ROLE OF THE APRN IN GLOBAL RESEARCH

From a global perspective, the role of the APRN researcher is dynamic and vital to informing and articulating the APN role, shedding light on

TABLE 6.15 Parasitic Treatments

the health care needs of disadvantaged populations internationally, and establishing a body of evidence of advanced practice nursing knowledge. The scope and perspectives of APRN research are broad ranging and may encompass epistemology; ethnography; role definition, justification, and expansion; exploration of the notion of competence and role-specific competencies; scope of practice and role potential; and disease- and intervention-specific research within APRN roles from an evidence-based practice perspective.

This research reflects both the APRN's own practice perspectives and also those of the national and international health care environments and jurisdictions in which APRNs work. APRN-related research is not confined to APRNs themselves, and the APRN role may be the subject of international research. For example, taking an international perspective and supported by the WHO, Lassi, Cometto, Huicho, and Bhutta (2013) published a systematic review and meta-analysis of 53 studies from the scientific literature comparing the quality of care provided by providers such as APRNs and that by what are considered higher level providers within developed and developing countries, such as the Africa region. The review concluded that there was no difference between the quality, effectiveness, and outcomes of care provided by the two groups of practitioners.

State of APRN Research in the World

Although the APRN role is well established in North America, the role continues to evolve internationally in both developed and developing countries, giving rise to a body of research literature with an evidential and exploratory focus. Researchers use the traditional available resources but also enjoy the use of Google Scholar or access to the Joanna Briggs Institute (JBI) and the JBI Library of Systematic Reviews, available at connect.jbiconnectplus.org/JBIReviewsLibrary.aspx. The following journals are also resources and publish international APRN research:

• American Association of Nurse Practitioners

• International journal of Evidence-Based Healthcare

• International journal of Nursing Practice

• International journal of Nursing Studies

• journal of Advanced Nursing

• Journal of Nursing & Care

• International Nursing Review

The following brief review considers APRN research emerging from Australia, Ireland, Japan, Jordan, the Netherlands, and Scandinavia.

Australia

In Australia, where some APRN roles role have been recognized for well over a decade, the research focus tends toward qualitative reviews of the evidence of the effectiveness of the role and discipline-specific interventional research. The focus of the Australian studies presented in this section reflects the scope of practice and the emerging trends in APRN research worldwide. In a systematic review Ramis, Wu, and Pearson (2013), explored the experience of being an APRN within Australian acute care settings. The findings from the study's meta-syntheses reinforced the complexity of the identity, education, and scope of practice of the APRN role.

Kucera, Higgins, and McMillan (2010) explored Australian APRNs' lived experiences and proposed an APRN futures model derived from their narrative analysis of nurses' stories. Earlier Australian studies focused on APRN role definition, role confusion, decision making, and practice autonomy within changing health care environments. In 2006 Gardner, Chang, and Duffield proposed an APRN framework and a "research-informed model of service incorporating operational structures and role parameters" (p. 382).

The Australian Nurse Practitioner Study (AUSPRAC), funded by the Australian Research Council (ARC), undertook a 3-year study of the work, processes, and outcomes of Australian nurse practitioners. An important outcome of the AUSPRAC study was publication of The Nurse Practitioner Research Toolkit to guide APRNs in practice, service, and outcome-related research (Gardner, Gardner, Middleton, & Delia, 2009).

Ireland

A University of Ireland study by Dowling, Beauchesne, and Murphy (2013) used concept analysis to clarify the meaning of advanced practice nursing from an international perspective and concluded further research and international collaboration are required to establish internationally consistent terminology.

Japan

Kondo (2013), in a review article published in the Journal of Nursing & Care, explored the role and contribution of nurse practitioners internationally and the potential for, and barriers to, implementation of the advanced practice role in Japan. In a 2014 article published in International Nursing Review, Fukuda et al. reviewed the first nurse practitioner graduate program in Japan and provided an overview of the research and project planning phases preceding implementation of the NP program.

Jordan

Zahran, Curtis, Lloyd-Jones, and Blackett (2012) presented an ethnographic approach to a study of the perceived concept of the introduction of the advanced nurse practitioner and APRN training programs in Jordon. The authors related their findings from the broader APRN literature to the context-specific Jordanian nursing educational and practice environments.

The Netherlands

Noordman, van der Wijden, and van Dulmen (2014) employed a pretest/ posttest design to examine the effects of video feedback on the communication skills of APRNs.

Scandinavia

A study by Slatten, Hatlevik, and Fagerstrom (2014), Validation of a New Instrument for Self-Assessment of Nurses' Core Competences in Palliative Care, explored the concept of competence as a core prerequisite for APRN quality of care within Scandinavia. The instrument—Nurses' Core Competence in Palliative Care (NCPC)—was developed in Norway in 2007. Findings from this study identified five domains of competence within the palliative care APRN role: knowledge of symptom management, systematic use of the Edmonton symptom assessment system, teamwork skills, interpersonal skills, and life-closure skills.