Advanced Nursing Practice: the next achievement of Brazilian nursing

Enfermería de Práctica Avanzada: el próximo logro de la enfermería brasileña

Nursing plays a fundamental role for the survival of health services, as its performance is aimed both at administrative aspects and direct care to patients, families, and communities, helping to prevent and to treat diseases in the most diverse health care conditions.

Although nurses represent about 50% of the health workforce, the number of these professionals worldwide is scarce, especially in Southeast Asia and Africa(¹). Moreover, the performance of nursing professionals is limited by political, organizational, and regional aspects, and, therefore, the work characteristics and freedom of labor of this group are extremely variable in each country and, eventually, different within the same country.

Thus, Advanced Nursing Practice (ANP)—which is performed by nurses who acquired, by specific training, specialized knowledge, clinical competency, and essential skills to autonomously make complex decisions—aims to expand the scope of this professionals’ performance, meeting the need to respond quickly to the population’s health problems, using the nursing workforce as a driving force to solve population health problems(²,³). The COVID-19 pandemic showed the world the challenges faced by health professionals and the importance of the nurses’ performance, with emphasis on solving complex situations based on ANP(⁴).

ANP has been successfully implemented in different countries and presents very satisfactory results, overcoming all challenges regarding professionals’ training(²,⁵). In Brazil, despite several implementations and many initiatives that approach Brazilian ANP development goals—such as the establishment of professional masters and doctorate courses and the increase of nurse residency programs—nurses and physicians do not fully understand ANP and present constant confusion regarding overlapping areas and the ethical and legal definition of this practice.

ANP is not a strategy to supplant the medical need in health services, not even to encourage nurses to act as physicians, but it is an important supporter to relieve the health system and grant greater public access to health(⁵,⁶), especially in more deprived areas of Brazil, accelerating processes and allowing nurses to provide a more resolutive care. As an example, more comprehensive nursing consultations regarding primary health care. In these cases, when nurses identify health problems, they are able (under rigorous and well-defined protocols) to determine the need for medical referral in more serious cases or to propose solutions, including prescription and administration of medications in mild cases. It accelerates the service and allows for the physician to focus on more complex and/or severe cases.

At the forefront of nursing teaching, research, and care, the Escola de Enfermagem da Universidade de São Paulo and the Graduate Program in Adult Healthcare Nursing (PROESA) addressed in its III International Conference on Adult Health Nursing (III SISA), in 2021, the discussion of this important topic, gathering national and international experts.

In this REEUSP special issue, the results of the meetings between these experts and some studies presented in the event are presented, showing how Brazilian nurses are preparing or have already performed ANP in their contexts.

We hope the III SISA and this special issue inspire nurses to seek for solutions for population’s health problems in a creative and articulated way, based on the most rigorous and current scientific information available, besides encouraging the discussion and regularization of ANPs in Brazil.

REFERENCES

• ^1.
  World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership [Internet]. Geneva: WHO; 2020 [cited 2022 May 9]. Available from: https://www.who.int/publications/i/item/9789240003279
  » https://www.who.int/publications/i/item/9789240003279
• ^2.
  Oldenburger D, De Bortoli Cassiani SH, Bryant-Lukosius D, Valaitis RK, Baumann A, Pulcini J, et al. Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean. Rev Panam Salud Publica. 2017;41:e40. DOI: http://dx.doi.org/10.26633/RPSP.2017.40
  » http://dx.doi.org/10.26633/RPSP.2017.40
• ^3.
  International Council of Nurses. Guidelines on Advanced Practice Nursing 2020 [Internet]. Geneva: ICN; 2020 [cited 2022 May 10]. Available from: https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf
  » https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf
• ^4.
  International Council of Nurses. COVID-19 and the international supply of nurses: report for the International Council of Nurses [Internet]. Geneva: ICN; 2020 [cited 2022 May 13]. Available from: https://www.icn.ch/system/files/documents/2020-07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf
  » https://www.icn.ch/system/files/documents/2020-07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf
• ^5.
  Whitehead L, Twigg DE, Carman R, Glass C, Halton H, Duffield C. Factors influencing the development and implementation of nurse practitioner candidacy programs: A scoping review. Int J Nurs Stud. 2022;125:104133. DOI: http://dx.doi.org/10.1016/j.ijnurstu.2021.104133
  » http://dx.doi.org/10.1016/j.ijnurstu.2021.104133
• ^6.
  Jakimowicz M, Williams D, Stankieewicz G. A systematic review of experiences of general practice nursing in general practice. BMC Nurs. 2017;16:6. DOI: http://dx.doi.org/10.1186/s12912-016-0198-7
  » http://dx.doi.org/10.1186/s12912-016-0198-7

Publication Dates

• Publication in this collection
  18 July 2022
• Date of issue
  2022

History

• Received
  18 May 2022
• Accepted
  18 May 2022