Perspectives of the Advanced Nursing Practice in Brazil and in the world

Allyne Fortes Vitor1
1 Federal University of Rio Grande do Norte

ABSTRACT

Changes in the nature of health requirements, given the new contexts, involve reorientation of care in order to contemplate the current demands and guarantee the principles of access to quality care. One of the paths to be followed for this purpose points to the Advanced Practice in Nursing. In essence, the Advanced Practice in Nursing, in countries whose area of operation is already consolidated, means the patient's first contact with the health care network. Promotes the progress of Nursing science, enhances theoretical knowledge of discipline and enhances disciplinary knowledge. For this process of change, there is a need for robust and wide-ranging discussions throughout the national territory on fundamental legislative changes regarding the professional practice of nurses and the evolution of nursing education to an advanced level of integration between research, education, practice and management.

Descriptors: Advanced Practice in Nursing; Evidence-Based Clinical Practice; Clinical Competence; Health Care.

The global and Brazilian health context has experienced new health needs, directly or indirectly influenced by epidemiological updates due to the natural aging of the population, the prevalence and incidence of emerging and reemerging diseases, or the broad spectrum of notoriously more frequent chronic clinical conditions(1). Changes in the nature of health requirements, in the face of new contexts, involve the reorientation of health systems in terms of redefining and updating human resources and improving the cost-benefit ratio of care, in order to take into account the existing demands and guarantee the principles of access to quality care(2,3). One of the paths to be followed for this purpose points to the Advanced Practice in Nursing.

In essence, the Advanced Practice in Nursing, in countries whose area of operation is already consolidated, means the patient's first contact with the health care network, through a high degree of professional autonomy and independent practice, advanced skills in health assessment, competence for decision and diagnostic reasoning, provision of consulting services to other health professionals, organizational skills recognized by the health network, planning, implementation, and evaluation of public health policies and programs(3).

According to the International Council of Nursing, the general characteristics of the role of Advanced Nursing Practice include the right to diagnose, prescribe treatment, refer patients to other professionals, and intern patients in a hospital, although not necessarily reflect the role played in all countries(4).

This refers to the fundamental adequacy of the health professionals' exercise models, and therefore includes progress in nurses' competencies and functions, incorporation of strong evidence in the practices and implementation of systematized care in a standardized language, from the perspective of nurses' empowerment for the best health decision(5).

By targeting the decision-making process for quality and safe care, aiming at the health of the individual and the population, the Advanced Practice in Nursing enables the intersection between profession, science, and discipline(6). It promotes, through the use of the best research results, progress as a science, in an evidence-based practice that, in turn, feeds the theoretical knowledge of the discipline, deductively applies theories in the field of assistance, and also permeates the development of inductive verifications that provide material for the enhancement of their disciplinary knowledge, such as the classification systems (Figure 1).

In this sense, it becomes possible to glimpse the translation of knowledge, the solution of health problems, the resolution of gaps between the academic panorama and the professional practice, in the process of evolution and consolidation of nursing.

Figure 1. Advanced Practice in Nursing and the translation of knowledge Subtitle: PE (Nursing Process, acronym in Portuguese); EBE (Evidence-Based Nursing, acronym in Portuguese)

Brazilian Nursing, in consonance with its indelible ancestors, progresses in differentiating its knowledge from other disciplines, as recommended by Florence Nightingale. This perspective of linking the past, present and future suggests the development of practice based on the best evidence, as a way to decide on systematized care, directed to advanced care and human needs.

For this process of change, there is a need for robust and wide-ranging discussions throughout the national territory on fundamental legislative changes regarding the professional practice of nurses and the evolution of nursing education to an advanced level of integration between research, education, practice, and management.

To do so, this training for Advanced Practice in Nursing requires advanced educational preparation, through the formal recognition of postgraduate programs accredited by a formal system of licensing, registration, certification and accreditation of advanced practice nurses in the country. During training, nurses must acquire advanced clinical knowledge and skills for direct and indirect care to patients, although the defining factor is education and, mostly, the practice focused on the direct care of individuals(7).

Depending on the appropriate adaptations to the specific regulatory model for Brazil, the training may include masters and doctoral levels. The curricular comprehensiveness leads to advanced clinical practice, organizational leadership, integration of knowledge into practice, development of computer skills and care technologies, knowledge on public policy planning, implementation and evaluation, as well as advocacy on care for the population and inter-professional ethical collaboration to improve health outcomes(8).

When considering the demand to reflect on the constant evolution of its own practice, to meet the scientific and professional advances reached and the principles of the health system where it is inserted, the Brazilian nursing has the challenge to rediscover its own professional identity. It is essential to consider the knowledge and the historically developed skills and achievements reached by this science, discipline and profession. It is related, for example, to the Systematization of Nursing Care, which, similarly to the Advanced Nursing Practice, integrates ethics, incorporation of evidence, contextual flexibility, care quality, communication, leadership, interdisciplinary collaboration, practice evaluation, and knowledge production(9).

These challenges therefore lie in the need to train educators in the Advanced Practice in Nursing, in the development of leadership capacity for their political activities, and in the importance of discussing changes in the national health system that allow nurses to act fully, according to the needs of access to health(8).

For the Brazilian nursing, the delineation of an agenda of discussions in fertile settings, such as curricular components, interest groups, scientific events and interdisciplinary public sessions, is proposed, with a view to contextualize, map and plan the performance of advanced practice nurses, according to the Brazilian characteristics and demands.

REFERENCES

  1. Cassiani Silvia Helena De Bortoli, Rosales Lauren Kelly. Iniciativas para a Implementação da Prática Avançada em Enfermagem na Região das Américas. Esc. Anna Nery [Internet]. 2016 [cited 2018 Aug 26] ; 20( 4 ): e20160081. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452016000400101&lng=en. Epub Aug 25, 2016. http://dx.doi.org/10.5935/1414-8145.20160081

  2. Pan American Health Organization. Strategy for Universal Health Coverage. In: 154th Session of the Executive Committee [Internet]. 2014 June 16-20; Washington, US [cited 2014 September 24]. Available from: file:///C:/Users/Cliente/Downloads/CE154-3-e.pdf

  3. World Health Organization (WHO). Health workforce 2030: towards a global strategy on human resources for health. Geneva: WHO [Internet] 2016 [cited 2018 ago 8]. Available from: http://www.who.int/gho/publications/world_health_statistics/2015/en/

  4. International Council of Nurses. Nurse practitioner/advanced practice nurse: definition and characteristics [Internet]. 2009 [cited 2018 ago 8]. Available from: https://international.aanp.org/Practice/APNRoles

  5. Nurse Practitioner/Advanced Practice Nurse: definition and characteristics. Nursing Matters [Internet]. 2009 [cited 2014 September 24]. Available from: https://acnp.org.au/sites/default/files/33/definition_of_apn-np.pdf

  6. Dowling Maura, Beauchesne Michelle, Farrelly Frances, & Murphy Kathy. Advanced practice nursing: a concept analysis. International Journal of Nursing Practice [Internet]. 2013 [cited 2018 Aug 10]; 19(2): 131-140. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijn.12050

  7. Bryant-Lukosius Denise, Valaitis Ruta, Martin-Misener Ruth, Donald Faith, Peña Laura Morán, Brousseau Linda. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health. Rev. Latino-Am. Enfermagem [Internet]. 2017 [cited 2018 Aug 10] ; 25: e2826. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100301&lng=en. Epub Jan 30, 2017. http://dx.doi.org/10.1590/1518-8345.1677.2826.

  8. International Council of Nurses. Perspectives on Nurse Practitioner/Advanced Practice Nursing in the USA-2012: Update [Internet]. 2012 [cited 2018 ago 8]. Available from: http://icn-apnetwork.org/

  9. Melnyk Bernadette Mazurek. Gallagher‐Ford Lynn, Long Lisa English, Fineout‐Overholt Ellen. The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing [Internet]. 2014 [cited 2018 ago 8]; 11(1): 5-15. Available from:https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12021

  10. Heale R, Rieck Buckley C. An international perspective of advanced practice nursing regulation. Int Nurs Rev. 2015;62(3):421-9. doi: 10.1111/inr.12193 [ Links ]