DEVELOPMENT OF NURSING PRACTICE

INTRODUCTION
Development of nursing practice is a central introductory point for NSW health
professionals to access information and resources relevant to practice development.

Practice development is gaining momentum very quickly in NSW as clinicians come

to appreciate the value of using a systematic approach to transforming work based cultures to
deliver person-centered care that encompasses the needs of patients, families and staff. While
practice development has largely been evident in nursing units it has applicability for all
professions.

DEFINITION
“Practice development is a continuous process of developing person-cantered
cultures. It is enabled by facilitators who authentically engage with individuals and teams to
blend personal qualities and creative imagination with practice skills and practice wisdom.
The learning that occurs brings about transformation of individual and team practices. This is
sustained by embedding both processes and outcomes in corporate strategy”. 
- McCormack & Wilson (2008)
Person-cantered care incorporates the practice development principles of
inclusiveness, respect for each other, valuing individual contributions and connecting.

NURSING PRACTICE
“Nursing practice is an umbrella term describes 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 individual, family, group and communities and
populations.”

THEORETICAL BASIS OF PRACTICE DEVELOPMENT

Practice development is underpinned by critical social theory which assumes that our
social structures and collective culture shape the community and society in which we exist.
Within nursing and our healthcare system in general there are cultures that either “invite” or
“impede” participation from health professionals and patients to discuss and, in turn, make
decisions to improve patient care. Practice development methods allow all participants to
have an equal opportunity to participate in meaningful conversations about practice and
environment thereby understanding, challenging and changing the culture to improve patient
care. Thus practitioners become active participants in knowledge generation and the
continuous change process leading to embedded cultural change.
CHARACTERSTICS OF NURSING PRACTICE-

 Provision of effective and efficient care, delivered with a high degree of autonomy.
 Demonstrate of leadership and initiation of change to improve client, organization and
system outcomes.
 Demonstration of advanced judgment and decision making skills.
  Critical analysis of and influencing on health policy.
 Ability to explain and apply the theoretical, empirical, ethical and experimental
foundation of nursing practice

DEVELOPMENT OF THE FRAMEWORK

One of the first priorities of nursing 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 established a definition of
professional practice and a guidelines or framework that nurse 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 consultation with nurse 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 distributes during
nurses week .

The
The art
art of
of
nursing
nursing

Values

personal
personal Competence
Competence
commitment
commitment

Mission

attributes
attributes of
of
practice
practice

FRAMEWORK OF PROFESSIONAL NURSING PRACTICE

Art of nursing:- Nurses demonstrate ethical , insightful caring practice by focusing on the
health and well- being of individuals, families and communities is health and during episodes
of illness and transition.

Attributes of practice:- Autonomous professional practice in nursing requires taking

personal responsibility for excellence in practice and effective collaboration with
multidisciplinary team members in meeting the health needs of the population.
Competence: - Nurse Competence is grounded upon nursing theory, scientific knowledge
and experience, and is reflected through continuous learning, shared through continuous
learning.

Personal commitment:- Nurse demonstrate commitment to the profession by valuing nurse

and nursing contributing of the advancement of the profession and continually striving for
excellence in patient care.

IMPLEMENTATION OF 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 preceptor and change nurses.
 Further elaboration of framework will be ongoing.
SCOPE IN NURSING PRACTICE

 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.
 Since each state has legal authority for the regulation of nursing, the definition and
therefore the scope vary from state to state.
BACKGROUND:

 The scope of practice is defined within a legislative regulatory framework, and

communication to others the roles and the competences and the professional
accountability of the nurse.
 Nursing authority comes from evidence-based knowledge related to its spheres of
practice.
 However nursing is also allied to other health professions through its collaborating,
referring and coordinating activities and thus has distinctive as well as shared body of
knowledge and practice.
 The nursing requires appropriate initial and ongoing education and training as well as
lifelong learning to practice competently within their scope of practice.
 To enable the profession to provide competent leadership.
 The practice and competence of an individual nurse within the legal scope of practice
is influenced by education, experience and expertise.
NURSING PRACTICE IN DIFFERENT SETTING
 MOBILE NURSING SERVICES
 MILITARY NURSING SERVICES
 OCCUPATIONAL HEALTH SERVICES
 SCHOOL HEATH SERVICES
 THE NURSING ROBOT
 SPACE NURSING SOCIETY
 TELE-NURSING
MOBILE NURSING SERVICES –

In 1984 a need was seen to offer more extensive home health care for local resistance
who preferred to receive needed care n their own homes. This enables many to reduce costs
and remain in their homes at least for a long period of time. The organization became known
as mobile health care ltd.

These services provide home teaching and care for patients with varied needs and health
problems.

 Patients discharged early from the hospital.

 Patient suffering from chronic and acute medical problems
 Surgical patients
 The elderly
 The seriously ill
 Hospice concept
 Ventilator dependent
 Assistance in bathing, dressing, meals, transportation, light and housekeeping.
MILITARY NURSING SERVICES–

Military nursing has its origin from army nursing services formed in 1881part of royal
army. The army nurses served in Flanders, the Mediterranean, the Balkans, and the Middle
East and on board hospital shifts. It war on 1st Oct. 1926.

Rank structure: various ranks in military nursing

 Lieutenant
 Captain
 Major
 Lieutenant colonel
 Colonel
 Brigadier
 Major general
 Commissioned officers
TELE- NURSING DEFINITION- It is use of telecommunication and information
technology for providing nursing services in health care whenever a large physical distance
exist between patient and nurse or between any number of nursing.

APPLICATIONS OF TELE-NURSING

 Information exchange between hospitals and physicians. Networking of group of

hospitals, research events.
 Linking rural health clinics to central hospital. video conferencing between patient
and nurse.
 Training of other health care professionals.
 Instant access to medical knowledge base, technical papers. Better quality care.
THE NURSING ROBOT –

Development of a nursing robot system includes 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 also integrated were seven
different sensor systems.

 The system controlled by four networked on board Sinclair spectrum computers and
an off-board IBM PC.
 The nursing robot system comprise of three major components: a self-propelled
vehicle, a robotic arm mounted on it, and a communications post next to the disabled
person’s bed.
OCCUPATINAL HEALTH NURSING

"A registered nurse practicing in the specialty of Occupational Health & Safety to deliver
integrated occupational health and safety services to individual workers and worker
populations. Occupational Health Nursing encompasses the promotion, maintenance and
restoration of health, and the prevention of illness and injury."

Occupational health nurse activities:

 Documentation of injury.
 Observation and assessment of both the worker and work environment.
 Interpretation and evaluation of worker’s medical and occupational history, subjective
complaints and physical examination along with any laboratory values.
 Interpretation of medical diagnosis to workers and their employers.
 Appraisal of the work environment for potential exposures.
 Identification of abnormalities.
 Description of workers response.
SCHOOL HEATH NURSING–
 A school heath nurse is a qualified, experienced professional and the only trained
nurse working across health and education boundaries. They also provides link between
school, home and community.

ACTIVITIES OF SCHOOL HEALTH NURSING

 Heath assessment for children at entrance to school as required.

 Individual health interviews offered to young people aged 13-14 years.
 Immunization programs.
 Child protection.
 Heath education
 Implementation of other school health services.
SPACE NURSING ASSOCIATION-

Is an international space advocacy organization devoted to space nursing and the contribution
to space exploration by registered nurses.

 Provides a forum for the discussion and exploration of issues related to nursing in
space.
 The information being learned in the microgravity environment of space has
tremendous application for bed bound patient on earth.

TRENDS IN NURSING PRACTICE- Trends of nursing are closely tied to what is

happening to health care in general. Trends are fascinating phenomena, but they do not exist
in vacuums one trend often spawns another.

 Total care-It refers to assignments in which a nurse assumes all the care for small
group of clients. This method focuses more on the client as whole rather than the
collection of nursing tasks that need to be accomplished. It is often practiced in the
ICU.
 Case method- This is the oldest models of nursing care delivery where one nurse
provided all the care needed by a particular client. Although she would accompany
the client to the hospital if necessary. She provides care in the home and did many
household duties. As time changed this model became so very impractical
 Health care informatics- The current erratic and inconsistent use of paper records
and computers to document, store and retrieve patient care information is undergoing
a major upheaval as federal initiatives promote the development of uniform electronic
health record. An electronic health record is computerized record of all the health
information related to an individual that can be electronically accessed by variety of
health care providers.
 Evidence based practice- Nurses are faced with the challenge of providing safe,
effective care. One way to achieve this goal is to provide evidence based practice.
Evidence based clinical practice is an approach to health in which the clinician uses
current research to help guide client care decisions.
 Nursing informatics- It is a nursing specialty integrating nursing science, computer
science, information science in identifying, collecting, processing and managing data
 and information to support nursing administration, research and expansion of
knowledge.
 Standardized nursing terminologies- The demand of current health care systems is
challenging the nursing profession Nursing has moved towards standardizing nursing
terminology. It is used to clearly define and evaluate nursing care.
 Primary nursing- Here an RN assumes 24 hrs. Accountability for the client care and
for the nursing care of assigned client during his or her shift. The advantage is that the
clients are assured of having a care given who sees to all of his or her need and who
provides holistic and comprehensive care.
 Patient focused care-An updated version of team nursing and primary care is called
patient focused care where an RN is partnered with one or more assistive personnel to
take care of a group of clients. The RN may work with an assistant, respiratory
therapist.
 Ambulatory care centres- Some office settings have broadened to include diagnostic
and treatment facilities such as laboratory, radiology service, sometimes surgery.
They are often operated by large health care systems such as corporation who has
hospital and other facilities.
 Functional Nursing-It is a task oriented model where distinct duties are assigned to
specific personnel for e.g. one takes all the vital signs and other does all the dressing
and so on. Tasks are divided and client sees several people during the shift. Although
efficient it fragments care and is confusing to the client.
 Team nursing- It emerged to accommodate the staff with varying level of education
and skill. Here team is made up of an RN team leader. Other RN, LP‘s and nursing
assistants who provide care to group of clients. The leader directs the care provided
by her juniors and works with them in various capacities.
 Quantification of nursing care cost- The professions attention is thus focused on the
cost of providing nursing care to the patient within the settings of prospective
reimbursement, fewer rupees, limited time and reduced beds and staff.
 Reduced length of stay- The provision of personalized can must be planned and
provided with the continuity as the quantity of care time decreases. Many patients
who leave the hospital earlier are still in need of health care.
 Increasing reliance on high technology- In the hostile environment of a litigious
society, the practice of defensive medicine has resulted in increased dependency on
sophisticated diagnostic technology and treatment interventions.
 Need for collaboration and communication- Interdepartmental communication and
collaboration may take the form of a patient care conference. The nurse who works as
a liaison between health care professionals incorporates information obtained from
these conferences into the overall plan of care.
 Innovation in planning care through computerization- Many nurses believe that
their limited time can be better spent at bedside giving patient care rather than filling
out paper work. Now a day’s institutions are using computers which help in
maintaining digital recording and reporting of the patient’s documentation.
 Consumer orientation- The main goal of nursing care is promotion of health,
prevention of illness, restoration of health when illness ill occur. During care given to
the client nurse must be oriented to the client, physical, emotional, spiritual,
psychological nature. Ethical concern: It is important trend which is growing among
 patients and nurses. Ethical issues sprout when question arises as to who is right and
is right to prevail.

MODERN TRENDS IN NURSING PRATICE-

In the late 1960’s and early 1970’s “natural new age self-help movements ‘’begin to
attract followers, first among consumers and later among health care practitioners. During
that time provide, there was a growing trend towards rejection of traditional medicine
because it was perceived invasive, pain full, cost effectiveness.

A FEW THERAPIES INVESTIGATED AS PEOPLE USING ARE-

 Biofeedback to control pain.

 Acupuncture to relieve depression.
 Imagery to control asthma.
 Ayurveda medicine to treat Parkinson’s disease.
 Music therapy to treat brain injured client
 Shark cartilage to treat cancer.
ROLE OF ROFESSIONAL NURSE-

 Coordinator
 Communicator
 Teacher
 Counselor
 Manager
 Leader
 Team player
 Motivator
 Delegator
 Critical thinker
 Innovator
 Researcher
 Advocate

Coordinator-
 Coordinates and plans care
 Piece together fragmented care
 Prepares pt. for discharge
 Liaison in health care team

Communicator-
 Communications facilitates all nursing actions.
 The nurses communicates to other health care personnel the nursing interventions
planned and implemented for each client.
  Communications shapes the relationships between nurses and clients, nurses and
support persons and nurses and colleagues.

Teacher
 It is interaction process between the teacher and learner in which specific objective or
desired behaviour changes are achieved.
 Educate patient to develop self-care abilities.
 Provide knowledge to allow pt. to make informed decisions.
 Demonstrate needed skills.
 Promote health, prevent illness, restore health & facilitate coping.

Counsellor-
 It is the process of helping the client to recognize and cope with stressful
psychological or social problems, to develop improved interpersonal relationship and
to promote personal growth.
 It involves providing emotional, intellectual and psychological support.

Manager-
 The nurse manages the nursing care of individual, groups, family and community.
 The manager delegates nursing activity to ancillary worker and other nurses and
supervisor and evaluates their performance.

Change agent-
 Is a person or group who initiates change or who assists others in making
modifications in the moor in the system.

Nurse’s clinician-
 The clinician provide bed side and direct care in speciality area. They may or may not
have advanced education preparation.

Researcher-
 Nurse who will engage in research, there is growing expectation that all nurses will be
able to critically appraise research reports and will utilize the scientific studies as
abases for making decisions in their work.
IMPORTANCE OF PROFESSIONAL DEVELOPMENT FOR NURSES

Nurses work in a fast-paced, technical environment. They must make quick decisions about
patient care and effectively communicate with other healthcare personnel. 

Professional Development for New and Established Nurses

New nurses typically have limited experience so they may have difficulties in their
first permanent nursing position. Established nurses, on the other hand, understand their
professional responsibilities, but they might have questions about how to become a nurse
leader or advance their careers. Both types of nurses have to develop a way to achieve their
career goals while abiding by nursing regulations. A Nursing Professional Development
(NPD) specialist helps inexperienced nurses transition from school to practice, and they
advise seasoned nurses on ways to stay current and advance their careers.

Professional Development for Nurses

Professional development is critical to the nursing profession because it emphasizes the
importance of the following:
 Continuing education.

 Assessing learning needs.

 Upholding competency.

Nurses should continue learning throughout their careers. They need to stay up-to-date on
patient care, healthcare trends, treatments and techniques. NPD specialists are available to
advise nurses about certification and licensing requirements, and they can also address a
nurse’s need for additional instruction. Furthermore, NPD specialists ensure that the nurses
under their supervision always demonstrate competency.

Nursing Professional Development Specialists

A NPD specialist is also called a nurse educator. NPD specialists support nurses in
every aspect of nursing. They are not only educators but also servant leaders, facilitators,
change agents, researchers and mentors.
Generally, most healthcare organizations employ NPD specialists to guide nurses in their
professional nursing role. NPD specialists work in the following facilities:
 Hospitals.
 Long-term care facilities.
 Public health centres.
 Colleges and universities.
 Outpatient clinics.

Supporting Professional Development for Nurses

The lack of participation in nursing professional development activities surprised
nurse leaders at Medina Hospital in Cleveland, Ohio when the hospital merged with the
Cleveland Clinic in 2009. By 2013, there was a 57 percent increase in the number of certified
nurses, and 65 nurses earned a promotion. In 2014, 19 percent of the nurses enrolled in an RN
to BSN program, 19 percent enrolled in an MSN program, and 21 percent enrolled in a
doctoral program.
Nursing is a constantly developing profession. Nurses must maintain confidence and
remain open to collaboration and evaluation to attain the best patient care. For a lasting and
thriving career, nurses should commit to improving their skills through lifelong learning.
Many colleges offer courses focused on professional development in their online RN to BSN
programs.
Personal and professional development

The aim of personal and professional development is to help you manage your own
learning and growth throughout your career.

It is important that you continue to learn and develop to keep your skills and
knowledge up to date and ensure you continue to work safely, legally and effectively.

TRANSITION TO SPECIALTY NURSING

  Registered nurses in emergency departments (EDs) or intensive care units (ICUs)

require specialised knowledge and skills to safely and effectively care for their patients.
Individual intensive care and emergency department services have developed orientation or
transition programs to provide a structure for the development of nursing practice to meet the
standard of safe and effective care. These programs are directed at the transitional needs of:
 New employees with little or no ED or ICU experience
 New employees with ED or ICU experience but without formal qualifications
 Experienced nurses wishing to make a transition to ED or ICU nursing
 Nurses returning to ED or ICU
 Individual nurse professional development.
 SUMMARIZATION
The theory and application of practice development is undergoing constant research and
evaluation by clinicians and academics. A comprehensive list of useful readings about the
theory and use of practice development is including at the end of this discussion on practice
development.

CONCLUSION
Clinical competencies consist of advanced skills, which typify an expanding role that offers
new possibilities for holistic patient care practice. APNs' scope of practice is characterized by
responsibility and competence in making autonomous judgments based on expanded clinical
competence.

BIBLIOGRAPHY
 Basheer P. Shebeer. A concise Text book of advanced nursing practice. Second
edition: 2017; EMMESS Medical publishers.banglore.p-613-625.
 Brar Kaur Navdeep, Rawat HC. Text book of advanced nursing pratice.2015; Jaypee
brother’s medical publishers. New Delhi. P762-765.

Net reference-

o www.https:// scribd.com/doc/.../nursing pratice-in-Ind...

o www.https://nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-
past/
o www.https:/news-medical.net/health/trends in nursing pratices.aspx.
o https://www.slideshare.net/mobile/FIROZQURESHI/Framework-scope-and-
trends
 ERA UNIVERSITY
ERA COLLEGE OF NURSING

ASSIGNMENT
ON
SUBJECT :- ADVANCED NURSING
PRACTICES

SCOPE AND FRAMEWORK IN NURSING PRACTICE

SUBMITTED TO SUBMITTED BY
MS. SONIA A SINGH PRATIMA KUSHWAHA

ASSISTANT PROFESSOR MSC (N) 1ST YEAR

ERA COLLEGE OF NURSING ERA COLLEGE OF NURSING

LUCKNOW LUCKNOW

SUBMITTED ON: / /