Contributors xi
Introduction xiii
1 The Development of Advanced Nursing Practice in the United Kingdom 1
Paula McGee
Introduction 1
Health policies and reforms 2
The UKCC and higher-level practice 4
The interface with medicine 4
The introduction of new roles 8
Modern matrons 8
Nurse consultants 8
Physicians' assistants 9
Nurse practitioners and the Royal College of Nursing 9
The Nursing and Midwifery Council 11
Conclusion 12
Key questions for Chapter 1 12
References 12
2 UK Health Policy and Health Service Reform 15
Alistair Hewison
Introduction 15
The policy process 16
Labour health policy since 1997 17
UK health policy and its implications for advanced nursing practice 19
Advanced nursing practice 20
Advanced nurses as policy implementers 23
Conclusion 24
Key questions for Chapter 2 25
References 25
3 Advanced Practice in Allied Health Professions 29
Paula McGee and David Cole
Introduction 29
The introduction of the consultant allied health professional 30
Physiotherapy 33
Radiography and sonography 35
Sonography: an example of advanced radiography role 37
Are these new roles in physiotherapy and radiography/sonography advanced? 39
Conclusion 41
Key questions for Chapter 3 41
References 41
4 The Conceptualisation of Advanced Practice 43
Paula McGee
Introduction 43
The context of the development of advanced practice 43
The nature of advanced practice 45
Professional maturity 46
Challenging professional boundaries 46
Pioneering innovations 49
Is advanced practice a generic term? 53
Conclusion 53
Key questions for Chapter 4 54
References 54
5 Advanced Assessment and Differential Diagnosis 56
Paula McGee
Introduction 56
The nature of advanced assessment 57
Types of advanced assessment 58
Conducting an advanced assessment 63
Limitations of advanced assessment 64
Formulating a differential diagnosis 64
Conclusion 68
Key questions for Chapter 5 68
References 68
6 Prescribing and Advanced Practice 70
Sue Shortland and Katharine Hardware
Introduction 70
Recent developments in non-medical prescribing 71
Preparation for prescribing 72
Who may prescribe what? 73
Nurses 73
Allied health professionals 73
Controlled medicines 74
Patient group directions 74
Emergency situations 74
The principles of safe prescribing 75
Safety and clinical governance 76
The future of non-medical prescribing 77
Conclusion 78
Key questions for Chapter 6 78
References 78
7 Advanced Practice in Dietetics 81
Linda Hindle
Introduction 81
Reasons for the development of consultant roles in dietetics 82
The consultant role 82
Working as a consultant in obesity management 83
Role development 83
Clinical practice 83
Professional leadership 84
Education, training and professional development 87
Service development, research and evaluation 88
Setting up a consultant post 89
Examples of dietetic consultant roles 90
Conclusion - the future for consultant dietitians 93
Key questions for Chapter 7 94
Acknowledgements 94
References 95
8 Advanced Practice in Occupational Therapy 97
Lynne Frith and Janette Walsh
Introduction 97
Advanced practice in occupational therapy 98
Specialist roles in occupational therapy 98
Clinical caseload and expertise 99
Clinical leadership 99
Clinical teaching and mentoring 99
Specialist advisory role 99
Consultant roles in occupational therapy 100
Expert clinical practice 100
Practice and service development 100
Professional leadership and consultancy 100
Research audit and evaluation 101
Education, training and development 101
The clinical specialist and consultant occupational therapist as advanced roles 101
Current issues for consultant occupational therapists 103
The future for occupational therapists 104
Conclusion 105
Key questions for Chapter 8 105
References 105
9 Working as an Advanced Nurse Practitioner 107
Mark Radford
Introduction 107
Defining a need 108
Organisational preparation 110
Job planning 111
Maintaining focus and delivery 112
Developing strategic influence 113
Consultancy and entrepreneurship 114
Review and evaluation 116
Career progression 119
Conclusion 121
Key questions for Chapter 9 121
Acknowledgements 121
References 122
10 Pioneering New Practice 124
Kate Gee
Introduction 124
Background to the quadrant model 124
The quadrant model 127
Quadrant 1: pioneering innovations in technical acute cure cultures 128
Quadrant 2: pioneering innovations in high-technology/care cultures 130
Quadrant 3: pioneering innovation in low-technology/cure cultures - strategies for patient education and rehabilitation 131
Development of ICD nursing expertise 132
Development of heart failure nursing expertise 132
Quadrant 4: pioneering innovations in low-technology/care quadrant 134
Conclusion 136
Key questions for Chapter 10 137
References 137
11 Cultural Competence in Advanced Practice 141
Paula McGee
Introduction 141
Culture and equality 142
Cultural relationships among health, illness, treatment and care 145
Theoretical approaches to culturally competent practice 146
Papadopoulos, Tilki and Taylor's theory of cultural competence 147
Purnell and Paulanka's theory of cultural competence 149
McGee's theory of cultural competence 150
Relevance of theory to advanced practice 153
Conclusion 155
Key questions for Chapter 11 155
References 155
12 Leadership in Advanced Practice: Challenging Professional Boundaries 158
Sally Shaw
Introduction 158
Leadership in advanced practice 159
Theories and characteristics of leadership 160
What leadership is not 160
Leadership can be learned 161
What is leadership? 161
Theories of leadership 161
Key elements of leadership 162
Other important leadership characteristics 165
The setting for leadership 166
The followers 168
Leadership styles and their relevance for advanced practice 169
Sustaining and nurturing leaders 172
Indicators of effective leadership 174
Conclusion 175
Key questions for Chapter 12 175
Acknowledgements 175
References 176
13 Management Issues in Advanced Practice 177
Paula McGee and Mark Radford
Introduction 177
Managing the self 178
Management issues and their implications for advanced practitioners 180
Current health service priorities 181
Modernising health professionals' careers 183
Patient and public involvement in health care 184
The strategic and business plans 185
Managing advanced practice roles 186
The advanced practitioner as manager 188
Conclusion 189
Key questions for Chapter 13 189
References 189
14 The Preparation of Advanced Practitioners 192
Paula McGee
Introduction 192
The concept of competence 193
Competencies for advanced practice 195
The educational preparation of advanced practitioners 201
Clinical doctorates 204
Conclusion 206
Key questions for Chapter 14 207
References 208
15 The Careers of Advanced Practitioners 210
Chris Inman and Paula McGee
Introduction 210
Context of the survey 211
Findings 212
Employment issues 212
Perceptions of the role and its effects on practice 214
Evaluation of the advanced practice role 217
Perceived helpfulness of the preparation for the advanced practice role 217
Career development 219
Consultant practitioners 220
Discussion 221
Conclusion 225
Key questions for Chapter 15 225
References 225
16 An International Perspective of Advanced Nursing Practice 227
Madrean Schober
Introduction 227
Factors contributing to the emergence of advanced nursing practice globally 228
Extent of international presence 229
An international presence marked by confusion 230
Advanced nursing practice defined: an international view 231
Characteristics 231
Country illustrations of development 234
The role of international organisations 235
Scope of practice, regulation and standards 236
Practice settings 237
Interaction with health professionals 238
Future directions in advanced nursing practice 239
Conclusion 240
Key questions for Chapter 16 240
Acknowledgements 241
References 241
17 The Future for Advanced Practice 243
Paula McGee
Introduction 243
An agenda for research 244
Direct practice 244
Collaboration with service users 245
Diversity and inclusiveness 247
Professional regulation and control 248
Education and assessment 250
Recording developments 250
Conclusion 251
References 253
Index 255
