Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean

Abstract

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

Estratégia de implementação para a prática avançada de enfermagem na Atenção Primária à Saúde no Chile

“…A key recommendation from this meeting was for nurse leaders in each country to apply systematic and evidenced based approaches as outlined by the PEPPA framework to initiate role development. (11) As a meeting participant, the Dean of Nursing, University of the Andes, took on a leadership role to begin this process in Chile. As of 2018, we have advanced to Step 6 of the framework and are working closely with universities that have or could implement the advanced practice nursing programs.…”

“…For Chile specifically, this involves identifying patients and/ or populations requiring PHC as the main focus of activities". (11) According to 2018 Census, Chile has 18 million inhabitants concentrated mainly in central region and urban areas. The Gross Domestic Product is around 24.500 USD with a great variability among regions, where the richest regions are related to minery and the poorest to agriculture sectors.…”

“…The PEPPA Framework has been recognized as a best practice for the redesign of health care; it is useful to introduce, implement, and sustain the advanced practice nursing role. (10,11) In our work, the framework has been useful to identify and implement the key steps at relevant points to advance the effective implementation of the role in Chile. It was key to describe and analyze the national context in order to define the right population to focus advanced practice nurse role development.…”

“…Its adaptation to the local context allows for solid planning based on relevant data about the population and health system of each country. (11) Framework objectives are to: i) use relevant data to make evidence-informed decisions to improve health services and outcomes, ii) support the development of the advanced practice nursing role and its orientation to patient-centred and holistic care, iii) promote the integration and maximization of APN expertise, iv) promote work environments that sup-port role development, and v) continually assess the impact of the role and expected short and long-term outcomes. (11) The framework includes nine steps in a flexible and iterative process.…”

Prática Avançada de Enfermagem: uma análise conceitual

“…(3,6,10-27) system and have generated evidence regarding the quality and safety of care provided by nurses in this role and of the positive health outcomes to this type of nursing. It is important to note, however, that readiness for implementing the role in Latin American is presently under discussion (1,28) and preparation of advanced practice nurses to attend to the existing health access disparities in these countries is recommended as a priority strategy for the region. (29) Advanced practice nursing has mainly focused on primary health care of urban and rural populations.…”