De Geest Sabina, Moons Philip, Callens Betty, Gut Chris, Lindpaintner Lyn, Spirig Rebecca
Institute of Nursing Science, University of Basel, Basel, Switzerland.
Swiss Med Wkly. 2008 Nov 1;138(43-44):621-8. doi: 10.4414/smw.2008.12293.
An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context.
Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented.
Argumentation developed using data based papers and policy reports on Advanced Practice Nursing.
The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role.
Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.
越来越多的国家正在探索引入高级执业护士（APN），如执业护士（NP），作为医疗保健劳动力的一部分。鉴于老年人和慢性病患者数量的增加，这一点尤为重要。在引入之前，深入理解高级执业护理的概念并分析相关背景至关重要。
首先，对高级执业护士和执业护士进行概念澄清。其次，引入一个框架，以协助分析特定医疗保健系统中高级执业护士角色的引入和发展。第三，介绍高级执业护理的结果研究。
利用关于高级执业护理的基于数据的论文和政策报告进行论证。
所提出的框架由五个驱动因素组成：（1）人群的医疗保健需求，（2）教育，（3）劳动力，（4）实践模式，以及（5）法律和卫生政策框架。这些驱动因素协同作用，在时间和空间上具有动态性。结果研究表明，执业护士的临床结果与医生相似或更好。进一步的例子表明，对于高级执业护士发挥重要作用的护理模式，在结果研究的六个方面（死亡、疾病、残疾、不适、不满和成本）都有良好的结果。
诸如执业护士之类的高级执业护士显示出有潜力为保障最佳医疗保健做出积极贡献。高级执业护士通过关注社会上最紧迫的健康问题，尤其是慢性病护理，将对医疗保健产生最大影响。
