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Aspects of Nursing Education: The Types Of Skills And Knowledge Required To Meet The Changing Needs Of The Labour Force Involved In Nursing - Literature Review

Appendices

Appendix A

Definition of terms (Alphabetical Order)

The following are terms used frequently throughout this review.

Assistive or support workers in health care

This category includes workers who are generally not regulated through statutory rulings. "They are required to act safely and effectively within their sphere of competence...under the direct or indirect supervision" of a registered nurse (ICN). This includes unlicensed assistants,

Attribute

An attribute "is an inherent characteristic of a person and is used in many cases to distinguish one individual or group of individuals from another (Merriam-Webster's Collegiate Dictionary, 2000, as quoted in KPMG).

Enrolled nurses

Enrolled nurses are regulated by government to practice under the supervision of a registered nurse. Competency standards reflect the standards and scope of practice for which the enrolled nurse is responsible. (ANCI)

Knowledge

Acquaintance with a fact or facts; a state of being aware or informed; awareness, consciousness. Intellectual perception of fact or truth; clear and certain understanding or awareness. (New Shorter Oxford English Dictionary 1993)

Nursing

ICNP® reflects the ICN definition of nursing which follows:Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual, family, and group "responses to actual or potential health problems". These human responses range broadly from health restoring reactions to an individual episode of illness to the development of policy in promoting the long-term health of a population (ICN, 1987).

Nursing workforce

"The Australian nursing workforce consists of nurses educationally prepared at two levels", that being the registered nurse and enrolled nurse (ANCI). The nursing workforce consists of the employed individuals who are regulated by a statutory body. The workforce reflects a fluctuating number and skill mix of full time, part time or casual workers.

Registered nurses

Registered nurses are those who are regulated by government, are accountable to the community and responsible for their own practice. Registration is achieved and maintained through the attainment of standards of competence that reflect expected behaviours, roles and functions. Registered nurses have responsibility for the supervision of enrolled nurses (ANCI).

Role

The characteristic or expected function of a person or thing, in a particular setting or environment. (New Shorter Oxford English Dictionary 1993)

Scope of nursing practice

'Scope of nursing practice' incorporates:

• the settings in which nursing may occur and includes hospitals, primary care services, public health, child health settings, home environment, schools, prisons and the workplace
• the sectors in which nursing may occur and includes primary, secondary or tertiary centres; hospitals, hospital in the home, community care, home care, preventative health, health promotion
• a recognition of specialty and/or generalist nursing practice
• independent or collaborative nursing practice
• clinical practice, consultancy, administration, management, education and research

There is recognition that nursing practice often overlays the practices of other health care professionals and other health care workers.

The scope on nursing practice will in influenced by length and range of experience, attainment of competencies and educational preparation.

Service

Assistance or benefit provided to someone by a person or thing (New Shorter Oxford English Dictionary 1993)

Skills

Skills are "the ability to use knowledge effectively in performing tasks and activities. Skills are not static, but are learned or developed and thus can be acquired and subsequently refined over time." (Merriam-Webster's Collegiate Dictionary, 2000 in KPMG)

Appendix B

Key to in-text abbreviations relating to country of origin:

AUS = Australia

CAN = Canada

NETH = Netherlands

SC = Scandanavia

UK = United Kingdom

USA = United States of America

Appendix C

Nurse Practitioner and Clinical Nurse Specialist

While the role of nurse practitioner was developed and became firmly established in both the USA and Canada approximately thirty years ago, the role has been introduced in the United Kingdom, Australia and New Zealand in the last five to ten years.

Before going on to outline the nurse practitioner literature it is important to have brief background information on the title "nurse practitioner", its protection in legislation and the educational preparation of nurse practitioners since these vary from country to country and between States in Australia. These differences influence the interpretation of the articles.

Background - the title, Nurse Practitioner, and the legislation

In the United States of America nurse practitioners are one of a number of nurses considered under the umbrella title, Advanced Practice Nurse (APN). This umbrella title also includes clinical nurse specialists, nurse midwives and nurse anaesthetists. The title, nurse practitioner or its equivalent (registered nurse practitioner, etc), is protected in legislation in the individual states' Nurse Practice Act (or their equivalent). Nurse practitioners are registered nurses who have additional knowledge and skills in their area of specialty gained through an organised educational program and are certified by the Board of Nursing (or similar body) to engage in practice as an advanced practice nurse.

While the title, nurse practitioner, has been in common use in Canada since the 1970's, and nurse practitioner specific education became available in 1975, the title is not protected in relevant Canadian Acts. Regulation of advanced nursing practice is seen to be '...within the current scope of nursing practice and prevailing regulatory approaches.' (Canadian Nurses Association 1999, p 3)

In the United Kingdom educational programs that prepare nurse practitioners for practice began in 1990, however like Canada, the title 'nurse practitioner' is not protected in legislation.

New Zealand is currently discussing protection of title and in a Nursing Council of NZ document, "the Nurse Practitioner Responding to Health Needs in New Zealand" protection of title is proposed in the interests of public safety.

Australian states have approached nurse practitioners in a variety of ways. New South Wales, following an evaluation of the role in a variety of metropolitan and rural settings, amended the Nurses Act 1991 to provide for nurses to practise as nurse practitioners and the title has been protected since 1998. At least one emergency nurse practitioner and a community nurse practitioner have been appointed.

Victoria had pilot nurse practitioner projects in 1999 and currently has further pilots underway. The title, nurse practitioner, was recently protected in legislation and proclaimed in the Nurses Amendment Act 2000 in December.

In the Australian Capital Territory four pilot nurse practitioner projects are currently underway however the title is not currently protected.

South Australia has had extensive consultation about the role through their Department of Human Services and the Nurses Board is currently seeking comment from key stakeholders on a draft standards statement for NP practice. These standards include protection of title. Similarly in Western Australia the Remote Area Nurse Practitioner Report of April 2000 has recommended that the title nurse practitioner be protected.

Tasmania is also looking at the role but does not appear to have progressed as far as other states. In Queensland the title is not protected and there appears no move to do this however legislative changes have already been made to enable isolated practice nurses to administer specific medications, order x-rays and perform pap smears.

Appendix D

Abstract sorting by broad category and level of evidence

Key

Qual = qualitative study
Ex = expert opinion
Oth = other (literature review, narrative)

Appendix E

Summary of articles by country of origin

Key:

Aus = Australia
UK = United Kingdom
USA = United States of America
Scan = Scandinavia
Can = Canada
Com = Combined (USA/Scan, UK/Aus, UK/USA, Aus/USA)

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