This article examines the nature of advanced nursing practice. It identifies confusion around the terms of advanced nurse practitioners (ANPs), nurse practitioners and specialist nurses, and identifies what advanced practice is. The history of how ANPs evolved is discussed from its haphazard development to a more organised approach. Current advanced practice is identified, along with NHS plans for nurse development. Law, ethics and professional accountability are examined in relation to the additional responsibility ANPs have. Finally, the author's role as an ANP is considered within the context of primary care and NHS reforms.

Background In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D). Aims To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise. Methods Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data. Results Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components. Conclusion Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.

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The authors of this study conducted a literature review in 2015 to ascertain the nursing activity that currently operates in the primary healthcare (PH) system in Portugal. They analysed 11 studies published between 2007 and 2013. Their analysis identified four key aspects of PH nursing in Portugal: technical procedures, health promotion, independent actions, and management and training practices. The authors believe that the healthcare model in Portugal is in transition, although reasons for this were not clearly identified. To understand the paper, the healthcare system in Portugal needs description. The Portuguese national health service (NHS) is similar to the British model, with healthcare being free at the point of delivery. The Ministry of Health is responsible for developing Portuguese health policy, with the Healthcare Regulatory Authority (2018) responsible for regulating the activity of all healthcare. Portuguese PH is given via a mix of public and private health service providers, with patients having access to the NHS via their family doctors (GPs) and PH nurses for health surveillance and promotion, disease prevention, diagnosis and treatment, and social and medical rehabilitation. Since 2008, healthcare has been delivered by public health units such as family health units (FHUs), community care units and personalised healthcare units. FHUs give GPs and nurses greater flexibility and allow for better integrated inter-professional working, and are recognised as giving superior care to other PH units (Organisation for Economic Cooperation and Development (OECD), 2015). All these units utilise various levels of multidisciplinary teamwork and inter-cooperative and complementary networks, administrative autonomy and clinical governance systems (Redondo and Santana, 2011). They have organisational (but not financial) autonomy, and vertical integration of healthcare allows local health units to integrate with hospitals and PH units in the same organisation (European Observatory on Health Systems and Policies, 2017). Like many countries, Portugal faces challenges such as population aging and inequalities in health (Directorate-General of Health, 2016), which in turn is affected by a shortage of GPs that is expected to worsen due to GP retirement (World Health Organization, 2017). A total of 23 countries in the European Union have licensed advanced nurse practitioners, who