Developing and Implementing the Family Nurse Practitioner Role in Eswatini: Implications for Education, Practice, and Policy

Abstract

Introduction: Eswatini, a small, largely rural country in Southern Africa, has a high burden of morbidity/mortality in the setting of a critical shortage of human resources for health. To help achieve universal access to healthcare across the lifespan, the advanced practice family nurse practitioner (FNP) role was proposed and is in the process of being implemented. Methods/Approach: The PEPPA framework (Participatory, Evidence-based, Patient focused Process for Advanced practice nursing) illustrates the steps in the process of developing and implementing the FNP role in a country. These steps include: determining the need for the role, deciding on a model of care, developing/implementing the curriculum, relevant policies, and scope of practice (SOP), and integrating the role into relevant nursing regulations and Ministry of Health (MOH) guidelines and documents. Outcomes: The assessment has been completed, a locally tailored competency-based FNP curriculum has been developed, revised, and implemented, the FNP SOP has been approved and MOH guidelines are being updated to reflect current evidence-based practice and to integrate the FNP role. Continuous cycles of improvement/revision were needed to adapt the curriculum and SOP to meet local needs. Clinical placements were challenging since this is a new health cadre, but most challenges were overcome and many resulted in important opportunities for interdisciplinary collaboration. Summary: Outcomes from this quality improvement initiative demonstrate that it is feasible to develop and implement a locally responsive, competency-based FNP program in a low resource setting and enroll students, despite time and financial constraints. Adapting the curriculum and SOP from western countries can provide a foundation for program development but revision to assure that the program is responsive to local context is then needed. There is general acceptance of the role among Eswatini communities and professional stakeholders with emphasis on the need for FNP graduates to be clinically competent and able to function independently. Policy work related to deploying new graduates is ongoing.

The State of the Evidence about the Family and Community Nurse: A Systematic Review

“…The articles in our analysis showed the importance of such training programs for FCNs, which are heterogeneous and different from one country to another. In Africa, for example, the nursing council and nursing faculty assured courses for the graduate level, and provided FCNs with the didactic and clinical knowledge, skills, and abilities required for successful FCN practice [ 117 ]. Their courses focused on expected learning outcomes, course content, teaching and learning activities, and assessment measures.…”

Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study

“…This same limitation of data collection on APNs persists throughout many of the countries and jurisdictions of the world. Nonetheless, it is known NPs and CNSs are established in the Americas (US [ 19 ], Canada [ 19 ], Jamaica [ 20 ], Belize [ 20 ], Brazil [ 20 ], Chile [ 20 ], and Columbia [ 20 ], among others), much of Europe (Austria [ 21 ], Belgium [ 22 ], Czech Republic [ 22 ], Finland [ 22 ], France [ 22 ], Germany [ 23 ], Republic of Ireland [ 22 ], the Netherlands [ 19 ], Poland [ 22 ], Switzerland [ 23 ], the UK [ 22 ], among others), Australia [ 22 ], New Zealand [ 19 ], a few countries in Africa (Botswana [ 19 ], Ghana [ 24 ], Eswatini [ 25 ], Kenya [ 19 ], Namibia [ 19 ], and Zimbabwe [ 19 ], among others), and a few countries in Asia (Israel [ 23 ], Japan [ 22 ], Oman [ 19 ], Singapore [ 19 ], and Taiwan [ 26 ], among others). This aligns well with the responses obtained not only from this study but also those cited in Table 2 , and may point to areas of the world that could potentially benefit from NP and CNS role introduction.…”

Implantação de práticas avançadas de enfermagem na Atenção Primária à Saúde brasileira: percurso metodológico

“…O documento (7) apresentou ainda uma proposta de desenvolvimento, implantação e avaliação das PAE, formulada por Oldenburguer et al (2017) (8) , desenvolvida com base na proposta de Bryant-Lukosius e DiCenso (2004) (9) , conhecida mundialmente como estratégia PEPPA (Participatory, Evidence-based, Patient-focused Process for Advanced Practice Nursing role development, implementation, and evaluation). Esta estratégia tem sido implementada por diferentes países (10)(11)(12) e recentemente está sendo utilizada pelo Chile para o processo de desenvolvimento e implementação das PAE (13) .…”