INTRODUCTION

Society and it s healthcare need always evolving . Healthcare faces many challenges like rising
cost, shortage of professionals, ageing population. Then the introduction to the new technology
and difficulties with access to care . Nurses in advance nursing practice are well positioned to
respond to the evolution of healthcare .

Definition Of Nursing Practice

Advance nursing practice is an umbrella term describing an advanced level of clinical nursing
practice that maximizes the use of graduate educational preparation, in depth nursing knowledge
and expertise in meeting the health needs of the individuals families, groups, 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.

Characteristics Of Nursing Practice

1. Provision of effective and efficient care, delivered with a high degree of autonomy.

2. Demonstration of leadership and initiation of change to improve client, organization and

system outcomes.

3. Deliberate, purposeful and integrated use of in depth nursing knowledge , research and clinical
expertise.

3. Understanding , development and dissemination of evidence based nursing knowledge.

4. Demonstration of advanced judgement and decision making skills.

Development Of Framework
One of the first priorities of the vice-president and CNO (chief nursing officer) of the Calgary
health region was to develop a vision for nursing in the region. Through the development 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 guidelines or
framework that nurses could utilize on a daily basis to achieve the vision and mission of nursing
in the region.
Approval Of The Framework
after several months of consultations with nurses across the region, discussion at regional nursing
council and numerous revisions, the final draft of the professional practice framework was
approved by nursing council and distributed during nurses week 2003 . the professional nursing
practice framework for the Calgary health region.

Description Of Framework.
1. The framework is congruent with the values of the Calgary health region, honesty, integrity,
dignity, trust, respect, responsiveness, creativity, and learning.

2. It reflects elements that are common to other professional practice frameworks described in
the literature.

3. The framework logo was designed by one of the members of regional nursing council and is
an expression of her belief that the nurses cap has traditionally been an important symbol of
professionalism in nursing.

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 of preceptors and change nurses.

Further elaboration of framework will be ongoing. for example, use of the framework has
exposed the need to clarify some of its terms ; such as insightful practice.

Scope Of Nursing Practice

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 like other professions is accountable for ensuring that its members 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 an educational
system , providing research to further develop the practice base and developing the standards of
practice and code of ethics.

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 purpose of the law remains consistent to protect the public.

The Nursing Practice Act

The nurse practice act was enacted by the legisture to regulate the practice of nursing and to
define the parameters of nursing practice for the purpose of protecting the public.

The nurse practice act is designed to protect the public from incompetent nursing practice, not to
protect nurses from discriminatory or questionable employment practices.

Each nurse is responsible and accountable for making decisions and practicing in accordance
with that individuals educational background and experience in nursing.

Nursing practice in different setting.

Individuals RNs responsibility.

The registered nurse is responsible and accountable , professionally and legally, for determining
his/her professional scope of nursing practice .

Since the role and responsibilities of nurses, and consequently the scope of nursing practice , is
ever changing and increasing in complexity, it is important that the nurse makes decisions
regarding his/her own scope of practice.

The nurse manager and nurse executive responsibility

As a registered nurse ,the nurse manager is responsible and accountable , professionally and
legally ,for determining his/her professional scope of practice .

The nurse executive and /or nurse manager facilitate changes to assure quality patient care
outcomes and develop mechanism that will promote the same.

Mobile Nursing Practice

It was the first to offer such services at all times of the day and night.

this enabled many to reduce costs and remained in their homes , at least for a longer period of
time.
Mobile Nursing Services

 These services provide home teaching and care for patients with varied needs and health
problems.
 Patients discharged early from hospitals.
 Patients requiring iv therapy.
 The elderly.

Military Nursing Services

First World War .

The military nursing service has its origin from the army nursing service has its origin from the
army nursing service formed in 1881part of royal army. after the war of 1 st October 1926, the
nursing services was granted permanent status in Indian army. This date was formally recognized
as the formation of military nursing service.

Second World War

With the outbreak of second wporld war , nurses once again foun themselves serving all over the
world. The officers of the military nursing service are governed by military nursing service
ordinance 1943 and military nursing service rules ,1944.

Rank Structure

The various ranks of the military nursing services are listed:

 Commissioned officers
 Major general
 Brigadier
 Colonel
 Lieutenant colonel
 Major
 Captain
 Lieutant.

Tele-Nursing

 Refers to the use of telecommunication and information technology for providing

nursing services in health care.
 Tele nursing may help solve increasing shortage of nurses to reduce distance and save
travel time , and to keep patients out of hospital .
Nursing Robot

Development of a 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 manipulator arm .the vehicle can move autonomously in a room with
unexpected obstacles.

Occupational Health Nurse

OHNs are registered nurses who independently observe and assess the workers health status with
respect to job task and hazards . using their specialized experience and education , these
registered nurses recognize and prevent health effects from hazardous exposures and treat
workers injuries/ illness.

Activities .

 Observation and assessment of both the worker and the work environment .
 Appraisal of the work environment for potential exposures.
 Identification of abnormalities’.
 Management of occupational and non-occupational illness/injury.
 Documentation of the injury or illness.

School Health Nurses

School nurses are primary care nurses for school children . They work with individual children ,
young people, and families , schools and communities to improve health.

Activities

1. Assessments for children at entrance to school as required.

2. Individual health interview offered to young people aged 13-14 years.

3. Immunization programmes.

4. Child protection.

5. Health education.

Space Nursing Society

 Space nursing society is an affiliated , non profit special interest group associated with
the national space society.
  The SNS provides a forum for the discussion and exploration of issues related to nursing
in space and its impact upon the understanding of earthbound nursing through
conference participation and its newsletter expanding horizon s
 There are many earth bound counterparts that could benefit from what is being learned
via space research.

Trends In Nursing Practice.

Trends in nursing are closely tied to what is happening to health care in general . Trends are
fascinating phenomena but they don’t existing vaccum . 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 a particular trend will takes us, to remove the element of surprise .

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 client , the family, and in some instance
the community.

Another aspect of the broader nursing focus to the movement of nursing practice into the
community . in a sense , there is a return to the beginning of nursing.

The nursing activity not only assists those who are ill but also helps those who are healthy to
maintain or continue their health.

Scientific basis
In the past nursing largely was either intuitive or relie 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 became highly skilled in providing care through experience.

Technology
Technology or mechanization is being applied in the health field extensively . Certain areas of a
hospital are more technologic than others . Nurses find themselves in the midst of this rapidly
changing , increasingly technologic environment in hospital and in clients homes.

Indicators of increasing technology

 The proliferation of technologic equipment used in case of clients in hospitals and homes.
 The increasing home and self care equipment.
 Use of computers in many areas of health care.
Many nurses feel that they need more education to obtain the knowledge and skills necessary to
use the new technology . High technology has enabled the nurses to gather client assessment data
through non-invasive technique (e.g. pulse oxymetry)rather than , through the costly invasive
procedure.

Expansion Of Employment Opportunities

Nursing roles continue to expand and develop , broadening the focus of nursing care 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 and vitamins.

Nursing Public Perception

Any member of society who has been ill, hospitalized or visited an emergency department has
experienced nursing campaign noted . Everybody needs a nurse. The Johnson and Johnson
foundation has developed compelling , attention getting media campaign on the nursing
profession. These media clips show nursing practice , and the nurses featured in the
advertisement and described their satisfaction in profession. For example- American public
rated nurses high in honesty and ethics in their professional role.

Nursing Impact On Politics And Health Policy

 Nurses involvement in politics is receiving greater emphasis in nursing curricula ,
professional organizations, and health care settings.
 Professional nursing organizations have employed lobbyists to improve the quality of
health care.

Changing Trend In Nursing

1. Nursing has originated from the world nurturing which means nourishing ,helps in growth and
development of a human being . In the past nursing was family based work .

2. Modern nursing began in the 19th century under the leadership of Florence nightingale .

3. The aim of nursing was only to promote the recovering of patients.even now ,the central
concern of nursing edge nurturing the human being .

4.The present day nurse provides care for the people in health 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 .
5. Nursing process consist of five steps –assessment ,nursing diagnosis , planning
,implementation and evaluation . Each step of a nursing process leads to the next one , which
makes it a continuing cyclic process .

Modern Trends In Nursing Practice.

The public perception of alternative , complementary treatment method has been changing over
the past few decades .

In the late 1960s and early 1970s natural new age selp help movements begin to attract
followers, first among consumers and later among health care practitioners . During that time
there was a growing trend towards rejection of traditional medicine because it was perceived
invasive, painful, cost and ineffectiveness.

Clients are seeking out alternative /complementery therapies because most such therapies are non
invasive, holistic and in many instances less expansive than going to a physician .

A few therapies investigated as people using are :

1.Biofeedback to control pain

2. Acupuncture to relieve depression .

3. Imagery to control asthma .

4. Ayurvedic medicine to treat parkinsons disease .

5.Music therapy to treat brain injured clients .

6. Shark cartilage to treat cancer .

Summary

We have discussed ,

Introduction

Definition

Characteristics of nursing practice.

Development of framework,

Approval of the framework.

Description of framework .

Implementation of the framework.

Scope of nursing practices.

-mobile nursing practices.

-military nursing services.

- tele-nursing .

- nursing robot .

- occupational health nurses.

- space nursing society.

Trends in nursing practices.

Changing trends in nursing.

Modern trends in nursing practices.

Conclusion

Nurses in advanced nursing practice are well positioned to respond to the evolution of health
care. In particular advance nursing plays a key role in meeting the health needs by building the
nursing knowledge, advancing the nursing profession and contributing to a sustained and
effective healthcare system.

Bibliography.

Basheer p. shebeer. A concise text book of advanced nursing practices. Second edition: 2017;
emmess medical publishers. Banglore page no-645-650.

Brar kaur navdeep , rawath h.c. , a text book of advanced nursing practices, yjaypee medical
publications, first edition, 2015, page no.-630- 635.