State of the art on Advanced Nursing Practice: reflections for the agenda in Brazil

Angeli-Silva, Livia; Leitão, Tatiana de Sena; David, Helena Maria Scherlowski Leal; Mascarenhas, Nildo Batista; Acioli, Sônia; Silva, Tiago Parada Costa

doi:10.1590/0034-7167-2022-0151

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Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 75 (05) • 2022 • https://doi.org/10.1590/0034-7167-2022-0151 copy

State of the art on Advanced Nursing Practice: reflections for the agenda in Brazil

Estado del arte de las Prácticas Avanzadas de la Enfermería: reflexiones para la agenda en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to review the state of the art on Advanced Nursing Practices.

Methods:

a scoping review of existing publications up to 2020, in the PubMed/MEDLINE, SciELO, LILACS, BDENF, Web of Science and Scopus databases, identified by descriptors “Prática Avançada de Enfermagem” or “Advanced Practice Nursing”. A total of 184 documents were selected. The characterization of this study was carried out, followed by the construction of an overview of different regions of the world.

Results:

studies showed an increasing trend in the last decade, being present in all continents, although 43.5% correspond to opinion articles, comments, editorials and event reports. Even with similar aspects, the justifications for Advanced Nursing Practices reflect specific regional needs.

Final Considerations:

the studies still lack methodological variety and emphasis on the specificities of countries and their health systems, in addition to greater detail on labor regulation, professional training and the impacts of these practices in nursing.

Descriptors:
Advanced Practice Nursing; Work; Nurses; Health Systems; Brazil.

Time distribution	Study design		Countries with the highest volume of studies
2000 01 2001 01 2002 01 2003 00 2004 00 2005 00 2006 00 2007 01 2008 02 2009 03 2010 03 2011 03 2012 05 2013 02 2014 13 2015 19 2016 17 2017 19 2018 29 2019 39 2020 26	Opinions, comments, editorials and reports 80 (43.5%) Research reports 54 (29.3%) Review articles 17 (9.2%) Experience reports 15 (8.2%) No categorization 14 (7.6%) Other analytical studies 4 (2.2%)		United States (n=26) France (n=13) Spain (n=9) Norway (n=5) Australia (n=5) Chile (n=5) Colombia (n=5) Canada (n=4)
	AREAS OF PRACTICE OF ADVANCED PRACTICE NURSES
	Generalist clinical	Specific clinical	Clinical subarea
	• Primary Care • Clinical coordinator • Emergency care • Family care • Intensive care • Prolonged and home care • Rural and remote care • Chronic diseases • Nurse researcher • Care manager • School and college health	• Cardiology • Surgery • Palliative care • Respiratory disease • Geriatrics • Nephrology • Neurology • Obstetrics • Oncology • Orthopedics • Pediatrics/neonatology • Occupational health • Mental health • Sexual and reproductive health • Urology	• Anesthesia • Diabetes mellitus • Sleeping disorders • Inflammatory bowel disease • Cystic fibrose • Genetics • Hepatitis/HIV • Anticoagulant therapy • Opioid and neuroleptic therapy • Transplantation • Substance use disorders • Acute pain treatment • Wound care

Author Year	Countries	Study design and main content
Parker JM, Hill MN, 2017(¹1 Parker JM, Hill MN. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. Int J Nurs Sci. 2017;4(2):196-204. https://doi.org/10.1016/j.ijnss.2017.01.002 https://doi.org/10.1016/j.ijnss.2017.01.... )	USA, Canada, Australia, Hong Kong	Literature review on APN implementation: training, role, practice scope, career, accreditation and performance assessment.
Li Q et al, 2020(²2 Li Q, Liu M, Davidson PM, Reynolds NR, Buerhaus PI. A tale of two countries: nurse practitioners in the United States and China. J Adv Nurs. 2020;76(4):924-6. https://doi.org/10.1111/jan.14292 https://doi.org/10.1111/jan.14292... )	China and USA	Historiographical essay on historical aspects of APN in China, compared to the USA.
Bryant-Lukosius D et al, 2017(⁴4 Bryant-Lukosius D, Valaitis R, Martin-Misener R, Donald F, Peña LM, Brousseau L. Advanced Practice Nursing: a strategy for achieving universal health coverage and universal access to health. Rev. Latino-Am. Enfermagem. 2017;25:e2826. https://doi.org/10.1590/1518-8345.1677.2826 https://doi.org/10.1590/1518-8345.1677.2... )	Latin America	Literature review on APN in the international context and its role for developing coverage and universal access to health in Latin America.
Kaasalainen S et al, 2010(⁷7 Kaasalainen S, Martin-Misener R, Kilpatrick K, Harbman P, Bryant-Lukosius D, Donald F, et al. A historical overview of the development of advanced practice nursing roles in Canada. Nurs Leadersh. 2010;23:35-60. https://doi.org/10.12927/cjnl.2010.22268 https://doi.org/10.12927/cjnl.2010.22268... )	Canada	Literature review on historical aspects of APN role development in Canada.
Keeling AW, 2015(⁸8 Keeling AW. Historical Perspectives on an Expanded Role for Nursing. Online J Issues Nurs [Internet]. 2015 [cited 2021 May 5];20(2):2. Available from: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Historical-Perspectives-Expanded-Role-Nursing.html http://ojin.nursingworld.org/MainMenuCat... )	USA	Historiographic essay on APN in the USA, its development and challenges.
Sheer B, Wong FKY, 2008(⁹9 Sheer B, Wong FKY. The development of advanced nursing practice globally. J Nurs Scholarsh. 2008;40(3):204-11. https://doi.org/10.1111/j.1547-5069.2008.00242.x https://doi.org/10.1111/j.1547-5069.2008... )	All continents	Documentary research on historical aspects, needs, facilities, performance and training for APN.
Maier C, Aiken L, Busse R, 2017(¹¹11 Maier CB, Aiken LH, Busse R. Nurses in advanced roles in primary care: policy levers for implementation. OECD Health Working Papers. 2017;(98):13-69. https://doi.org/10.1787/a8756593-en https://doi.org/10.1787/a8756593-en... )	OECD and Europe	Analytical study on the development and regulatory reforms of APN role, functions performed, educational programs, legislation and regulations.
Lee G, Hendriks J, Deaton C, 2020(¹²12 Lee G, Hendriks J, Deaton C. Advanced nursing practice across Europe: work in progress. Eur J Cardiovasc Nurs. 2020;19(7):561-3. https://doi.org/10.1177/1474515120917626 https://doi.org/10.1177/1474515120917626... )	Europe	Editorial on APN overview in Europe and its role in the follow-up of people with chronic cardiovascular diseases.
ANNP, 2021(¹⁴14 American Associations of Nursing Practitioners (ANNP). Historical Timeline [Internet]. 2021 [cited 2021 Jun 15]. Available from: https://www.aanp.org/about-aanp/historical-timeline https://www.aanp.org/about-aanp/historic... )	USA	American Nursing Practitioners Association timeline.
Brooten D et al, 2002(¹⁶16 Brooten D, Naylor MD, York R, Brown LP, Munro BH, Hollingsworth AO, et al. Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care. J Nurs Scholarsh. 2002;34(4):369-75.https://doi.org/10.1111/j.1547-5069.2002.00369.x https://doi.org/10.1111/j.1547-5069.2002... )	USA	Literature review on APN at early discharge in different groups of patients, focusing on health condition, patient satisfaction and cost.
Yi M, 2016(¹⁷17 Yi M. Creating a Culture of Professional Development for Oncology Nursing in Asia. Asia-Pacific J Oncol Nurs. 2016;3(1):30-2. https://doi.org/10.4103/2347-5625.177392 https://doi.org/10.4103/2347-5625.177392... )	Asia	Analysis of the oncology situation in Asia and proposal to expand the performance in oncology nursing, through APN, aiming to enhance prevention and screening actions as well as continued and palliative care.
Almukhaini S et al, 2020(¹⁸18 Almukhaini S, Martin-Misener R, Weeks LE, Macdonald M, Hussain H, Macdonald D, et al. Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review protocol. JBI Evid Synth. 2020;19(4):891-8. https://doi.org/10.11124/JBIES-20-00002 https://doi.org/10.11124/JBIES-20-00002... )	Arab countries	Scoping review research protocol on the APN role of in the region.
Christmals CD, Armstrong SJ, 2019(¹⁹19 Christmals CD, Armstrong SJ. The essence, opportunities and threats to Advanced Practice Nursing in Sub-Saharan Africa: a scoping review. Heliyon. 2019;5(10). https://doi.org/10.1016/j.heliyon.2019.e02531 https://doi.org/10.1016/j.heliyon.2019.e... )	Sub Saharan Africa	Literature review on relevance, opportunities and challenges to implementation of an APN program focused on child health in sub-Saharan Africa.
Scanlon A, Murphy M, Smolowitz J, Lewis V, 2020(²⁰20 Scanlon A, Murphy M, Smolowitz J, Lewis V. Low-and lower middle-income countries advanced practice nurses: an integrative review. Int Nurs Rev. 2020;67(1):19-34. https://doi.org/10.1111/inr.12536 https://doi.org/10.1111/inr.12536... )	Middle- and low-income countries	Literature review on APN roles in low- and middle-income countries.
Cassiani SHDB, Zug KE, 2014(²¹21 Cassiani SHDB, Zug KE. Promoting the Advanced Nursing Practice role in Latin America. Rev Bras Enferm. 2014;67(5):673-4. https://doi.org/10.1590/0034-7167.2014670501 https://doi.org/10.1590/0034-7167.201467... )	Latin America	Editorial that addresses PAHO’s initiatives to promote APN in Latin America.
Cassiani SHDB, Zug KE, 2015(²²22 Cassiani SHDB, Zug KE. The Advanced Practice Nursing role in Latin America: challenges, opportunities and implications for universal health coverage. Investig Enferm Imagen Desarrol. 2015;17(1). https://doi.org/10.11144/Javeriana.IE17-1.apnr https://doi.org/10.11144/Javeriana.IE17-... )	Latin America	Editorial that addresses some PAHO initiatives to achieve Universal Health Coverage and APN implementation to expand PHC.
Cassiani S, Lopez RS, Rosales LK, 2016(²³23 Cassiani S, Lopez Reyes S, Rosales LK. [Building Curricular Competencies to Facilitate Advanced Practice Nursing Implementation in Latin America]. Enfermería Univ. 2016;13(4):199-200. https://doi.org/10.1016/j.reu.2016.09.003 Spanish. https://doi.org/10.1016/j.reu.2016.09.00... )	Latin America	Editorial that addresses some PAHO initiatives to achieve Universal Health Coverage and APN implementation to expand PHC.
Cassiani SHDB, Rosales LK, 2016(²⁴24 Cassiani SHDB, Rosales LK. Initiatives towards Advanced Practice Nursing Implementation in the Region of the Americas. Esc Anna Nery. 2016;20(4). https://doi.org/10.5935/1414-8145.20160081 https://doi.org/10.5935/1414-8145.201600... )	Americas	Editorial on initiatives for ANP implementation in the Americas region.
Morán-Peña L, 2017(²⁵25 Morán-Peña L. Advanced Practice Nursing: What is it and what could it become in Latin America? Enfermería Univ. 2017;14(4):219-23. https://doi.org/10.1016/j.reu.2017.09.004 https://doi.org/10.1016/j.reu.2017.09.00... )	Latin America	Editorial that addresses some PAHO initiatives for APN implementation, in order to strengthen PHC actions.
Morán Peña L, 2015(²⁶26 Morán Peña L. Advanced practice nurses, global and regional trends to support access and universal health coverage. Rev Iberoam Educ Invest Enferm [Internet]. 2015 [cited 2021 Jul 10];5(3):4-7. Available from: http://www.enfermeria21.com/revistas/aladefe/articulo/167/ http://www.enfermeria21.com/revistas/ala... )	Americas	Editorial on historical aspects of APN and its implementation in the Americas.
Honig J, Doyle-Lindrud S, Dohrn J, 2019(²⁷27 Honig J, Doyle-Lindrud S, Dohrn J. Moving towards universal health coverage: advanced practice nurse competencies. Rev Lat Am Enfermagem. 2019;27(3132). https://doi.org/10.1590/1518-8345.2901.3132. https://doi.org/10.1590/1518-8345.2901.3... )	Latin America	Description of a project’s first phase that sought to develop a set of consensus-based ANP competencies to produce a curriculum prototype to be adapted in Latin American countries.
Cassiani SHDB et al, 2018(²⁸28 De Bortoli Cassiani SH, Aguirre-Boza F, Hoyos MC, Barreto MFC, Peña LM, MacKay MCC, et al. Competencies for training advanced practice nurses in primary health care. ACTA Paul Enferm. 2018;31(6):572-84. https://doi.org/10.1590/1982-0194201800080 https://doi.org/10.1590/1982-01942018000... )	Latin America	Descriptive quantitative study, which verified central competencies for the training of APN in PHC.
Zug KE et al, 2016(²⁹29 Zug KE, Cassiani SHB, Pulcini J, Bassalobre Garcia A, Aguirre-Boza F, Park J. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice. Rev. Latino-Am. Enfermagem. 2016;24:e2807. https://doi.org/10.1590/1518-8345.1615.2807 https://doi.org/10.1590/1518-8345.1615.2... )	Latin America	Study on APN regulation, education and practice in Latin America and nursing leaders’ perception in the region regarding APN role in PHC.
Bezerril MS et al, 2018(³⁰30 Bezerril MS, Chiavone FBT, Mariz CMS, Sonenberg A, Enders BC, Santos VEP. Advanced practice nursing in Latin America and the Caribbean: context analysis. Acta Paul Enferm. 2018;31(6):636-43. https://doi.org/10.1590/1982-0194201800087 https://doi.org/10.1590/1982-01942018000... )	Latin America	Literature review on factors that may influence ANP implementation.
Bellaguarda ML, 2015(³¹31 Bellaguarda MLR, Nelson S, Padilha MI, Caravaca-Morera JA. Prescriptive Authority and Nursing: a comparative analysis of Brazil and Canada. Rev Latino-Am Enfermagem. 2015;23(6):1065-73. https://doi.org/10.1590/0104-1169.0418.2650 https://doi.org/10.1590/0104-1169.0418.2... )	Brazil and Canada	Comparative study, which analyzed the differences between prescription of medications by nurses in Brazil and Ontario, Canada.
Pereira JG, Oliveira MAC, 2018(³²32 Pereira JG, Oliveira MAC. Nurses’ autonomy in Primary Care: from collaborative practices to advanced practice. Acta Paul Enferm. 2018;31(6):627-35. https://doi.org/10.1590/1982-0194201800086 https://doi.org/10.1590/1982-01942018000... )	Brazil	Qualitative research on nurses’ professional autonomy in daily work and how this autonomy is perceived by other multidisciplinary team professionals.
Nascimento WG et al, 2018(³³33 Nascimento WG, Uchôa SADC, Coêlho AA, Clementino FS, Cosme MVB, Rosa RB, et al. Medication and test prescription by nurses: Contributions to advanced practice and transformation of care. Rev Latino-Am Enfermagem. 2018;26:e3062. https://doi.org/10.1590/1518-8345.2423-3062 https://doi.org/10.1590/1518-8345.2423-3... )	Brazil	Documentary analysis on medication prescription and test request, with a view to advanced practice in the scope of PHC.
Andriola IC, Sonenberg A, Lira ALBC, 2020(³⁴34 Andriola IC, Sonenberg A, Lira ALBC. Understanding advanced practice nursing as a step towards its implementation in Brazil. Rev Panam Salud Publica. 2020;44:e115. https://doi.org/10.26633/RPSP.2020.115 https://doi.org/10.26633/RPSP.2020.115... )	USA and Brazil	Observational study of APN practice in an American hospital, with a view to supporting the ANP implementation in Brazil.
Dias CG et al, 2013(³⁵35 Dias CG, Duarte AM, Ibanez ASS, Rodrigues DB, Barros DP, Soares JS, et al. Clinical Nurse Specialist: a model of advanced nursing practice in pediatric oncology in Brazil. Rev Esc Enferm USP. 2013;47(6):1426-30. https://doi.org/10.1590/reeusp.v47i6.78110 https://doi.org/10.1590/reeusp.v47i6.781... )	Brazil	Experience report of APN implementation in the oncology pediatric nursing staff.
Souza BML, Salviano CF, Martins G, 2018(³⁶36 Souza BML, Salviano CF, Martins G. Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District. Rev Bras Enferm. 2018;71(1):223-7. https://doi.org/10.1590/0034-7167-2016-0654 https://doi.org/10.1590/0034-7167-2016-0... )	Brazil	Experience report of university extension program of APN in uropediatrics, developed in the outpatient clinic of a teaching hospital of the Federal District.
Mattos-Pimenta CA et al, 2020(³⁷37 Mattos-Pimenta CA de, Coca KP, Amorim MHC, Belasco AGS, Gabrielloni MC, Schirmer J. Women's health care in advanced practice nursing: a professional master's degree program. Acta Paul Enferm. 2020;33. https://doi.org/10.37689/acta-ape/2020AE01235 https://doi.org/10.37689/acta-ape/2020AE... )	Brazil	It describes the experience of their professional master’s degree in women’s health, which integrated the concepts of ANP.
Rewa T et al, 2019(³⁸38 Rewa T, Miranda Neto MV de, Bonfim D, Leonello VM, Oliveira MAC.[ Advanced Nursing Practices: perception of graduates of the residency and professional master's programs]. Acta Paul Enferm. 2019;32(3):254-60. doi: 10.1590/1982-0194201900035 Portuguese. https://doi.org/10.1590/1982-01942019000... )	Brazil	This qualitative study that perception of graduates of nursing residency and professional master’s degree in Primary Care about APN in PHC and the necessary training model.
Andriola IC, Sonenberg A, Lira AL, 2020(³⁹39 Andriola IC, Sonenberg A, Lira ALBC. Advanced Practice Nursing: a strategy to improve mater. Acta Paul Enferm. 2020;33. https://doi.org/10.37689/acta-ape/2020ar02356 https://doi.org/10.37689/acta-ape/2020ar... )	Brazil	Literature review on SUS process indicators and outcomes and possible APN contributions to improve maternal and child health care in Brazil.
Robazzi MLCC, 2014(⁴⁰40 Robazzi MLCC. Possibilities of advanced practices and Professional Master's Programs in Nursing. Rev Latino-Am Enfermagem. 2014;22(5):707-8. https://doi.org/10.1590/0104-1169.0000.2470 https://doi.org/10.1590/0104-1169.0000.2... )	Brazil	Editorial on possibilities of advanced practice and professional master’s degrees in nursing.
Silvan Scochi CG et al, 2015(⁴¹41 Scochi CGS, Gelbcke FL, Ferreira MAMA, Alvarez AM. Professional Master’s Degree: potential contribution to Advanced Practice Nursing. Rev Bras Enferm. 2015;68(6):874-7. https://doi.org/10.1590/0034-7167.2015680626i https://doi.org/10.1590/0034-7167.201568... )	Brazil	Reflection on the contribution of professional master’s programs to APN in Brazil.
Vitor AFAF, 2018(⁴²42 Vitor AFAF. Perspectives of the advanced nursing practice in Brazil and in the world. Online Braz J Nurs. 2018;17(1):1-4. https://doi.org/10.17665/1676-4285.20186189 https://doi.org/10.17665/1676-4285.20186... )	Brazil	Editorial on APN perspectives in Brazil and worldwide.
Oliveira JLC, Toso BRGO, Matsuda LM, 2018(⁴³43 Oliveira JLC, Toso BRGO, Matsuda LM. Advanced practices for care management: reflections on the Brazilian Nursing. Rev Bras Enferm. 2018;71(4):2060-5. https://doi.org/10.1590/0034-7167-2017-0115 https://doi.org/10.1590/0034-7167-2017-0... )	Brazil	Theoretical-reflexive essay, based on international literature on ANP and analysis pertinent to the profession to the Brazilian context.
Miranda Neto MV et al, 2018(⁴⁴44 Miranda Neto MV, Rewa T, Leonello VMVM, Oliveira MAC. Advanced practice nursing: a possibility for Primary Health Care? Rev Bras Enferm. 2018;71(1):716-21. https://doi.org/10.1590/0034-7167-2017-0672 https://doi.org/10.1590/0034-7167-2017-0... )	Brazil	Reflection on APN role in the context of Brazilian PHC.
Cassiani SHB, Silva FAM, 2019(⁴⁵45 Cassiani SHB, da Silva FAM. Expanding the role of nurses in primary health care: the case of Brazil. Rev Latino-Am Enfermagem. 2019;27. https://doi.org/10.1590/1518-8345.0000.3245 https://doi.org/10.1590/1518-8345.0000.3... )	Brazil	Editorial that addresses the international context of APN and points to Brazil as a favorable context for implementation to strengthen PHC, mainly for professional master’s degree.

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[1] Corresponding author: Livia Angeli-Silva E-mail: liviaangeli2001@yahoo.com.br