Nieminen Anna-Lena, Mannevaara Bodil, Fagerström Lisbeth
Health Care and Social Welfare, Novia University of Applied Sciences, Vasa, Finland.
Scand J Caring Sci. 2011 Dec;25(4):661-70. doi: 10.1111/j.1471-6712.2011.00876.x. Epub 2011 Mar 3.
To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice.
Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined.
The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis.
Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis.
Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture.
Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.
描述并探究高级实践护士的临床能力以及这些能力在临床实践中的表现方式。
自20世纪60年代起，美国就开始了关于高级临床实践的讨论，自20世纪80年代末起，英国也开始了相关讨论。除美国外，约有24个国家实施了高级实践护士（APN）这一角色。在北欧国家，尤其是瑞典和芬兰，一些机构引入了APN，但他们的能力领域尚未明确界定。
该研究的理论框架源自亚里士多德对知识的三维观点，即epistêmê（理论知识）、technê（技艺）和phronesis（实践智慧）。
在2005年10月至2006年1月期间，对在儿科、内科和外科科室发挥专家职能的临床护士专家（n = 26）和APN学生（n = 8）进行了焦点小组访谈。使用归纳性内容分析法对数据资料进行了分析。
研究结果分为五个主要主题，表明APN在以下方面具备高级临床能力：（A）评估患者的护理需求和护理活动；（B）护理关系；（C）多专业团队合作；（D）能力发展和护理；（E）在学习和护理文化中的领导力。
临床能力由高级技能组成，这些技能代表了一个不断扩展的角色，为整体患者护理实践提供了新的可能性。APN的实践范围的特点是基于扩展的临床能力做出自主判断的责任和能力。在高级层面上，临床能力不仅包括评估和满足患者需求的高级技能，还包括与患者建立安全和信任的关系以及与同事协作。APN可以通过他们的认知、行动和存在方式在行动中实现高级技能。
