Advanced Practice in Nursing and the Allied Health Professions, 3rd Edition

Contributors xi

Introduction xiii

1 The Development of Advanced Nursing Practice in the United Kingdom 1
Paula McGee

Introduction 1

Health policies and reforms 2

The UKCC and higher-level practice 4

The interface with medicine 4

The introduction of new roles 8

Modern matrons 8

Nurse consultants 8

Physicians’ assistants 9

Nurse practitioners and the Royal College of Nursing 9

The Nursing and Midwifery Council 11

Conclusion 12

Key questions for Chapter 1 12

References 12

2 UK Health Policy and Health Service Reform 15
Alistair Hewison

Introduction 15

The policy process 16

Labour health policy since 1997 17

UK health policy and its implications for advanced nursing practice 19

Advanced nursing practice 20

Advanced nurses as policy implementers 23

Conclusion 24

Key questions for Chapter 2 25

References 25

3 Advanced Practice in Allied Health Professions 29
Paula McGee and David Cole

Introduction 29

The introduction of the consultant allied health professional 30

Physiotherapy 33

Radiography and sonography 35

Sonography: an example of advanced radiography role 37

Are these new roles in physiotherapy and radiography/sonography advanced? 39

Conclusion 41

Key questions for Chapter 3 41

References 41

4 The Conceptualisation of Advanced Practice 43
Paula McGee

Introduction 43

The context of the development of advanced practice 43

The nature of advanced practice 45

Professional maturity 46

Challenging professional boundaries 46

Pioneering innovations 49

Is advanced practice a generic term? 53

Conclusion 53

Key questions for Chapter 4 54

References 54

5 Advanced Assessment and Differential Diagnosis 56
Paula McGee

Introduction 56

The nature of advanced assessment 57

Types of advanced assessment 58

Conducting an advanced assessment 63

Limitations of advanced assessment 64

Formulating a differential diagnosis 64

Conclusion 68

Key questions for Chapter 5 68

References 68

6 Prescribing and Advanced Practice 70
Sue Shortland and Katharine Hardware

Introduction 70

Recent developments in non-medical prescribing 71

Preparation for prescribing 72

Who may prescribe what? 73

Nurses 73

Allied health professionals 73

Controlled medicines 74

Patient group directions 74

Emergency situations 74

The principles of safe prescribing 75

Safety and clinical governance 76

The future of non-medical prescribing 77

Conclusion 78

Key questions for Chapter 6 78

References 78

7 Advanced Practice in Dietetics 81
Linda Hindle

Introduction 81

Reasons for the development of consultant roles in dietetics 82

The consultant role 82

Working as a consultant in obesity management 83

Role development 83

Clinical practice 83

Professional leadership 84

Education, training and professional development 87

Service development, research and evaluation 88

Setting up a consultant post 89

Examples of dietetic consultant roles 90

Conclusion – the future for consultant dietitians 93

Key questions for Chapter 7 94

Acknowledgements 94

References 95

8 Advanced Practice in Occupational Therapy 97
Lynne Frith and Janette Walsh

Introduction 97

Advanced practice in occupational therapy 98

Specialist roles in occupational therapy 98

Clinical caseload and expertise 99

Clinical leadership 99

Clinical teaching and mentoring 99

Specialist advisory role 99

Consultant roles in occupational therapy 100

Expert clinical practice 100

Practice and service development 100

Professional leadership and consultancy 100

Research audit and evaluation 101

Education, training and development 101

The clinical specialist and consultant occupational therapist as advanced roles 101

Current issues for consultant occupational therapists 103

The future for occupational therapists 104

Conclusion 105

Key questions for Chapter 8 105

References 105

9 Working as an Advanced Nurse Practitioner 107
Mark Radford

Introduction 107

Defining a need 108

Organisational preparation 110

Job planning 111

Maintaining focus and delivery 112

Developing strategic influence 113

Consultancy and entrepreneurship 114

Review and evaluation 116

Career progression 119

Conclusion 121

Key questions for Chapter 9 121

Acknowledgements 121

References 122

10 Pioneering New Practice 124
Kate Gee

Introduction 124

Background to the quadrant model 124

The quadrant model 127

Quadrant 1: pioneering innovations in technical acute cure cultures 128

Quadrant 2: pioneering innovations in high-technology/care cultures 130

Quadrant 3: pioneering innovation in low-technology/cure cultures – strategies for patient education and rehabilitation 131

Development of ICD nursing expertise 132

Development of heart failure nursing expertise 132

Quadrant 4: pioneering innovations in low-technology/care quadrant 134

Conclusion 136

Key questions for Chapter 10 137

References 137

11 Cultural Competence in Advanced Practice 141
Paula McGee

Introduction 141

Culture and equality 142

Cultural relationships among health, illness, treatment and care 145

Theoretical approaches to culturally competent practice 146

Papadopoulos, Tilki and Taylor’s theory of cultural competence 147

Purnell and Paulanka’s theory of cultural competence 149

McGee’s theory of cultural competence 150

Relevance of theory to advanced practice 153

Conclusion 155

Key questions for Chapter 11 155

References 155

12 Leadership in Advanced Practice: Challenging Professional Boundaries 158
Sally Shaw

Introduction 158

Leadership in advanced practice 159

Theories and characteristics of leadership 160

What leadership is not 160

Leadership can be learned 161

What is leadership? 161

Theories of leadership 161

Key elements of leadership 162

Other important leadership characteristics 165

The setting for leadership 166

The followers 168

Leadership styles and their relevance for advanced practice 169

Sustaining and nurturing leaders 172

Indicators of effective leadership 174

Conclusion 175

Key questions for Chapter 12 175

Acknowledgements 175

References 176

13 Management Issues in Advanced Practice 177
Paula McGee and Mark Radford

Introduction 177

Managing the self 178

Management issues and their implications for advanced practitioners 180

Current health service priorities 181

Modernising health professionals’ careers 183

Patient and public involvement in health care 184

The strategic and business plans 185

Managing advanced practice roles 186

The advanced practitioner as manager 188

Conclusion 189

Key questions for Chapter 13 189

References 189

14 The Preparation of Advanced Practitioners 192
Paula McGee

Introduction 192

The concept of competence 193

Competencies for advanced practice 195

The educational preparation of advanced practitioners 201

Clinical doctorates 204

Conclusion 206

Key questions for Chapter 14 207

References 208

15 The Careers of Advanced Practitioners 210
Chris Inman and Paula McGee

Introduction 210

Context of the survey 211

Findings 212

Employment issues 212

Perceptions of the role and its effects on practice 214

Evaluation of the advanced practice role 217

Perceived helpfulness of the preparation for the advanced practice role 217

Career development 219

Consultant practitioners 220

Discussion 221

Conclusion 225

Key questions for Chapter 15 225

References 225

16 An International Perspective of Advanced Nursing Practice 227
Madrean Schober

Introduction 227

Factors contributing to the emergence of advanced nursing practice globally 228

Extent of international presence 229

An international presence marked by confusion 230

Advanced nursing practice defined: an international view 231

Characteristics 231

Country illustrations of development 234

The role of international organisations 235

Scope of practice, regulation and standards 236

Practice settings 237

Interaction with health professionals 238

Future directions in advanced nursing practice 239

Conclusion 240

Key questions for Chapter 16 240

Acknowledgements 241

References 241

17 The Future for Advanced Practice 243
Paula McGee

Introduction 243

An agenda for research 244

Direct practice 244

Collaboration with service users 245

Diversity and inclusiveness 247

Professional regulation and control 248

Education and assessment 250

Recording developments 250

Conclusion 251

References 253

Index 255