The origins of the Advanced Practice Nursing trace back to 1861- the time of the American Civil war. At this period of time, America lacked professional nurses, except for many Catholic sisters who were frequently called to assist at surgeries. The end of 19th century documents the beginning of Nurse Anesthetists practice. Already in the 20th century, Nurse Anesthetists became regarded as subordinated to surgeons. The American Association of Nurse Anesthetists was founded only in 1931. Nurse Practitioners’ duties as such, primarily, included caring for immigrants. During World War II, their scope of duties widened to include curing of the wounded, too. Later on, in the mid 19th century, Clinical Nurse Specialists emerged, and their primary role was to take care of the psychiatric patient. Certified Nurse-Midwives appeared with the establishment of the American Association of Nursing Midwives, in 1941. In 1965, thanks to the implementation of Medicare, new models of patient care were adopted. They focused on closer collaboration to achieve the best health improvement for patients.
The 21st century marks a new era for the Advanced Practice Nursing. As Nurse Anesthetists started to collaborate with anesthesiologists, they became part of a “pain management team”. CRNAs are registered nurses who can practice of nurse anesthesia. CNMs are licensed practitioners of nursing and midwifery. Alongside, NPs scope of duties has increased, from managing chronic patients to acute patients. NPs are registered nurses who make examinations, diagnoses and treatment. Up to present day, their work is highly valued in the Emergency Department and the Intensive Care. The number of CNSs has doubled since 1995 in the U.S., reaching over 80,000. CNSs are experts in clinical practice who participate in research, leadership and ethical decision making.
Although APNs aim is to maintain as high a professional quality as possible compliant with latest medical trends, it seems not an easy task. Lately, APNs have been facing certain barriers, especially in Florida, as Florida law prevents full practice. As a result, State residents suffer from immediate access to health care and medical services, which become more cost-effective, too. I will identify just a few obstacles: HMOs and Medicaid do not cover directly many of APNs services; also, Advanced Registered Nurse Practitioners lack the usual privileges in hospitals. These barriers make clear evidence that the governing State laws need to be amended as soon as possible. All APNs should be granted rights to apply their respective education and experience without limitations. Recommended solutions here include amending statutory references with regard to authorizing ARNPs to decide and sign patients for physical therapy, as well as being able to certify the cause of death. Moreover, access to patients’ Medicaid and Managed Care has to be granted, along with extending of other common privileges to ARNPs.
Secondly, a lack of collaboration and insufficient cross-disciplinary work is common among all APNs. For this purpose, new viable models should be adopted to improve quality and safety with regards to acute and chronic care. The particular models include the Rapid Response Team (RRT) and the Chronic Care Model. As it was previously mentioned, the nurse practice acts do not have a clear framework so far. Some States require APNs with doctorates, while some still do not require APNs to be nationally certified.
Cultural considerations of the Advanced Practice Nursing (APN) are sturdily related to integration of Christianity into transcultural healthcare. The question is about how Advanced Practice Nurses (APNs) can integrate basic Christian virtues into their practice when it comes to caring for culturally diverse patients. A current research revealed that APNs need to become culturally competent. This has to do with the integration of cultural desire, awareness, knowledge, skill and cultural encounters (Campinha-Bacote, 2005, p. 18). When delivering healthcare services, the desired model should include cultural competence that is composed of certain intellectual and moral virtues. Engagement of APNs in the process of caring is exactly what is understood as becoming culturally competent. On the other hand, caring for a patient itself is a virtue. The highest virtues for APNs to strive for are openness, a respect, a commitment, and a sense of humility (Campinha-Bacote, 2005, p. 19).
One of the aspects, to come across in delivery of healthcare, is racism. It has been documented to a large extent, too. Research in the field reveals that in the U.S. minorities are usually disadvantaged and under-privileged. Even more, they are likely to receive lower quality care in hospitals and nursing homes. To improve the situation, the healthcare professionals might think of adopting a biblical stance that supports love of truth, believing that we are all made in the image of God. Then, it will be of an advantage if APNs are devoted to God. Wisdom and seeing surrounding world from God’s eyes will help them make truthful judgments.
As important as racial and cultural issues, are attentiveness and understanding when it comes to caring for patients with culturally diverse backgrounds. Interaction between APN’s and the patient also consists of speaking and attentive listening. It is important for patients to express their feelings, so that a caring professional can understand their concerns. Besides, emotional involvement with the patient can help, too (Campinha-Bacote, 2005, p. 20). Although, sometimes, these emotions turn out to be negative, APNs can benefit from developing significant virtues, such as compassion and patience. To conclude with, a cross-cultural experience is unquestionably valuable to help develop the mentioned virtues in APN professionals.
Campinha-Bacote, J. (2005). A biblically based model of cultural competence in health care delivery. The Journal of Multicultural Nursing & Health, 11(2), 16-22.