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Contents

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

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