Overview of Advanced Nursing Practice Roles and Responsibilities

Discuss about the Concept of Midwifery Practice.

Advance nursing practice (ANP) is a nursing practice that employs prolonged and expanded skills, knowledge and acquaintance in assessment, analysis, arrangement, employment and appraisal of the care required. ANP roles and responsibilities can be categorized into Certified nurse midwives (CNM), Clinical nurse specialists (CNS) and Certified registered nurse anesthetists (CRNA). An arena of advanced nursing practice is a growing trend globally in the provision of several healthcare services. ANP is often used to refer to the advanced roles and levels of nursing practice, specific education required and the professional regulation relevant to the nurse. The use of ANP is a general term, but different countries have different titles to the advance nurses such as clinical nurse specialists, nurse practitioners as well as advanced practice practitioners (Begley et al. ,2013).

In comparison to ANP, advanced midwifery practice is sightseen to a reduced degree. The progressive training in midwifery is a recent development in the nursing arena. The newly developed role of midwives is perceived as necessary and much crucial to the contribution of high-quality healthcare as well as professional development. Arguments have erupted on discussions on competent midwives’ work at a progressive level based on whether they practice separately and to the choice of their practice.

If the advancement of midwifery is developed to an extraordinary extent, then there will need to advance the concepts in the discipline. Concepts are the primary structural component of the development of a theory. Concepts provides essential influence to the development and expansion of midwifery skills and facts by enhancing theoretical foundation for further research and practice. Clarity of concepts is also necessary to avoid incompetency in the midwifery profession and for the achievement of effective external lawfulness (Bryar & Sinclair, 2011).

There is a lack of precise description and connotation of the conception on a global state thus the paper is aimed to clarify what is presently perceived as an advance midwifery practice. The analysis of the research recognizes the component of innovative midwifery exercise and forms a base for extra advancement and progress (Tofthagen & Fagerstrøm, 2010).

• The concept analysis purpose to simplify advanced midwifery practice and categorize its mechanisms.
• To clarify what is presently perceived as an advance midwifery practice.
• To clarify what is presently perceived as an advance midwifery practice.
• To know trained midwives who function at an unconventional level based on whether they exercise separately and the choice of practice.
• To evaluate implications of advanced midwifery practices in health care.

For the concept analysis (CA), a literature review was performed using Rodgers evolutionary method of concept analysis. That technique gives an emphasis that concept depends on the context which is dynamic. An idea is viewed as a tool for added progress for it changes by determined redefinition. Concept analysis choice was to emphasis on the examination of raw statistics instead of creation of cases evident in other concept analysis methods.

Advanced Nursing Practice Education and Professional Regulation

A reviewer possessing midwifery training and methodical literature evaluation drafted a search strategy. The second reviewer conducted another search strategy with expertise in organized reviews and ANP. Both interviewers agreed to a concluding search strategy for catalogues. The basic search concepts were advanced practitioners, midwifery, and advanced practice. The publications were searched in databases such as Web of science, Invert and Cochrane Library. Literature was searched by screening the websites of the European Network for Midwifery Regulators (NMR). In those websites of specific partners, documents concerning advanced midwifery practice were retrieved. Midwife Associations of various states such as New Zealand, Australia, and Canada who are members of International Confederation of Midwives were sent by e-mail (Collins et al., 2010).

In the full-text screening, publications that adhered to Rodgers evolutionary model of concept analysis were retained while those that lacked any of the components were excluded. The components are the consequences, roles, related terms, and attributes. Execution was also done to those references that did not contain the elements.

One view proofread the retained publications before the extraction of data. By use of self-facilitated data extraction sheet which entailed the author’s publication, data was extracted. An analysis based on themes was performed. Relevant themes were identified for each data casing the critical components of component analysis. The obtained data were classified according to countries to further describe the advance midwifery practice as well as their comparison (Dinmohammadi, Peyrovi & Mehrdad, 2013, January).

Attributes of advanced midwifery practice

Definition A definition of AMPs was obtained in the National Council for the Professional Development of Nursing and Midwifery of Ireland. The council defines AMPs as those midwives who offer healthcare interventions, promote wellness as well as advocating healthy lifestyles choices for patients, cares and families in several settings together with professionals based in the practice strategies given. The midwives use they are acquired and learned skills and knowledge to offer optimum care to the patients through the management of their chronic illness (Scanlon, Cashin, Watson & Bryce,2012).

Autonomous practice

Is was discovered that its essential for AMPs to operate separately and independently which means that the midwives are solely responsible for their practices and actions in the nursing sector. AMPs can provide care for women and children as well as make independent decisions in focusing midwifery management rather than obstetric management where views of other groups might be articulated (Dowling, Beauchesne, Farrelly & Murphy, 2013).

Comparison of Advanced Nursing Practice and Advanced Midwifery Practice

Leadership

Research indicate that AMPs ought to be professional and clinical influential. A view on clinical leadership was that they are all the activities in support of the progress of practice in midwifery service. The clinical leadership was characterized by events such as being an originator of transformation in care, being responsible for the policy and implementation of the set guidelines. The AMPs should be role model in independent medical decision making. They should also provide a satisfactory environment for partners, midwifery and those medicinal scholars in practice (Sargent,2012).

Professional leadership entailed the activities in support of progress alfresco of the service at global and national position. The teaching involved is done outside a facility, engaging in professional committees and development of policy. Members should be active in creating awareness of strategic factors and political factors affecting care sector (Goemaes et al.,2016).

Expertise

Expertise is an essential attribute of AMPs. Experienced and skilled practitioners practice advanced midwifery. Depth and breadth of midwifery knowledge characterize the practice. It is therefore advisable to the advanced midwives to engage in all methods based on the midwifery activities other than confining the delivery ward.

There is also a necessity of using the clinical and professional leadership together in theoretical knowledge. AMPs ought to put theory into practice in their daily activities. There is also the need for the AMPs to balance the technology advancement and caring skills in that, practice advancement should not only focus on technological capabilities. Advancement also includes the high level of critical thinking and evaluation of practice (Emmanuel & St John, 2010)

Research skills

The aim of examination skills to the AMPs ought to be focused on advancing the practice of midwifery and deliver adequate attention as well as provide evidence-based care. The practitioners have a risk of becoming too academic but forget on the clinical requirements of midwifery. AMPs should be involved in research projects to become expertly knowledgeable. 

References to advanced midwifery practice

Titles

Literature has also identified various titles regarding AMPs. In Australian publications. Advanced practice midwife or midwife practitioners are commonly in use. AMPs is commonly used in Irish publications.

Roles

Roles played by AMPs in healthcare facilities are researchers, auditors, consultants, managers, clinical and professional leaders as well as educators. To avoid role fragmentation in healthcare, there is the need for development of midwifery functions which leads to better interpretation of midwifery practices. As clinicians, AMPs have a global aim of practice within women gynecology. CNMs have established original services such as endometrial operations, vacuum removal, ultrasound examinations and additional technical measures (Halldorsdottir & Karlsdottir,2011).

Definition and Connotation of the Concept of Advanced Midwifery Practice

Related terms of advanced midwifery practice

Various terms are connected and are commonly used in advanced midwifery practice. For example, clinical midwife specialist (CMS) is a related term. Experts are viewed as professionals in their zone of specialization. CMS mostly use the research findings to provide practices that are evidence-based compared to the AMPs who are expected to involve themselves in conducting research.  CMSs are required t to participate and induct audit while AMPs are supposed to disseminate, lead and conduct the audit. AMPs and CMS are expected to deliver clinical control but for the AMPs are supposed to engage in specialized leadership (Schneider & Whitehead,2013).

New Zealand

Advanced midwifery in New Zealand is not recognized because their midwives are referred to as autonomous practitioners. These practitioners have their primary and only role is to provide maternity care entirely.

Australia

Australian College of Midwives believes in the midwives fulfilling their role of midwifery in an effective manner other than focusing on the scope of midwifery practice as an advanced or specialized range. Midwifery board of Australia enforced the rejection of registration standard for midwife practitioners. Those that had received those title wee only allowed to continue if only they are certified by the board and meet the requirement of nurse practitioners (World Health Organization, 2010).

South Africa

In 1990, an advanced midwifery practice database was initiated at the graduate level in South Africa.  The principal purpose of the program was to improve the practices given to the patients. The program was to improve the value of midwifery facility. This was to be achieved by cultivating skilled and professional’s assistants to give the care services. For South Africa to attain the Millennium Development Goal both 4 and 5, implementation of AMPs was seen to be the useful measure to the reduction of maternal and neonatal mortality as well as morbidity (Jacob, Sellick & McKenna,2012).

There is evidence of growth and development in the number of AMPs and the role they play in healthcare. Research has also shown that there is an increase in the number of births attended by CNM compared to births attended by physicians. Perinatal complications are also few in births attended by CNM.  CNM is less costly for it is not associated with unnecessary interventions. CNM births are less associated with caesarian births, augmentation, higher rates of breastfeeding as well as labor induction.

In gynecological care, research has it that abortion performed by specialists who received specific training such as the CNMs was less inferior compared to the abortions performed by physicians who trained in a general level of health care.

Related Terms and Attributes of Advanced Midwifery Practice

Finally, data from qualitative descriptive research suggests that AMPs provide quality services to the patients on an advanced level. AMPs are referred as leaders in the guideline, policy development, audit and education of staffs. In comparison to the care provided by doctors, AMPs are expected to come up with new initiatives, improve the quality of care as well as to enhance continuity of the advanced care (Johansen & O’brien,2016, January).

The enclosure of publication in languages like English, French, and Dutch could have resulted to a partial investigation of advanced midwifery practice.  No separate analysis was reported on publications commentary on penalties of AMPs attention in exception of obstetrical care. Caution is required in interpreting the estimation of the implications of AMPs on strategic and clinical conclusions. Another limitation is that no assessment of quality was performed. Application of caution is fundamental concerning the outcomes in the concept analysis.

The strength of concept analysis can be seen in the implementation of a mixed literature evaluation opposed to analyzing of a taster that involves only 20% of the whole sum of forms which can be viewed in the recommendations of Rodgers. Concept analysis is the first analysis which focuses specifically on advanced midwifery practice. It gives an outline as well as the form of the sculpture of the mechanisms categorizing the notion.

Conclusion

In summary, CA is the initial analysis which focuses precisely on advanced midwifery practice. It gives an outline as well as the form of the sculpture of the components categorizing the concept. The purpose of researching concept analysis was to bring clarification to the impression of advanced midwifery practice. Even though the literature evaluation revealed only one definition and various characteristics of AMPs:  leadership, separate practice research skills, and expertise, a global consensus concerning advanced midwifery is in lack (Middleton, Gardner, Gardner & Della,2011).

If the argument of advanced midwifery practices is pushed to a further extent, an enhanced understanding of the prickly matters in arrival to an agreement on advanced midwifery practice is essential. The conclusions are backing various constructive implications of the AMPs on strategic and clinical outcomes. The data from qualitative descriptive research suggests that AMPs provide quality services to the patients on an advanced level. AMPs are referred as leaders in the guideline, policy development, audit and education of staffs. In comparison to the care provided by doctors, AMPs are expected to come up with new initiatives, improve the quality of care as well as to enhance continuity of the advanced care.

Roles Played by Advanced Midwifery Practitioners in Healthcare Facilities

Forthcoming research studies should focus on the surveys of necessities and provisions for a further effective development and implementation as well as the increase in useful AMPs roles and responsibilities globally. Caution is required in interpreting the estimation of the implications of AMPs on strategic and clinical conclusions. Another limitation is that no assessment of quality was performed. Application of caution is fundamental concerning the outcomes in the concept analysis. With the high rate of growth of some AMPs. It is therefore essential and possible to engage in more research studies comprehensively evaluating the contribution of AMPs to a nursing specialty of healthcare (Rezaei-Adaryani, Salsali, & Mohammadi,2012)

References

Begley, C., Elliott, N., Lalor, J., Coyne, I., Higgins, A., & Comiskey, C. M. (2013). Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). Journal of advanced nursing, 69(6), 1323-1337.

Bryar, R., & Sinclair, M. (Eds.). (2011). Theory for midwifery practice. Palgrave Macmillan.

Collins, C. T., Fereday, J., Pincombe, J., Oster, C., & Turnbull, D. (2010). An evaluation of the satisfaction of midwives’ working in midwifery group practice. Midwifery, 26(4), 435-441.

Dinmohammadi, M., Peyrovi, H., & Mehrdad, N. (2013, January). Concept analysis of professional socialization in nursing. In Nursing forum (Vol. 48, No. 1, pp. 26-34).

Dowling, M., Beauchesne, M., Farrelly, F., & Murphy, K. (2013). Advanced practice nursing: a concept analysis. International journal of nursing practice, 19(2), 131-140.

Emmanuel, E., & St John, W. (2010). Maternal distress: a concept analysis. Journal of Advanced Nursing, 66(9), 2104-2115.

Goemaes, R., Beeckman, D., Goossens, J., Shawe, J., Verhaeghe, S., & Van Hecke, A. (2016). Advanced midwifery practice: An evolutionary concept analysis. Midwifery, 42, 29-37.

Halldorsdottir, S., & Karlsdottir, S. I. (2011). The primacy of the good midwife in midwifery services: an evolving theory of professionalism in midwifery. Scandinavian journal of caring sciences, 25(4), 806-817.

Jacob, E., Sellick, K., & McKenna, L. (2012). Australian registered and enrolled nurses: Is there a difference?. International Journal of Nursing Practice, 18(3), 303-307.

Johansen, M. L., & O’brien, J. L. (2016, January). Decision making in nursing practice: a concept analysis. In Nursing forum (Vol. 51, No. 1, pp. 40-48).

Middleton, S., Gardner, A., Gardner, G., & Della, P. R. (2011). The status of Australian nurse practitioners: the second national census. Australian Health Review, 35(4), 448-454.

Rezaei-Adaryani, M., Salsali, M., & Mohammadi, E. (2012). Nursing image: An evolutionary concept analysis. Contemporary nurse, 43(1), 81-89.

Sargent, A. (2012). Reframing caring as discursive practice: a critical review of conceptual analyses of caring in nursing. Nursing Inquiry, 19(2), 134-143.

Scanlon, A., Cashin, A., Watson, N., & Bryce, J. (2012). Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum. Journal of the American Association of Nurse Practitioners, 24(11), 649-659.

Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.

Tofthagen, R., & Fagerstrøm, L. M. (2010). Rodgers’ evolutionary concept analysis–a valid method for developing knowledge in nursing science. Scandinavian journal of caring sciences, 24(s1), 21-31.

World Health Organization. (2010). Strategic directions for strengthening nursing and midwifery services 2011-2015