Advanced clinical practice : Past and present
Article # 1
Title : Advanced clinical practice : Past and present
Authors : Julie Reynolds , Jane Jervis , Kerri Douglas
Keele University
DOI : https :// doi . org / 10.21252 / 7pjk-3m06
Advanced clinical practice : Past and present
Early historical accounts cite the growth of advanced clinical practice within the Canadian outback as a consequence of the First and Second World Wars , which resulted in a lack of available people with the correct skills and knowledge to provide health care ( Kaasalainen et al . 2010 ). Within the United States of America ( USA ), the response to the growing demands placed on health care resulted in the expansion of specialist practitioners , who adopted the role and skills of junior doctors to help meet the needs of the population ( Barton and Allan , 2015 ). Other initiatives stemmed from the arrival of anaesthetics as a branch of medicine within the USA , which at the time attracted less interest from medical doctors . Subsequently nurses were encouraged to develop skills in this role , with the first clinical programme of study appearing in the USA in 1954 ( MacDonald , Herbert and Thibeault , 2006 ). However , advanced clinical practice remained controversial , as Nurse Practitioners who were advancing their nursing knowledge and skills , often adopted a form of medical model to do so . This challenged relationships not only within nursing , but with other health professions , including medicine ( Barton and Allan , 2015 ).
The development of advanced clinical practice within the United Kingdom ( U . K ) has partly been in response to growing service need . The first steps towards advanced clinical practice came about in 1987 . Stilwell et al ( 1987 ) conducted a study to consider the impact of a specially trained nurse , within an innercity practice , on patient consultations and outcomes . The nurse had been provided with education in physical examination skills and management of acute and chronic conditions frequently seen in general practice . The outcome demonstrated that nurses could practice greater autonomy and by doing so provide a wider clinical service to patients ( Stilwell et al . 1987 ). Further expansion of nursing knowledge and skills arrived with the introduction of the Scope of Practice ( United Kingdom Central Council ( UKCC ), 1992 ) allowing care to be delivered more swiftly to patients with increasingly complex needs . To acknowledge such skills and knowledge the UKCC produced theStandards for Specialist Education and Practice which helped define higher level practice , although not all agreed ( Castledine , 2002 ), as the document stipulated that the standards did not relate to advanced practice .