Introduction
The evolution of Advanced Practice Nursing (APN) within the context of primary care (PHC) has developed over time and, in this era, embodies a significant response to the expanding intricacies of healthcare needs. From the very humble beginnings in remote areas to the creation of formal roles such as Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs), APNs have grown to become a fundamental part as far as addressing the gaps in primary care are concerned. For this assignment, this introduction sets a stage for comprehending the historical devolvement and current importance of APNs in promoting access to comprehensive healthcare services.
The Historical Development of the Role of the Advanced Practice Nurse in Primary Care
To start, available literature and research by Lopes-Júnior (2021) alluded that nurses possess an education background that is predominantly favorable to the growing needs of the 21st century, and this is indicated by the acceleration in demographic transitions coupled with circumstances of triple disease burden, which are; unparalleled agenda for infectious diseases, high toll death rates which are attributable to external factors and the predominance of the chronic non-communicable illnesses. It is against such background that their research seems to be in complete agreement with the works of Hibbert et al. (2017) as they argued the role of Advanced Practice Nurse (APN) in the context of primary health care (PHC)evolving from the early pioneers who dispensed comprehensive care in the remote regions and changed to formalized roles as Nurse Practitioner (NPs) and Clinical Nurse Specialists (CNS) to respond to the healthcare needs. According to research facilitated by Carter (2010), Advanced Practice Nurse roles date back and stem from the 1890s. However, their research indicates that the nurse practitioner (NP) began in Western countries and this was during the 1960s. The response was to the unrealized healthcare needs of the population in the remote areas. The research seems to be in harmony with that conducted by Devictor et al. (2010) illustrated that the early NPs utilized medical models of care to examine, diagnose and provide medication. Ever since, nursing has developed as a profession having its distinguishable and unique traits as a holistic science-based knowledge and this is complementary within the multidisciplinary team. In this modern day, APNs showcase nursing expertise in clinical practice, education and even leadership and research, and they are no longer perceived as “physician replacements” or assistants, as alluded by (Devictor et al., 2010).
Summary of The Advanced Practice Nurse Role in Primary Healthcare Care
In other research, Nikpour et al. (2024) alluded that owing to the additional training that is required to become an APN, APNs are mandated with an opportunity to dispense services in clinical care settings with a high degree of autonomy and are responsible for patient care in the context of the healthcare stream. In a different research, Hibbert et al. (2017) stated that APNs are certified to see patients in the absence of a doctor, order medication and conduct diagnostic tests for making clinical diagnoses and making critical medical decisions.
It is vital to understand that the role of APN in Primary Healthcare (PHC) is complex and critical as far as improving healthcare access and outcomes is concerned. APNs, including Nurse Practitioners (NPs) in addition to Clinical Nurse Specialists (CNSs), play key and pivotal roles as far as the delivery of comprehensive care is concerned, health promotion, preventing disease burden and management of chronic conditions within the context of PHC setting. Research by Liu et al. (2020) revealed that APNs are endowed with advanced clinical skills, expertise, knowledge and critical thinking capabilities that enable them to assess, diagnose and manage a different range of healthcare issues. APNs are also tasked with drug prescription both for non and pharmacologic treatments, counseling and patient education, including their families and communities.
Furthermore, APNs do not work independently, they work in collaboration with interdisciplinary teams to educate patients and their families as they front healthcare equity besides undertaking research and policy development programs to advance PHC practices. Through this, APNs are able to deliver evidence-based, patient-centered care, thus significantly contributing to the development of healthcare quality, efficiency and patient satisfaction within the PHC setting and eventually improving population health outcomes.
Role Critique with Reference to The Domains of Advanced Practice
According to a systematic review by McMenamin et al. (2023), the role of Advanced Practice Nurse (APN) in primary healthcare can be critiqued by assessing its alignment with the domains of advanced practice, which are clinical leadership, education, research and leadership.
To begin with, talking of clinical practice, APNs are required to showcase high proficiency in the delivery of advanced care, evidence-based and personalized care in a broad spectrum of health conditions within the context of PHC. McMenamin et al. (2023) insinuated that they independently examine, diagnose and manage both acute and chronic conditions in addition to medication prescription and conducting advanced procedures as enshrined in their scope of practice. The domain highlights the significance of APNs’ clinical professionalism in meeting the multifaceted healthcare needs of diverse patient populations efficiently and effectively.
Altogether, APNs are involved in education provision to the patient, family and community. The education must be focused and centered on its goals and objectives of counseling and support. In essence, they must be empowered to make informed choices concerning their health and enhance strategies for behavioral modification to achieve complete efficacy (DeNisco, 2023). In addition, APNs also contribute to the education of nursing students, healthcare professionals and the community in various ways as mentorship, preceptorships and formal teaching roles. The domain underscores the role of APNs as educators concerned with health promotion literacy and individual empowerment to take control of their health and well-being.
Alternatively, APNs play an active role in research and policy development that is aimed at advancing clinical practice and promoting health outcomes (DeNisco, 2023). APNs participate in evidence-based programs, facilitate clinical inquiries, and contribute to scholarly programs that enhance both the quality and effectiveness of the PHC services. Through the incorporation of research inferences into practice, APNs deliver care that is current, relevant and evidence-informed. The domain, therefore, emphasizes the vital role APNs play in generating and disseminating knowledge in the context of PHC.
Lastly, APNs are able to demonstrate leadership in their various dealings within the PHC setting. APNs are advocates of patients’ rights, healthcare policies and resource distribution to maximize health outcomes while addressing healthcare inequalities. In addition, APNs are able to assume leadership roles through multidisciplinary settings, healthcare organizations and professional associations to influence standards of practice, policy development and quality improvement programs (DeNisco, 2023). It is against this background that the domain underscores the leadership capabilities of APNs as far as driving positive change and fostering innovation besides the promotion of excellence within the PHC setting.
Generally, the role of APNs in PHC through the above discussion is in close alignment with domains of advanced practice and reflects a comprehensive skill set, an all-inclusive approach to care and a commitment to advancing nursing as a profession. However, there are multifaceted challenges as limited autonomy, scope of practice limitations and variations in the regulatory structures across the jurisdictions, which may deter the complete realization of APNs’ full potential in PHC background (Woo et al., 2017). The same research by Woo and colleagues also fronts the need to address such issues through advocacy reforms, policy changes and inter-professional partnerships to optimize the impacts of APNs in care promotion and quality care dispensation among different pollutions in PHC settings.
Conclusion: Evaluative Statement About the Role and Recommendations
To conclude, the role of the Advanced Practice Nurse (APN) in Primary Healthcare (PHC) serves as a key pillar in addressing the ever-changing healthcare landscape besides meeting the diverse and unmet needs of populations and their communities. It is vital to understand that APNs prove proficiency in all domains of advanced practice, and this embodies clinical expertise, research acumen, influential leadership qualities and exceptional educational leadership. Nevertheless, to advance the role of APNs in PHC, the need for continuous advocacy, policy reforms and inter-disciplinary collaboration to promote autonomy is needed. Also imminent is the scope of practice extension and standardization of the regulatory frameworks. Noteworthy, there is a need to invest in progressive professional growth and mentorship initiatives and generally inter-professional education programs that are able to optimize PHC delivery, hence ensuring high and exceptional care quality that is accessible to all.
References
Carter, N. (2010). A historical overview of the development of advanced practice nursing roles in Canada. Nursing Leadership, pp. 23, 35–60.
Devictor, J., Burnet, E., Henriot, T., Leclercq, A., Ganne‐Carrie, N., Kilpatrick, K., & Jovic, L. (2023). Implementing advanced practice nursing in France: A country‐wide survey 2 years after its introduction. Nursing Open, 10(3), 1437–1448.
DeNisco, S. M. (2023). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.
Hibbert, D., Aboshaiqah, A. E., Sienko, K. A., Forestell, D., Harb, A. W., Yousuf, S. A., Kelley, P. W., Brennan, P. F., Serrant, L., & Leary, A. (2017). Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia. Annals of Saudi Medicine, 37(1), 72–78. https://doi.org/10.5144/0256-4947.2017.72
Lopes-Júnior L. C. (2021). Advanced Practice Nursing and the Expansion of the Role of Nurses in Primary Health Care in the Americas. SAGE open nursing, 7, 23779608211019491. https://doi.org/10.1177/23779608211019491
Liu, C. F., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., … & Wong, E. S. (2020). Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health services research, 55(2), 178–189.
McMenamin, A., Turi, E., Schlak, A., & Poghosyan, L. (2023). A systematic review of outcomes related to nurse practitioner-delivered primary care for multiple chronic conditions. Medical Care Research and Review, 80(6), 563-581.
Nikpour, J., Brom, H., Mason, A., Chittams, J., Poghosyan, L., & Carthon, M. B. (2024). Better Nurse Practitioner, Primary Care Practice Environments, Reduce Hospitalization Disparities Among Dually-Enrolled Patients. Medical Care, pp. 10–1097.
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, pp. 15, 1–22.
Wood C. (2021). Leadership and management for nurses working at an advanced level. British journal of nursing (Mark et al.), 30(5), 282–286. https://doi.org/10.12968/bjon.2021.30.5.282
write