A nurse is “the agent of a patient doing for a patient what he would do for himself if he were able” (Husted & Husted, 2001).Thus, nursing has always been regarded to as one of the professions with the most responsibilities and accountabilities and Gastmans (1998) states, “The nurse functions both as a professional and as a human being within a variety of contexts. These contexts influence directly or indirectly the way in which the nurse performs caring tasks.”
Nevertheless, the scope of nursing has continued to expand over the years to meet the demands of the growing public in matters of health concerns in general. One area of nursing that practically evolved is advanced practice nursing and its practice showed the multi-faceted world of the nursing profession.
Moreover, Advanced Practice Nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. (Brayant –Liusd, Dicensoa, Browneg & Pinellij ( 2004). In addition, Advanced Practice Nurse (APN) is nurse with a masters degree and it falls into 4 categories namely: Nurse Practitioners (NP) whose main function includes provision of basic care focused on a specific population or health need, including writing prescriptions and Certified Nurse Anesthetist (CRNA) whose job is to administer anesthesia for all types of surgery. The other two categories of APN are Clinical Nurse Specialist (CNS) and Certified Nurse Midwife (CNM) who provide specialist care in a number of areas: cardiology, oncology, neonatology, OB/GYN, pediatrics, neurology, and mental health and provide prenatal care, delivers babies, and provide postpartum care to normal healthy respectively.
Moreover, the evolution of APNs has been a major event in the history of nursing. While each of the four APN disciplines—clinical nurse specialist, nurse practitioner, certified nurse midwife, and nurse anesthetist—has a unique history and place within nursing, the commonalities have established a force within health care that has changed the way care is delivered and will continue to change the system. In fact, the commonalities provide a critical basis for forging an even more powerful coalition of APNs to tackle common challenges related to ensuring patients get the best care possible. The social contract that nurses have with the public is unique, and APNs have extended that contract to higher levels of service, decision-making, and accountability. (Stanley, 2005).
Furthermore, advanced practice nursing includes a variety of roles in which nurses function at an advanced level of practice (ANA 1995a, Brown 1998, RCNA 2000). In countries such as the United States, where legislation, regulatory mechanisms and protected titles for clinical nurse specialists, nurse midwives, nurse anaesthetists, and nurse practitioners exist, there is less difficulty distinguishing APN roles. However, most countries do not have protected titles and there is no international agreement about the use of titles to distinguish APN roles. Role confusion arises when the same title, such a nurse specialist is applied to different roles with varied purposes, educational preparation, and scopes of practice (Alcock 1996, Bamford & Gibson 2000, Whyte 2000). Role compe- tencies involving domains of advanced nursing practice related to clinical practice, education, research, organizational leadership, and professional development are better indicators of APN roles than role titles alone. There is mounting agreement that graduate education combined with practice experience is required for APN roles (ANA 1995a, CNA 2000, RCNA 2000, ICN 2003).
Health care restructuring in many countries has led to substantial
increases in the different types and number of APN roles. (Brayant –Liusd, Dicensoa, Browneg & Pinellij ( 2004). This is imperative so that every client needs are catered appropriately. In Hongkong, nursing profession is practiced with the ultimate goal of providing its citizen the quality care they deserve. In fact, The College of Nursing, Hong Kong promotes the highest possible standards of professional nursing endeavor by determining and examining issues relevant to nursing practice and the health of the community; initiating and supporting research to seek solutions to nursing and health related problems; taking action on issues of significance to nursing and health; promoting and facilitating professional development in areas of clinical practice, management and education; disseminating information on issues of significance to nursing and health; advising and contributing to the formulation and implementation of nursing and health related policies; providing an advisory and consultative service to Government and other bodies on nursing and health related matters; promoting social and international links with nursing and other professional and educational establishments and securing the widest possible representation of the nursing profession in order to increase the effectiveness of its service to members and the profession. [The College of Nursing, Hongkong. Available at http://www.fmshk.com.hk/conhk/frame2.htm. (Accessed at 25/01/2008.]
Furthermore, the mission of the Nursing Council of Hongkong is to fulfill the statutory obligations as stipulated in the Nurses Registration Ordinance and to ensure the quality of nursing practice in Hong Kong meeting the rapidly changing health care needs of the society through the establishment of a registration system, provision of guidance and intervention with discipline. In addition to that, the then Nursing Board of Hong Kong formulated in 1986 a Code for Professional Conduct for Nurses in Hongkong. This is to keep pace with contemporary health care development commensurate with societal and cultural changes, the Nursing Council of Hong Kong which replaced the Nursing Board of Hong Kong in 1999 has now revised the code and also devised a Code of Ethics for an accurate representation of Nurses’ ethical responsibilities. The Code of Ethics is adapted largely from the “Code of Ethics for Nurses in the New Millennium” published in a Chinese nursing magazine with due regard to practices in the international community.
According to The Nursing Council of Hong Kong Code of Professional Conduct and Code of Ethics for Nurses in Hong Kong each nurse (registered or enrolled) is accountable for his/her practice. In the exercise of his/her professional responsibilities, each nurse has an obligation to uphold and adhere to the Code of Professional Conduct for Nurses in Hong Kong and the code aims to make explicit the standards for professional conduct that nurses shall act at all times in their course of duty. It may also serve to provide the public with a basis for decisions regarding standards of professional conduct. Moreover, the Code of Professional Conduct for Nurses in Hong Kong highlights eight aspects of professional conduct that nurses are to comply with in discharging their professional duties and the explanatory statements provide guidelines regarding the way each aspect of professional conduct is to be enacted in practice situations. [The Nursing Council of Hongkong Code of Professional Conduct and Code of Ethics for Nurses in Hongkong. Available at http://www.nchk.org.hk/conduct/conduct_eng.pdf (Accessed at 25/01/2008.)
It can then be summarized that to be able to practice the nursing profession in Hongkong, one should uphold upright moral values, discipline, empathy and most importantly sound decision making skills. Aside from these, advanced practice in Hong Kong includes clinical skills, education, research and consultancy (Wong, 2001). Meanwhile, decision-making is what which most characterizes advanced practice and underlying decision-making are clinical judgments, scholarly inquiry, and leadership. The work of the advanced nurse is practice, the product is patient care; therefore, leadership in the advanced practice role supports the scientific process by: interpreting the context of practice, demonstrating influences on care and leading changes in practice. (Erickson & Sheehy, 1998.) Benner, Tanner, and Chelsa (1996) added, “The development of clinical expertise inherently demands the development of ethical expertise.” But if developed together will yield favorable outcome. Ethical reasoning and clinical judgment share a common process, and both serve to teach and inform the other. The importance, therefore, of attention to clinical practice, regardless of how far removed an APN is from the clinical setting, cannot be overemphasized (Solomon, et al., 1991.)
On the other hand, advance practice nursing has its share of legal and professional implications. Rapid advances in technology make many demands on the character, education, and abilities of the advanced nurse practitioner. The emphasis on scientific developments throughout the past several centuries has caused ethics to take a quantitative rather than a qualitative approach. Science has sought to separate itself from concerns about human values and values systems. (Callahan & Mannino, 1998.) That ethical decision-making skills are part of the core competencies of all APNS is a basic tenet and central to the definition of advanced nursing practice (Reigle, 1996). It is paramount also that the ethical aspects of her practice will be coupled with the clinical aspects.
Husted & Husted ( 1998) stressed that an APN has come to a state of development wherein she can interweave the ethical and professional aspects of her practice. She may well have adopted some aspects of a practice-based ethic. Nothing does more to produce effective professional practice. She can master skill in ethical decision making by attending to what is important in her patient’s life. In doing this, she will establish pride in what she is and what she is doing. Thus, the Code of Ethics for Nurses in Hong Kong aims to make explicit the fundamental moral commitments of the profession; provide nurses with a basis for ethical practice, and to indicate to the community the values that nurses hold.
The Code of Ethics for Nurses in Hong Kong is organized around four broad value statements and seventeen provisions that represent the morals and ideals of the profession and are regarded as central to ethical nursing practice. The four broad value statements are: Respect life, and improve quality of life; Respect individual rights and dignity; Be responsive to society’s needs, and work towards a healthy community through partnership; Strive for excellence, and assure quality of care. The provisions articulated in each value statement are ethical responsibilities that nurses should act upon in order to enact the broad values in practice situations. For each of these statements, the scope of responsibilities identified extends beyond individuals to include families, communities and society. By upholding these values in practice, it is envisaged that nurses can improve their personal quality, provide quality nursing care and earn the trust of those under their care. [The Nursing Council of Hongkong Code of Professional Conduct and Code of Ethics for Nurses in Hongkong. Available at http://www.nchk.org.hk/conduct/conduct_eng.pdf (Accessed at 25/01/2008.)
Meanwhile, the Nursing Council's powers in this regard are as laid down in the Nurses Registration Ordinance, the Nurses (Registration and Disciplinary Procedure) Regulation and the Enrolled Nurses (Enrolment and Disciplinary Procedure) Regulation, Cap. 164, Laws of Hongkong and complaint against a registered nurse or an enrolled nurse for professional misconduct should be forwarded in writing to the Secretary who will then refer it to the Chairman of the Preliminary Investigation Committee (PIC) for consideration. It is the PIC that will decide whether to dismiss the complaint or refer it to the Council for inquiry. The Council, at the conclusion of the inquiry, will exercise its powers in accordance with the Ordinance and make such disciplinary awards as it deems fit. [The Nursing Council of Hong Kong. Available at http://www.nchk.org.hk/council/index.htm. Accessed at (25/01/2008.)
(Wong 1997) reiterates that much more work is still to be done to drive the role of nurse practitioners forward in Hongkong and ‘Not only after the NP position is recognized and legitimized, and that the education program meets the global credential criteria, that these NPs then have the power in the organization to make claims and to control work in their role and expertise. It is important that clients’ needs are carefully assessed ensuring that optimal level of care is rendered in a low cost setting. Evidence suggests that advance nursing practice provides cost effective care in terms of patient outcomes as well as the benefits of advanced nursing practice outweighing any costs of introducing such approaches to practice (Byers & Brunell, 1998; Schroeder, et al., 2000). Further research of advanced nursing practice in public health nursing suggests that although findings consistently demonstrate high levels of patient satisfaction, research needs to be extended to include patient groups with more complex health needs and chronic diseases (Horrocks, et al., 2002).
Wong (1997) pointed out the global trend in advance practice nursing such as the increasing initiative of developing NP educational programs in various countries and a global interest in promoting the highest quality of educational preparation and she suggested that there should be a criteria or guideline of NP program education at the international level.
In conclusion, introduction and evaluation of APN roles warrant greater
attention to the concept of advancement, other attributes of advanced nursing practice, and environmental factors that affect APN roles. Lack of clarity about the multi-dimensional nature and mandate of APN roles to improve patient health through innovation in nursing and health care delivery is a central barrier to the optimal utilization of APN roles. The ad hoc introduction of APN roles suggests the nursing profession and APN community must provide stronger leadership by: establishing consensus and communicating clearer messages about the purpose, scope and education of APN roles; providing organizations with guidance about the introduction of APN roles; and advocating for health polices that support APN role development. Advanced practice nursing roles interact across various clinical settings and influence change to improve patient health through clinical, educational, professional development, organizational, and research activities (Corner et al. 1995, Davies & Hughes 1995, Plant et al. 2000, Brooten et al. 2002, McGee & Castledine 2003). This broad vision of APN suggests the need for a systems approach to role introduction that recognizes the environments in which the roles operate. Of primary importance is identification of social factors or patient health needs and stakeholder expectations for how the APN role will improve care delivery. Existing models of care delivery are defined by health care provider roles and relationships, and are influenced by stakeholder values, beliefs, and experiences with APN (Dunn & Nicklin 1995, Beal et al. 1997, Woods 1998, Cameron & Masterson 2000). Role implementation is affected by the role acceptance and support of administrators and health care providers. These stakeholders must participate in the introduction of APN roles in order to promote role clarity, systems entry, and integration of roles within local environments. The value added component of APN roles involves maximizing health and quality of life through coordinated,
holistic, patient-centred care (Watson 1995, Bredin et al. 1999, Brooten et al. 2002). The extent to which medically- driven and illness-oriented health systems permit these dimensions of care is a challenge for developing innovative APN roles. Therefore, the process of role introduction must include strategies to promote social change consistent with the fundamental values of APN. Many barriers to realizing the full potential of APN roles could be avoided with better planning and systematic efforts to develop and evaluate APN roles. (Brayant –Liusd, Dicensoa, Browneg & Pinellij ( 2004.)
BIBLIOGRAPHY
Alcock D.S. (1996) The clinical specialist, clinical nurse specialist/ nurse
Practitioner and other titled nurse in Ontario.Canadian Journal of Nursing Administration Jan–Feb, 23-44
ANA (1995a) Standards of Clinical Practice and Scope of Practice for the Acute
Care Nurse Practitioner. American Nurses Association. Washington, DC, USA
Barnes, D. M., & Boyle, J. S. (1995). Transcultural concepts in nursing case (ed.
2).Philadelphia: Lippincott.
Benner, P., Tanner, C. A., & Chelsa, C. A. (1996). Expertise in nursing practice.
New York: Springer
Bryant-Lukosius, D. et al (2004). Advanced nursing practice role: development,
implementation and evaluation. Canada: Blackwell Publishing, Inc.
Byers, J.F. & Brunell, M.L. (1998). Demonstrating the value of the advanced
practice nurse: an evaluation model. Advanced Practice in Acute and Critical Care, 9(2), 296-305
Callahan, L., & Mannino, M. J. (1998). Legal aspect of advanced nursing
practice. In Sheehy, C. M., & McCarthy, M. C. (Eds.), Advanced practice
nursing (pp. 281–302). Philadelphia: F.A. Davis.
Corner J., Plant H., A’Hern R. & Bailey C. (1996) Non-pharmacological
intervention for breathlessness in lung cancer. Palliative
Medicine 10, 299–305
Dunn K. & Nicklin W. (1995) The status of advanced nursing roles
in Canadian teaching hospitals. Canadian Journal of Nursing
Administration Jan–Feb, 111–135
Erickson, R., & Sheehy, C. M. (1998). Clinical research in the advanced practice
role. Philadelphia: F.A. Davis.
Gastmans, C. (1998). Challenges to nursing values in a changing nursing
environment.Nursing Ethics, 5, 236–245.
Horrocks, S., Anderson, E. & Salisbury, C. (2002). Systematic review of whether
nurse practitioners working in primary care can provide equivalent care to
doctors. British Medical Journal, 324, 819-823.
Husted, G. L., & Husted, J. H. (2001). Ethical decision making in nursing and
health care: The symphonological approach (ed. 3). New York: Springer
Reigle, J. (1996). Ethical-decision making skills. In Hamric, A. B., Spross, J. A., &
HansonC. M. (Eds.), Advanced nursing practice: An integrative approach
(pp. 273–295).Philadelphia: Saunders
Stanley, J. M. (2005). Advanced Practice Nursing: Emphasizing Common Roles
Edition 2. Philadelphia: F.A. Davis Company
Solomon, M. Z., Jennings, B., Guilfoy, V., Jackson, R., O’Donnell, L. Wolf, S. M.,
Nolan,K., Koch-Weser, D., & Donnelley, S. (1994). Toward an expanded
vision of clinicalethics education: From individual to the institution.
Kennedy Institute of Ethics Journal, 1,224–226
Styles M. & Lewis C. (2000) Conceptualizations of advanced nursing
practice. In Advanced Nursing Practice: An Integrative Approach
(Hamric A.B., Spross J.A. & Hanson C.M., eds), W.B. Saunders,
Philadelphia, pp. 33–51.
Watson J. (1995) Advanced nursing practice…and what might be.
Nursing & Health Care: Perspectives on Community 16, 78–83
Wong, F.K.Y. (2001). Senior clinical nurse specialist pilot position in Hong Kong.
Clinical Nurse Specialist, 15(4), 169-176.
Wong, F. (2002). Development of advanced nursing practice in Hong
Kong: A celebration of ten years’ work. The Hong Kong Nursing
Journal.38(3), 25-29.
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