Advanced Practice Nursing Decisions

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Advanced Practice Nursing Decisions

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Topic 1: Advanced Practice Nursing Decisions that Cause Moral Distress
Choose an ethical-legal dilemma that would cause the advanced practice nurse moral distress. The dilemma could be one you have faced in your practice. Write at least the introductory paragraphs for the Unit 4 Assignment. Be specific about the dilemma — something you may have experienced in your practice. Outline the topics that will be discussed in the Unit 4 Assignment using level one APA headings.
Use the APA template provided in the class for this paper. It is set up for all papers in APA format. Place the beginning of your paper in the Discussion Board for all to read and critique.
After receiving feedback from your peers and instructor, work on refining the paper to submit in Unit 4. Choose someone to peer review that does not have feedback.
Cite and reference at least three nursing peer reviewed articles to support the content in the paragraph. In the final Assignment, you will have a minimum of seven references relating to legal and ethical issues.
Chapter 16, titled Effective Peer Reviews, in the Kaplan Guide to Successful Writing handbook explains the importance of conducting peer reviews (critiques), how to conduct the peer review, and how to help your classmates and the reviewer achieve an improved learning experience.
Review pages 213–219 of 



Topic 2: Evaluation of Ethical Models and the Ethics Committee
You identified an ethical dilemma in Discussion topic 1 of this unit. Present your dilemma to the ethics committee of your institution. Outline an ethical theory or model you wish the committee to consider when reviewing this case. What arguments do you have to support the use of this model? Discuss the role of the ethics committee in this particular ethical dilemma.

Both in Australia and abroad, there is lack of unambiguous consensus on the idea of advanced practice nursing [1–5]. 
Efforts to resolve this ambiguity have focused on terminology [1], scope [6, 7], and practice domains [2–5]. 
We believe that this uncertainty has hampered the move to unqualified acceptability, trapping advanced practice nursing in liminal zone with limited opportunities for recognition and expansion. 
This is especially true in general practice, where advanced practice role development is more fluid and less supported by the hospital system’s hierarchical structures [5].


Nurses conduct advanced practice activities such as diabetes teaching, chronic disease management, and mental health casework in general practice, replacing work previously performed by general practitioner [8–10]. 
In terms of comprehensive care, systems support, teaching, research, and professional leadership, it is generally acknowledged that this range of tasks satisfies worldwide expectations of advanced practice nursing [3, 4].


The majority of general practice research has focused on either (1) Nurse Practitioners, legislatively recognized subset of advance practice nurses, or (2) Practice Nurses, larger group of nurses who operate in general practice and include advance practice nurses. 
review by McInnes et al. [11] and research by Merrick et al. [12] gave useful insights into the challenges of cooperation, collaboration, and decision-making in general practice settings, but they did not particularly address advanced practice nursing issues. 
Other research looked at nurses in specific tasks [13, 14], in specific settings [10, 15], or handling specific illnesses [16–18].


The goal of this review is to compile list of published qualitative studies that detail advanced practice nursing experiences in general practice. 
The unique perspective provided by patients, nurses, and doctors in this new setting sheds new light on why advanced practice nurses have struggled to acquire acceptability in the hospital environment. 
This new information will contribute to broader discussions about the establishment and continuation of advanced practice jobs in any setting.


Methods of investigation
Bettany-Saltikov [19] described the Population Exposure Outcome (PEO) technique for framing our research question. 
This methodology made the search process easier and allowed for more concentrated evaluation of the papers that were found.


Only patients, nurses, and doctors (P) who had interaction with advanced practice nurses working in general practice were of interest to us (O) (E). 
We were aware of regional differences in the definition of ‘advanced practice,’ so we agreed to utilize Roche et al[5] .’s larger and, hence, more comprehensive definition, which included the demonstration of skill set beyond general nursing duties. 
While basic nursing tasks are crucial, it was necessary to establish that advanced practice nursing entailed extra obligations including sophisticated critical reasoning that would not ordinarily be expected of nurse practicing at lower level. 
While it is possible that the intangibility of these higher order abilities could lead to recognition errors, distinguishing what is and is not advanced practice nursing is quite simple in practice [1]. 
Case management, peer education, chronic illness management, counselling, and health promotion are examples of additional work performed by advanced practice nurses in general practice. 
To emphasize this distinction, Table presents two instances from the general practice context.
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