This document discusses advanced nursing practice, the definition of nursing practice, characteristics of advanced practice nursing, development and implementation of a professional nursing practice framework, and the scope of nursing practice in different settings. It defines advanced nursing practice as utilizing graduate education and expertise to meet patient health needs. Nursing practice is providing patient care based on their condition and nursing theories. Characteristics of advanced practice include autonomy, leadership, expertise, and influence on policy. The framework was created with input from nurses to define practice and guide nurses. Evaluation examines how it affects practice and outcomes. The scope of nursing is broad and affects many roles across settings.

1. • Framework introduction
• Definition of nursing practice
• Characteristics of advanced nursing
practice
• Development of the framework
• Implementation of the framework
• Evaluation and research
• Scope of nursing practice
• Principles
• Values and key components
• The nursing practice act
• Nursing practice in different settings
• Trend in nursing practice
• Broadening focusing
• Scientific basis
• Technology
• Indication of increasing technology
• Expansion of employment opportunity
• Nursing public perception
• Changing and modern trends in nursing

2. DEFINITION OF ADVANCED NURSING PRACTICE
Advance nursing practice is an umbrella term describing an advance level of
clinical practice that maximizes the use of graduate educational preparation,
in depth nursing knowledge and expertise in meeting the health needs of the
individual, families, group, communities and population. It involves
Analyzing and synthesizing knowledge.
Understanding, interpreting and applying nursing theory and research.
Developing and advancing nursing knowledge and the profession as the whole.

3. DEFINITION OF NURSING PRACTICE
“Nursing practice is an act of providing care to
the patient. In providing care to the patient the
nurses implement a nursing care is based on
initial condition of the patient. It is based on
specific nursing theory following nursing theory
and nursing practice research side by side is
must for patient care and nursing practice”
Nursing practice is the term for the diverse activities that nurses perform to promote health
and care for patients in various settings and roles

4. CHARACTERSTICS OF NURSING PRACTICE
In advance nursing practice nurses builds on their expertise in a specially
area, integrating and consistently displaying the following feature and
characteristics:-
• Provision of effective and efficient care, delivered with a high degree of
autonomy.
• Demonstrate of leadership and initiation of change to improve client,
organization and system outcomes.
• Deliberate, purposeful and integrated use of in-depth nursing knowledge,
research and clinical expertise.

5. CONTI……
• Depth and breadth of knowledge that draws on a wide range of strategies to
meet the needs of client and to improve access to and quality of care.
• Ability to apply and explain the theoretical empirical, ethical and experiential
foundation of nursing practice.
• Demonstration of advance judgment and decision making skills.
• Critical analysis of and influence on healthy policy.

6. DEVELOPMENT OF THE FRAMEWORK
• One of the first priorities of the vice president and CNO
(Chief Nursing Office) of the Calgary Health Region was to
developmental of this vision, it became apparent that a
mission for nursing was also essential. As this work
progressed, an evident need emerged to establish a
definition of professional practice and a guideline or
framework that nurses could utilize on daily basis to
achieve the vision and mission of nursing in the region.

7. APPROVAL OF THE FRAMEWORK
• After several month of consultation with nurses across the region,
discussion at regional nursing council and numerous revisions, the final
draft of professional practice framework was approved by Nursing
Council and distributes during nurse week 2003. The professional
nursing practice framework for the Calgary Health Region.

8. PROFESSIONAL NURSING PRACTICE
FRAMEWORK

9. IMPLEMENTATION OF THE FRAMEWORK
•Numerous sessions were held to familiarize nursing staff with the framework
when it was first launched.
•Introduction to the framework is now routinely incorporated into the orientation
of all new nurses who join the region
•The framework also gives the development preceptors and change nurses.
•The major element of the framework next have been linked to the expected RN
and RPN competencies articulated in job description, and application of the
nurse’s ongoing professional development and continuing education plan.

10. EVALUATION AND RESEARCH
• What facilitate internalization of the professional practice framework?
• Did its implementation change nursing practice of select units?
• Did changes in nursing practice affects the role of other members of
the health care team/ what difference if any?
• Did implementation of a professional practice framework make in job
satisfaction and patient outcomes?
• What went well in implementing the framework? What could have
been done differently?

11. SCOPE OF NURSING
PRACTICE
The scope of nursing includes:-
 Direct care giving
Evaluation of care and its impact
Advocating for patient and for health
Supervising ad delegating to other
Leading and managing
Teaching,
Conducting research
Developing health policies for health care
system.

12. The scope of nursing practice is the range of roles, functions,
responsibilities and activities which a registered nurse is
educated, competent and has the authority to perform.
Nursing is both an art and science. It requires the understanding
and applications of specific knowledge and skills and its draws
on knowledge and techniques drive from the humanities and the
physical, social, medical and biological science.
DEFINITION

13. PRINCIPLES
•The following are the basis for making decision with regards to the
scope of practice for an individual nurse:-
The primary motivation for expansion of practice must be the
best interest of patient/clients and the promotion and
maintenance for the best quality health services for the
population.
Expansion of the practice must be made in the context of the
definition of nursing and the values that underpin nursing
practice.

14. • Expansion of practice must only be made with due consideration to
legislation National policy, local policy and guidelines.
• In determining of his or her scope of practice the nurse/midwife must
make a judgment as to whether he/she is competent to carry out the
role function.
• The nurse/midwife must take measures to develop and maintain the
competence, communications and evaluations.
• Expansion of the practice must be based on appropriate assessment,
planning, communication and evaluation.
PRINCIPLES

15. • The nurse who is delegating a particular role/function (the delegator) is
accountable for the decision to delegate.
• The individual nurse is accountable for his/her practice this means that
he/she is accountable for decision he/she makes in determining his/her
scope of practice that included decision to expand or not to expand
his/her practice.
PRINCIPLES

16. The following values are mentioned below:-
In making decision about an individuals nurse’s scope of
practice, the best interest of the patient/client and the
importance promoting and maintaining the highest standards
of quality in the health services should be foremost.

17. Nursing care should be delivered in a way that respects the
uniqueness and dignity of each patient/clients regardless of
culture and religion.
Fundamental nursing practice is the therapeutic relationship
between the nurse and the patient/client that is based on trust,
understanding and support and serve to empower the
patient/client to make life choice.

18. KEY COMPONENTS

19. SCOPE OF NURSING PRACTICE
• Nursing profession is accountable for ensuring that its member act in
the public interest and provide the unique service that has been
designated to them by society. This process is called professional
regulation
• The profession of nursing regulates itself through defining practice,
establishing and developing the public standard of practice and a
code of ethics.

20. CONTI……..
• In turn, the state through statues, attests to the public that registered
nurses meet minimal standards for practice and prohibits unlicensed
individual from practicing as registered nurse.
• Since each state has legal authority for the regulation of nursing, the
definition and therefore the scope of nursing practice may vary from
state to state.
• However the laws remain consistent to protect the public.

21. THE NURSING PRACTICE
ACT
The nurse practice act was enacted by the legislature to regulate the
practice for the purpose of protecting the public.
The act does not designed to protect the public from incompetent
nursing, not to protect nurses from discriminatory or questionable
employment practice.
Each nurse is responsible and accountable for making decision and
practicing in accordance with the individual’s educational background
and experience in nursing.

22. NURSING
PRACTICE IN
DIFFERENT
SETTING

23. INDIVIDUAL RNS
• The registered nurse is responsible and accountable,
professionally and legally for determining his/her
professional scope of nursing practice.
• Since the role and consequently the scope of nursing
practice, is ever changing and increasing in complexity. It
is important that the nurse makes decision regarding
his/her own scope of practice.

24. THE NURSE MANAGER AND NURSE
EXECUTIVE
• The nurse executive in a changing and complex health delivery
system is knowledgeable regarding change in rules and regulation
accreditation standards and standards for care and practice in
addition to evaluation of boundaries specified in nurse practice
act.
• The nurse executes and/or the nurse manager facilitates changes
to assure quality patient care outcomes and develop mechanism
that will promote the same.

25. MOBILE NURSING PRACTICE
• The need was seen in 1984, for local resident to offer extensive care at home.
• Reduce the cost and remain in their home for a longer period of time
• Organization known as Mobile health care limited and later changed into Mobile
nursing services limited.
• Provides care during day and night but previously it was given only on business
hours.
• This practice is innovative leader in home health are service and transformed this
method to southeast area.
• It is a largest and oldest home health care system in that area.

26. MOBILE NURSING SERVICES
• Patient discharge early from
hospital
• Patient suffering from chronic and
acute medical problems
• Surgical patient.
• Patient requiring I.V. therapy.
• The elderly.
• Respiratory patients.
• The seriously ill.
• Patient in need of medication
management
• Hospice concept
• Ventilator dependent
• (Assistance) with bathing, dressing,
meals, transportation, light
housekeeping
• Service may be covered by Medicare,
medical private insurance, private
payment.
These services provide home teaching and care for patient with varied
needs and health problem:-

27. MILITARY NURSING SERVICES
• The military nursing services has its origin from the Army Nursing
Service formed in 1881 part of Royal army.
After the war on 1 October 1926 the
nursing services was granted
permanent status in Indian Army

28. Second World War:-
With the outbreak of second world war, nurses once again found
themselves serving all over the world
During the mid of the war,1943 Indian Army
Nursing services separated from Indian Military
nursing service ordinance. And redesignated as
Military Nursing Service (MNS)

29. THE MILITARY NURSING SERVICE STANDS OUT AS ONE OF THE OLDEST SERVICES
WHERE WOMEN HAVE CONTRIBUTED DIRECTLY TO THE NATION’S WAR EFFORT BY
PROVIDING CARE TO THE SICK AND WOUNDED SOLDIERS; THIS IS TRUE FOR ALL THE
ARMED FORCES OF THE WORLD.
The army nurses have made a permanent place in every Nation’s heart
by nursing million of sick and wounded soldiers back to health

30. THE OFFICERS OF MILITARY NURSING SERVICES HAD DISTINGUISHED
THEMSELVES IN THE SECOND WORLD WAR, THROUGH THE CARE OF
THE SICK AND WOUNDED SOLDIERS IN INDIA AND ALSO AT MANY
FOREIGN THREATS OF WAR
Post independence, the nursing officers cared for the wounded
soldiers in five major bloody conflicts with the neighboring

31. RANK STRUCTURE
• Commissioned officers
• Major- General
• Brigadiers
• Colonel
• Lieutenant Colonel
• Major
• Captain
• Lieutenant

32. TELE NURSING
• Refers to the use of telecommunication and information technology for providing nursing
services in health care whenever a large physical distance exists between patient and nurse,
or between any numbers of nurses
• As a field it is part of tele health and has many points of contacts with other medical and
non medical application, tele monitoring etc.
• Tele nursing is achieving large number of growth in many countries, due to several factors,
the preoccupation in driving down the costs of health care, an increase in the number of
aging and chronically ill, population and the increase in coverage of health care to distant,
rural or small populated region.
• Among its many benefits, tele nursing may solve increasing shortages of nurses; to reduce
distance and save travel time and to keep patient out of hospital. A greater degree of job
satisfaction has been registered among tele nurses

33. THE NURSING
ROBOTS
• The development of nursing robot system included the
development of a mobile robot system to help physically
handicapped people.
• Completed in 1986, the nursing Robot was one of the first fully
functioning mobile robots equipped with a manipulators arm,
also integrated with seven different sensor systems.
• The system was controlled by four networked on board Sinclair
spectrum computer and on off board IBM-PC.

34. COTIN……
• The nursing robot system comprises their major components; a self
propelled vehicle, a robotic arm mounted on it, and a communication post
next to the disabled person’s bed.
• Onboard the mobile robot low cost micro-computers are interconnected
as a hierarchical network in order to control a variety of activities, sensor
data processing motion control, path planning, communication and others.
• The vehicle can move autonomously in a room with unexpected obstacles.

35. NURSING IN OCCUPATIONAL
HEALTH
• OHNs are registered nurses who independently observe
the assess the worker’s health status with respect to job
tasks and hazards, using their specialized experience and
education, these registered nurse recognize and prevent
health effects from hazardous exposure and treat
workers injuries/illness

36. SCOPE OF OHN
OHNs bring their nursing expertise to all industries such as meat packing,
manufacturing, construction as well as the health care industry, OHNs have:-
• Have special knowledge of work place hazards and the relationship to the employee
health status.
• Understand industry’s hygiene principles of engineering controls, administrative
controls, and personal protective equipment.
• Have knowledge of toxicology and epidemiology as related to the employee and the
work site.

37. SCHOOL HEALTH NURSING
School nurses are primary care nurses for school children. They work
with individual children young people and families, schools and
communities to raising educational standards.
A school nurse is qualified, experienced professional and the only
trained nurse working across health and education boundaries, they
also provide the link between school, home and the community

38. RESPONSIBILITIES OF SCHOOL HEALTH NURSE
•Promoting healthy life style and school
•Child and adolescent mental health.
•Chronic and complex health care need in
children and young people
•Vulnerable children and young people

39. ACTIVITIES OF SCHOOL HEALTH NURSES
• Health assessment for children at entrance to the
school when required.
• Individual health interviews offered to young
people aged 13 -14 years.
• Immunization programme.
• Child protection.
• Health education.

40. TRENDS IN NURSING PRACTICE

41. TRENDS IN NURSING
PRACTICE
• Trends in nursing care closely tied to what is happening to health care in general.
• Trends are fascinating phenomena, but they do not existing in vacuums; Most are
interrelated; one trend often spawns another, although trends are more than fads,
• They are far from money back guarantees. We watch to anticipate the direction that
particular trends will take us, to remove the elements of surprise,
• when we look back on trends, however, some will have permanent changes, but other
might have temporary.

42. BROADENING FOCUS
• The focus of nursing has broadened from the care of the ill person to the care of
the people in illness and from care of only the patient to care of the clients, the
family, and in some instance the community.
• In the past, nursing like medicine was oriented towards disease and illness.
• Today there is increasing recognition of people needs for health care as distinct
from illness care and of the nurse’s independent functions in this area.

43. CONTI…….
• Another aspect of the broader nursing focus is to the movement of nursing practice
into the community. In a sense there is a return to the beginning of nursing that is
before it becomes a recognized occupation.
• Throughout most of this century however nurse worked only in institution, increasingly
nursing services are provided in community often in homes and clinics.
• The nursing activity not only assists those who are ill but also helps those who are
healthy to maintain or continue their health.

44. SCIENTIFIC BASIS
• In the past nursing largely was either intuitive or relied
on experience or observation rather than on research,
through trial and error the individual nurses discovered
with measures that would assist the client and many
nurses become highly skilled in providing care through
experience.

45. TECHNOLOGY
• Technology or mechanization is being applied in the health
field extensively. Certain areas of a hospital care most
technologic than others. Nurses find themselves in the midst
of rapidly changing, increasingly technologic environment in
hospital and in client’s homes.

46. INDICATION OF INCREASING TECHNOLOGY
• The proliferation of the technologic equipment
used in case of client in hospitals and homes.
• The increasing home and self care equipment.
• Use of computers in many areas of health care.

47. Many nurses feel they need more
education to obtain the knowledge
skills necessary to use the new
technology. High technology has
nurse to gather client assessment data
through non-invasive techniques (eg:-
pulse oxymetry) rather than the costly
invasive procedure.

48. EXPANSION OF EMPLOYMENT
OPPORTUNITIES
• Nursing practice trends include a growing variety of employment setting in
which nurses have greater independence, autonomy and respect as member
of the health care team.
• Nursing role continue to expand and develop broadening the focus of
nursing are and providing a more holistic and all encompassing domain.
• Nursing therapies are not only drawing from traditional nursing and
medicine, spiritual and emotional realms, but also expanding into alternative
therapies such as healing touch, massage therapy and use of natural herbs

49. THE JOHNSON FOUNDATION HAS DEVELOPED COMPELLING, ATTENTION GETTING
MEDIA CAMPAIGN ON NURSING PROFESSION.
THIS MEDIA CLIPS SHOW NURSING PRACTICE, AND THE NURSES FEATURED IN THE
ADVERTISEMENT AND DESCRIBED THEIR SATISFACTION IN THE PROFESSION,
NURSING IS A PIVOTAL HEALTH CARE PROFESSION, AS FRONTLINE HEALTH CARE
PROVIDERS, NURSES PRACTICE IN ALL HEALTH CARE SETTING AND CONSTITUTE THE
LARGEST NUMBER OF PROFESSIONALS.
NURSES ARE ESSENTIAL TO PROVIDE SKILLED, SPECIALIZED KNOWLEDGEABLE CARE,
TO IMPROVE THE HEALTH STATUS OF THE PUBLIC AND TO ENSURE SAFE EFFECTIVE
QUALITY CARE; IN ADDITION, THE AMERICAN PUBLIC RATED NURSES HIGH IN
HONESTY AND ETHICS IN THEIR PROFESSIONAL ROLE
Nursing Public Perception

50. NURSING IMPACT ON POLITICS AND HEALTH POLICY
• The ability to influence or persuade an individual holding a government office to
exert the power of that office to affect a desired outcome is known as Political
power or influence.
• Nurse involvement in politics is receiving greater emphasis in nursing curricular
professional organization and health care setting.
• Professional nursing organizations have employed lobbyists to urge state
legislature and the US congress to improve the quality of health care.

51. CHANGING TRENDS IN NURSING
• Nursing has originated from the word “nurturing” which means
nourishing, helping in growth and development of a human being, in
the past nursing was family based work.
• Modern nursing began in the 19th century under the leadership of
Florence Nightingale.
• The aim of nursing was only to promote the recovery of patients.
Even now the central concern of nursing is nurturing the human
beings.

52. THE PRESENT DAY NURSE PROVIDES CARE FOR THE PEOPLE IN
HEALTH SERVICES AND ILLNESS. NURSING IS ONE OF THE
HEALTH SERVICES WHICH CONTRIBUTE TO WELL BEING OF AN
INDIVIDUAL, FAMILY AND COMMUNITY. THEREFORE, NURSING IS
DEFINED AS A HUMANISTIC SCIENCE DEDICATING TO MAINTAIN
AND PROMOTE HEALTH PREVENTING ILLNESS CARE FOR AND
REHABILITATION OF THE SICK AND DISABLED PERSON

53. NURSING PROCESS INCLUDES DOING, THINKING AND INTERACTION
COMPONENT. IT IS MAINLY AND BASICALLY A PROBLEM SOLVING
APPROACH OF NURSING CARES. THE NURSING PROCESS CONSISTS
OF FIVE STEPS
Assessment
Nursing
Diagnosis
Planning
Implementation
Evaluation

54. MORDEN TRENDS IN NURSING PRACTICE
• . A Rekindled interest in Eastern Religion, lifestyle and medicine has
fueled the development of complementary holistic, alternative
complementary modalities. Client are seeking out
alternative/complementary therapies because most such therapies
are non invasive, holistic and in many instance less expensive than
going to a physician.

55. • In 1993 a landmark survey found 1/3 of the US population had used some
nontraditional alternative method of treatment in addition to the standard
treatment.
• In 1993 the US Government established an Office of Alternative Medicine at
National Institute of Health. One of the reason for the OAMs creation was
citizens are pursuing alternative methods of health care with unpredicted
enthusiasm.
• In 1992, the OAMs was allocated 2 million to investigate the use of
treatment methods.

56. A FEW THERAPIES INVESTIGATED BY THE OAMS -1995:-
• Biofeedback to control pain
• Acupuncture to relieve depression
• Imagery to control Asthma
• Ayurvedic medicine to treatment to treat parkinson’s disease
• Music therapy to treat brain injured client
• Shark cartilage to treat cancer

59. Kozier, “Fundamental Of Nursing” 5th Edition, page no. 18-21, 40-41.
Lois While “ Fudamental of Nursing” Mosby Publication, Page No.85, 224.
Patricia A. Potter, “fundamental Of Nursing” 3rd edition, Mosby Publication,
Page no.- 29-31
Potter and Perry, “fundamental Of Nursing”, 5th edition Mosby publication.
Shabeer P. Basheer, “A Concise Book of Advanced Nursing Practice” 1st edition,
2012, Emmss medical publishers, page no. 648-675.
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