsFrom 2009-2018, 191 final DNP project reports were obtained from the DNP programme administrator. Essential project characteristics from the papers were extracted, including use of theoretical framework, design, setting, sample and dissemination through publication. To determine whether the results of the projects had been published, the title and student's name were searched in Google Scholar and Google.ResultsOf the 191 projects, 83% focused on adults and 61% were conducted in the hospital setting. Sample sizes ranged from 7 to 24,702. Eighty per cent of the projects employed a pretest/post-test design, including both single and independent groups. The projects spanned six overarching themes, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment. Twenty-one per cent of the project findings were published in scholarly journals.ConclusionsConducting a critical review of DNP projects has been useful in refining a strategy shifting from incremental to transformative changes in advanced practice.Relevance to clinical practiceProgramme evaluation is critical in order to sufficiently prepare nurses in advanced nursing practice to influence healthcare outcomes at the individual or population level.

Aims and Objectives: To explore the effectiveness of nurse-led interventions to prevent urinary tract infections in older adults living in residential aged care facilities. Background: While most empirical studies focus on the treatment of urinary tract infections, few studies have examined the effectiveness of nurse-led interventions in preventing urinary tract infections. Design: Systematic review. Methods: Eight electronic databases were searched for relevant studies published between 2008–2018. The inclusion criteria were as follows: (a) a focus on older adults, (b) evaluation of nurse-led interventions, focusing on prevention of urinary tract infection, (c) implemented in residential aged care facilities, and (d) outcomes reported as incidence or prevalence of urinary tract infection. The selected papers were critically appraised using the Mixed Methods Appraisal Tool. The data were analysed with narrative synthesis, and findings were reported following the PRISMA guidelines. Results: A review of 1,614 titles and abstracts identified four studies that met the inclusion criteria. Three types of nurse-led interventions were identified: (a) the appointment of advanced practice nurses, (b) those focused on a single specific nursing intervention, and (c) implementation of a multicomponent nursing intervention. All included studies reported at least some positive outcomes. However, the included studies were highly heterogeneous and it was impossible to determine the most effective intervention approach. Conclusions: Nurses are leaders in health care and are well placed to lead prevention of urinary tract infections in residential aged care; however, evidence of the effectiveness of a nurse-led approach is limited. High-quality randomised controlled trials are warranted to address the knowledge gap and advance practice in this area. Relevance to clinical practice: When developing an effective nurse-led intervention programme, the programme should be grounded in nurse-led principles and consider the complex staffing factors to ensure that nurse-led programmes are tailored to an effective level.

Resumo Objetivos: (i) Delinear os passos e progressos realizados pelo Chile para implementar a prática avançada do papel da enfermagem usando o Enfoque PEPPA (Participatory Evidence-based Patient-focused Process) como guia, (ii) demonstrar a eficácia da estrutura do PEPPA para a identificação de barreiras e guiar o processo de implementação, e (iii) discutir os próximos passos para a implementação do papel da enfermagem. Métodos: O enfoque inclui nove etapas em um processo flexível e iterativo. Resultados: O presente estudo fornece uma análise aprofundada das atividades empregadas para cada etapa do Enfoque PEPPA e sua contribuição para o desenvolvimento do papel da enfermagem na prática avançada no Chile. Em particular, as atividades de participação das partes interessadas foram essenciais para informar os principais decisores e formuladores de políticas de saúde sobre o papel das práticas avançadas de enfermagem, obtendo sua adesão e apoio ao papel da enfermagem e estabelecendo um consenso sobre suas prioridades. As estratégias usadas para superar alguns desafios na implementação das etapas do PEPPA também são discutidas, juntamente com os próximos passos para avaliar e monitorar a implementação e o estabelecimento do papel da enfermagem na prática avançada a longo prazo. Conclusão: O Enfoque PEPPA fornece diretrizes importantes para os países em que a prática avançada do papel da enfermagem está recém sendo introduzida, por meio da identificação e análise de barreiras para o delineamento eficaz do papel e sua implementação exitosa. Resumen Objetivos: (i) Delinear los pasos y avances logrados por Chile para implementar el rol de la práctica avanzada de enfermería utilizando el enfoque PEPPA (Participatory Evidence-based Patient-focused Process) como guía, (ii) demostrar la eficacia de la estructura del PEPPA para identificar barreras y guiar el proceso de implementación, y (iii) debatir los próximos pasos para la implementación de roles. Métodos: El enfoque incluye nueve etapas dentro de un proceso flexible e interactivo. Resultados: El presente estudio ofrece un análisis profundo de las actividades empleadas en cada etapa del enfoque PEPPA y su contribución al desarrollo del rol de la práctica avanzada de enfermería en Chile. En particular, las actividades de participación de las partes interesadas fueron esenciales para informar a los principales tomadores de decisiones y formuladores de políticas de salud sobre el rol de las prácticas avanzadas de enfermería, con lo que se obtuvo su adhesión y apoyo al rol de la enfermería y se estableció un consenso sobre las prioridades. También se discuten las estrategias usadas para superar algunos problemas de la implementación de las etapas del PEPPA, junto con los próximos pasos para evaluar y monitorear la implementación y el establecimiento del rol de la práctica avanzada de enfermería a largo plazo. Conclusión: El enfoque PEPPA ofrece importantes directrices para los países en que el rol de la práctica avanzada de enfermería está recién siendo introducido, por medio de la identificación y análisis de barreras para el diseño eficaz de roles y su correcta implementación. Abstract Objectives: (i) Outline the steps and progress made by Chile to implement the advanced practice nursing role using the PEPPA framework as a guide, (ii) demonstrate the effectiveness of the PEPPA framework to identify barriers and guide the implementation process, and (iii) discuss the next steps for role implementation. Methods: The framework includes nine steps in a flexible and iterative process. Results: This paper provides an in-depth analysis of activities employed for each step of the PEPPA Framework and their contribution to advanced practice nursing role development in Chile. In particular, stakeholder engagement activities were essential for informing key health care decision and policy-makers about the advanced practice nursing role, obtaining their buy-in and support for the role, and establishing consensus on role priorities. Strategies used to overcome some challenges in implementing framework steps are also discussed along with next steps to evaluate and monitor the implementation and establishment of the advanced practice nursing role in the long term. Conclusion: The PEPPA Framework provides important guidance for countries where advanced practice nursing roles are just being introduced by identifying and addressing barriers to the effective role design and successful implementation.

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.

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN’s roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.

Advanced practice registered nurses (APRNs) are leaders in clinical practice, systems-level care delivery, nursing practice, and policy. The challenge is that in the current environment, their leadership is not highlighted. With the national shortage of palliative care clinicians, APRN leaders will be necessary to care for all the patients and their families with serious illness. While many programs describe their APRNs as leader in clinical care, there is not much written about their leadership in other areas. This paper provides a description of APRN palliative care leadership and opportunities across all domains of clinical care, education, advocacy/policy, research, and administration/management.