ASSIGNMENT

ON
ROLE OF ADVANCE NURSE PRACTIONER IN EVIDENCE BASE
PRACTICE NURSING

SUBMITTED TO: SUBMITTED BY:

Miss. Arpandeep kaur Prabhjot kaur

Assistant professor M.SC nursing 1 st year

Dep. Of community health nursing Pediatric nursing

SUBMISSION DATE
23/08/2020

INTRODUCTION:-
  The advance Nurse Practitioners provide primary, acute, and specialty health care across the lifespan
through assessment, diagnosis, and treatment of illnesses and injuries. Advance practioner register
nurse is important in role modelling and ensuring evidence based practice engagement at the point of
care. As early as 2002, national competencies were being formulated for use not only in institutions
of higher education but also in the clinical area. Evidence-based practice is emerging as a widely
accepted paradigm for contemporary professional nursing practice. Institutions and providers of
healthcare services are adopting this framework to guide the structure, process, and outcomes of
patient care delivery. Advanced practice nurses are ideally prepared and positioned within healthcare
delivery systems to champion the integration of this practice as a model for evidence-based patient
care. These all are highlights opportunities and suggests strategies for advanced practice nurses to
serve as catalysts for optimizing patient care through evidence-based practice.

DEFINITION OF ADVANCE NURSE PRACTICE:-

Advance nursing practice is an umbrella term describing an advanced level of clinical nursing
practice that maximizes the use of graduate educational preparation, in-depth nursing knowledge and
expertise in meeting the health needs of individuals, families, groups, communities and population.

DEFINITION OF EVIDENCE BASED PRACTICE:-

Evidence based practice is the conscientious, explicit and judicious use of current best evidence in
making decisions about the care of the individual patient. The practice of evidence based medicine
means integrating individual clinical expertise with the best available external clinical evidence from
systematic research.

ADVANCE NURSING PRACTICE INVOLVES:-

 Analyzing and synthesizing knowledge.

 Understanding, interpreting and applying nursing theory and research.

 Developing and advancing nursing knowledge and the profession as a whole.

 Registered nurses who have gained advanced preparation for expanded clinical practice by
earning a mastetr’s degree in nursing.

CHARACTERSTICS OF ADVANCE NURSING PRACTICE AND EVIDENCE

BASED PRACTICE NURSING:-

 Provision of effective and efficient care, delivered with a high degree of autonomy to an identified

population.

 Demonstration of leadership and initiation of change to improve client, organization.

  Deliberate purposeful and integrated used in-depth nursing knowledge, research and clinical

expertise.

 Ability to explain and apply the theoretical, empirical ethical foundation of nursing practice.

 Understanding, development and dissemination of evidence-based nursing knowledge.

 Ability to initiate or participate in planning, co-ordinating, implementing and evaluating programs to

meet client needs and support nursing practice.

 Identify persons responsible for EBP implementation.

 Educate staff development specialists about EBP in staff development.

 Identify ethical and legal implications of EBP.

 Explain rationale for EBP implementation to staff, managers, and administration.

 Revise staff development products and services to reflect EBP.

 Revise or write policies and procedures to reflect EBP.

 Evaluate products and services based on evidence.

 Identify best practices and benchmarks based on evidence.

 Design and implement a staff development research investigation for the purpose of confirming best

practices or benchmarks.

 Revise staff development meeting format so reports, proposals, recommendations, etc. are based on
evidence.

NEED FOR ADVANCE NURSING PRACTICE IN EVIDENCE BASED

PRACTICE:-

 Supported by a growing body of evidence of the safe and cost-effective provision of care by
Advance practioner register nurses, there is a national call to remove all barriers to full practice
authority from organizations such as the Institute of Medicine (IOM), the National Governors
Association (NGA), the Federal Trade Commission (FTC), the Bipartisan Policy Center, and the
Veteran’s Health Administration (VHA), among others. Removal of regulatory barriers is work in
which the ANA and its’ Constituent , State Nurses Associations have been engaged for many years.
 “Full practice authority” is generally defined as an Advance practiced register nurses ability to utilize
knowledge, skills, and judgment to practice to the full extent of their education and training.

 ANA is a founding member of the Coalition for Patients' Rights which was formed to address the
AMA's Scope of Practice campaign dedicated to limiting the scope of practice for advanced practice
nurses and other licensed professionals.

 Many non-physician health care providers are trained and willing to help meet this need, but are not
permitted to do so because of limitations in their scope of practice. Given the shortage of primary
care physicians, allowing non-physician professionals, such as APRNs, to practice to the full extent
of their education and training gives patients more options and more types of services.

GOALS OF ANP IN EBP:-

The ultimate goal of the EBP movement is to standardize and improve access and quality of care
across the healthcare system. Certain patient and nurse benefits include the following:
 Improved patient outcomes. The heavy focus on raising the overall quality of care may lead to
improved outcomes and health for patients. Using the most current healthcare research can help
minimize complications associated with chronic illness and prevent additional illness or disease.

 Lower costs of care. Roughly one in four persons are living with multiple chronic illnesses and the
cost of caring for these patients can often be substantial. Using EBP’s patient-centered approach may
help eliminate unnecessary costs linked to treating chronically ill patients as well as reduce expenses
for healthier patients, too.

 Superior nursing skills. Incorporating EBP throughout a nurse’s education and clinical experiences
develops more advanced critical thinking and decision-making skills. Nurses are better able to adapt
to situations, utilize informatics and work in interdisciplinary teams. They also feel a greater sense of
confidence and pride in their work.
 Evidence from
research,
Evidenced based
theories and
Opinion leaders

Evidence- Evidence from

assessment of
Based clinical patients history
Clinical expertise and physical and
decision available health
making carere sources

Information
about patient
preferences and
values

MODEL FOR EVIDENCE BASED CLINICAL DECISION MAKING

MODEL FOR EVIDENCE BASED CLINICAL DECISION MAKING:-

 What is clinical decision making:-Clinical decision making (CDM) is an active, purposeful, and
spontaneous process that occurs within the clinician’s mind during an interaction with a patient. In
the past, CDM was thought to rely exclusively on the clinical experience of the practitioner or the
practitioner’s interactions with colleagues and experts in the field. With significant increases in the
number of clinical investigations and advances in the way clinical studies are conducted and
reported, we have made meaningful progress in creating a wealth of evidence-based knowledge
leading to practice guidelines that the practitioners can access and incorporate when making a
clinical decision. So the question arises: Does this existing and growing “evidence base” entail that
we are making evidence-based clinical decisions in every clinical.
1. Clinical Expertise:-
EBP is not just the use of the best evidence the clinician can find, and in fact in their early work
made a point of saying that when making patient care decisions, Evidence is not to be used by itself. 
The clinician’s clinical expertise, an accumulation of knowledge, patient care experiences, treatment
decisions, and outcomes, is a critical part of clinical decision-making, but if used solely for decision-
making, without integrating best evidence or patient choice, it’s not evidence, based
practice. Clinical expertise means integrating the accumulated wealth of knowledge and information
from patient care experiences and formal education as non-research forms of evidence for making
clinical decisions. It is the clinician’s experience that hones their ability to diagnose and manage
individual patient care situations.  Evidence is used to inform diagnosis and management, but it is not
the sole ingredient for EBP. Without the incorporation of clinical expertise and patient preferences,
best evidence could be used indiscriminately, just apply the latest study results from a population
sample to an individual patient. 
For example:- The clinician could use a validated algorithm of Yes-No decision points to choose an
intervention without input from the patient.  But the clinician may not interpret or answer the Yes-No
decision points the same way the patient would.  Decision trees or algorithms don’t work in every
instance.
2. Information about patient preferences and values:-
To be an evidence-based practitioner one must find the best evidence available, include one’s clinical
expertise as an additional source of evidence, and then incorporate patient preferences and
values into a recommendation for care defined patient values and preferences as: “The collection of
goals, expectations, predispositions, and beliefs that individuals have for certain decisions and their
potential outcomes”. If the goal of EBP is to provide excellent care for individual patients, we must
make sure we have the skills needed to elicit these preferences and then to consider them in shared
decision making with the patient. The beneficiary of EBP is the patient.  The patient is the one who
will benefit from clinicians who can interpret research findings, understand the patient’s unique
circumstances, and then work with the patient to construct a plan of care that will be in the patient’s
best interest, however the patient defines it. Newer conceptual models of patient and family
engagement are being developed to bring the patient and family into more of a partnership with the
healthcare team.  One, the Conceptual Model for Patient and Family Engagement, proposes to
involve the patient and family in evaluating the research findings for the patient’s own healthcare
decisions; and then extrapolated to the whole healthcare system. 
3. Evidence from assessment of patients history and physical and available health
care resources:-
The health history interview is a conversation with a purpose. As you learn to elicit the patient’s
history, you will draw on many of interpersonal skills that you use every day, but with unique and
important differences. Un-like social conversation, in which you can freely express your own needs
and interests and are responsible only for yourself, the primary goal of the clinician patient interview
is to improve

the well-being of the patient. At its most basic level, the purpose of conversation with a patient is
threefold:-
To establish a trusting and supportive relationship. To gather information, and to offer information.
As a beginning clinician, you will focus your energies on gathering information. At the same time,
by using techniques that promote trust and convey respect, you will allow the patient’s story to
unfold in its most full and detailed form. Establishing a supportive interaction helps the patient feel
 more at ease when sharing information and itself becomes the foundation for therapeutic clinician
patient relationships. Because illness can make patients feel discouraged and isolated, “A feeling of
connectedness with the doctor, of being deeply heard and understood, reduces this feeling of
isolation and despair. This feeling is the very heart of healing.”
4. Evidence from research, evidence-based theories, clinical experts, and opinion
leaders:-
 Evidence-based research (EBR) is "the use of prior research in a systematic and transparent
way to inform a new study so that it is answering questions that matter in a valid, efficient
and accessible manner".

 Theory-based nursing practice Health care agencies can designate a specific nursing theory to

guide the nursing practice within the entire organization. The critical component in choosing
a nursing theory for an organization is the 'fit' between the philosophical assumptions of the
organization and the theory.
 Leaders are experts and advisors that have earned a reputation in their field. They are an
important resource to organizations, providing in-depth information and counsel on trends
and activities within specific knowledge areas.

STEPS OF IMPLIMENTING EVIDENCE BASED PRACTICE:-

Following are the steps of implementing evidence based practice:-

 Formulating a clear question based on a clinical problem

Literature review to search for the best available

evidence / collecting the evidence

Evaluating and analysing the strengths and weaknesses of

that evidence in terms of validity and generalizability

Implementing useful findings in clinical practice based on valid

evidence

Evaluating efficacy and performance of evidences

5. Formulating a clear question based on a clinical problem:- The first step is to formulate a clear
question based on clinical problems. Ideas come from different sources but are categorized in two
areas; Problem focused triggers and knowledge-focused trigger.
 Problem focused triggers are identified by health care staff through quality improvement, risk
surveillance, benchmarking data, financial data or recurrent clinical problems. Problem focused
triggers could be clinical problems, or risk management issues. Example:- Increased incidence of
DVT and Pulmonary emboli in trauma and neurosurgical patients. Diagnosis and proper treatment of
a DVT is a very important task for health care professionals and is meant to prevent pulmonary
embolism.
 Knowledge focused triggers are created when health care staff read research, listen to scientific
papers at research conferences or encounter EBP guidelines published by federal agencies or
 organizations. Knowledge based triggers could be new research finding that further enhance nursing
or new practice guidelines. Example:- Pain management, prevention of skin breakdown, assessing
placement of naso-gastric and naso-intestinal tubes, and use of saline to maintain patency of arterial
lines.

1. Literature review to search for the best available evidence, collecting the evidence;-
Once the topic is selected , the research relevant to the topic must be reviewed, meta analysis and
well known and reliable existing EBP guidelines are accessed in the literature review process. With
the internet at one’s fingertips, a plethora of research is just a few clicks away. However, just
because you found it in a respectable journal does not signify high quality research. When reviewing
any article for evidence retrieval, read it very closely. Articles can appear to be precise and factual
on the surface but with further and much closer examination, flaws can be found. The articles can be
loaded with opinionated and or biased statements that would clearly taint the findings, thus lowering
the credibility and quality of the article. Time management is crucial to information retrieval. Nurses
making their way through the vast amount of research available may find it helpful to read research
article or critical reviews instead of clinical journals. Once the literature is located it is helpful to
classify the article as either conceptual (theory & clinical) or data based (systematic research
review). Before reading and critiquing the research, it is useful to read theoretical and clinical
articles to have a broad view of the nature of the topic and related concepts, and to then review
existing EBP guidelines.

2. Evaluating and analyzing the strength and weakness of that evidence in terms of validity and
generalizability:-
Use of rating systems to determine the quality of the research is crucial to the development of EBP.
There are several rating systems available online. The National Guidelines Clearinghouse is a
database of published EBP guidelines abstracts at (http;//www.guideline.gov).

3. Implementing useful findings in clinical practice based on valid evidence; evidence is used
alongside clinical expertise and the patients perspective to plan care:-
After determining the internal and external validity of the study, a decision is arrived at whether the
information gather does apply to your initial question. It is important to address questions related to
diagnosis, therapy, harm and prognosis. The information gathered should be interpreted according to
many criteria and should always be shared with other nurses and or fellow researchers.

4. Evaluating efficacy and performance of evidences through a process of self-reflection, audit,

or peer assessment:-
Finally after the implementation of the useful findings for the clinical practices , efficacy and
performance is evaluated through processes of self reflection, internal or external audit or peer
assessment.

ROLE OF ADVANCE NURSE PRACTIONER IN EBP NURSING:-

1. NURSE CLINICIAN:-

A clinician is a health care professional that works as a primary care giver of a patient in a hospital,
skilled nursing facility, clinic, or patient's home. A clinician diagnoses and treats patients.
According to Salary.com (2018), clinical nurse specialists earn an average annual salary
of $101,276, with the highest paid CNSs earning more than $120,000. Overall, the more experience
a CNS has, the higher salary he or she can expect to earn. A Clinical Nurse Specialist is an expert at
diagnosing and treating illness in their area of expertise. Clinical Nurse Specialists focus on one of
three main specialty areas, patients and their families, nurse management, and administration.
Requirements to take CNS exam, Masters of Science in Nursing degree or other graduate-level
 program preparation for the CNS role, which is accredited by the CCNE or ACEN. Current RN
licensure, a minimum of 500 supervised clinical hours in the specialty area. The evidence-based
interventions we learn can improve patient outcomes, help to provide high quality care, reduce costs
and eliminate practices that have become obsolete or are not effective.

Here are 10 ways nurse practitioners reduce healthcare costs while improving quality:-

 Nurse practitioners reduce the cost of patient visits across healthcare settings:- Numerous
studies show extensive savings for myriad practice settings that employ nurse practitioners. A 2009
study in Nursing Economics found nurse practitioner-led care was associated with lower drug costs
for inpatients in acute-care settings. Nursing Management  has also published findings that show
nurse practitioners in managed care deliver care at 23% below the average cost associated with other
primary-care providers.

 Nurse practitioners keep patients out of the hospital:- While chronic conditions take a toll on
patients' physical and emotional well-being, they also result in added costs. Nurse practitioners are
proven to decrease patient hospitalizations, visits and lengths of stay at various facilities, keeping
healthcare costs down for patients, institutions and taxpayers, and reducing time and income lost
from work. This has been confirmed by recent research in Nursing Management.

 Nurse practitioners are the fastest growing primary-care provider profession:- With more than
85% of nurse practitioners prepared in primary care. The field most needed in today’s healthcare
climate, and the one that keeps patient healthy as possible. Nurse practitioners are increasingly
providing preventive care that is equally essential for Budget health.

 Nurse practitioners treat the whole patient, not just the disease. Nurse practitioners go beyond
diagnosing and treating the condition afflicting the patient. They also address holistic healthcare
needs. This could encompass prescribing medicine while counseling about diet and exercise, and
trouble shooting how to best address other issues that have the potential to reverse a patient’s
progress. To illustrate, a 2012 report appearing in Health Affairs states that “the patient-centered
nature of nurse practitioner training, which often includes care coordination and sensitivity to the
impact on health of social and cultural factors, such as environment and family situation, makes
nurse practitioners particularly well prepared for and interested in providing primary care.”

 Nurse practitioners excel at managing complex health conditions:-A growing number of persons
today suffer from multiple, complex chronic illnesses like diabetes and heart disease, which are
major cost drivers in healthcare. Nurse practitioners see such patients in growing numbers and are
shown to help them get these conditions in check.

 Nurse practitioners are well-liked and trusted by their patients:- Nurse practitioners routinely
outscore other healthcare providers when it comes to patient satisfaction, namely their ability to
listen and understand patients’ concerns. In fact, a 2011 study showed only 50% of patients felt their
physician providers “always” listened carefully, compared to more than 80%of patients with nurse
practitioner providers. The trust this fosters between patient and provider is critical for ensuring
patients are engaged in their own healthcare. It also encourages patient adherence to treatment plans
and scheduled follow up and wellness visits appointments that are critical for cost efficiency and
healthcare quality.

 Nurse practitioners spend more time with patients overall. Among the reasons that nurse
practitioners are able to treat patients holistically, manage complex conditions and maintain patient
trust is that they spend more time with patients. This simple patient-centered act of carving out
longer appointments to accommodate more patient questions, education and counseling has proven
invaluable to improving health and reducing unnecessary costs in today’s healthcare climate.
 Nurse practitioners receive cost-efficient education and training. Nurse practitioners provide
advanced nursing care that builds on the professional license of a registered nurse and graduate
education that focuses on one specialty area, such as pediatrics, from “day one” of their graduate
academic programming. This is in direct contrast to medical school, where students begin their
graduate education without prior healthcare education or patient care, and spend time in rotations
that are often unrelated to the care they ultimately deliver. The result is that competency-based nurse
practitioner education costs 20% to 25% less than that of time-based physicians for similar patient-
care services with equitable patient-care outcomes.

 Nurse practitioners are educated and trained to provide care without physician
supervision. Not only are nurse practitioners high-quality, dedicated, cost-effective clinicians in the
ways illustrated above, they are prepared to practice without the supervision of physicians, meaning
they can advance patient care without the need for chart reviews, collaborative agreements and other
mandates that create redundancies and bottlenecks in care delivery. For this reason, a growing
number of states currently 21 and Washington, D.C. have granted nurse practitioners full-practice
authority, meaning patients have full and direct access to the full scope of services they’re educated
and trained to deliver.

 Reducing barriers to nurse practitioner practice improves patient access to quality, cost-
effective healthcare. Research in publications ranging from Nursing Management to The New
England Journal of Medicine reaches the conclusion that full-practice authority for nurse
practitioners promotes healthcare quality and savings. Such regulatory reform also prompts greater
numbers of nurse practitioners to practice in medically underserved rural communities, as verified in
2012 by the WWAMI Rural Health Research Center, which has joined the growing list of proponents
for full-practice authority for nurse practitioners nationwide.

2. NURSE EDUCATOR:-

Nurse educators combine specialized nursing expertise with a passion for teaching. Drawing on years
of clinical experience, nurse educators bring their particularized knowledge and enthusiasm into the
classroom to train and prepare the current generation of nurses and generations of nurses to come.
Whether it is teaching an aspiring nurse a new skill or offering continued education to seasoned
nurses, the nurse educator is vital to the nursing community at large. Choosing a career in nurse
education means cultivating and nurturing your own skills so that you may one day be well enough
versed and properly credentialed to assume the nurse educator role and pass on your knowledge and
skills to colleagues and pupils alike. Nurse educators constantly educate themselves as to the most
current practices and advancements in nursing, so that they may, in turn, transmit this knowledge to
their students. Nurse educators enjoy the opportunities that come with devoting themselves to an
intellectual and educational community, oftentimes engaging in research and utilizing technologies
that represent the cutting edge of the nursing industry. Nurse educators teach as full-time or part-time
faculty members at nursing schools on college and university campuses, as well as in teaching
hospitals. They instruct at the undergraduate level, guiding future licensed practice nurses (LPN) and
registered nurses (RN); they teach at the graduate and doctoral level, leading future advanced
practice nurses, nurse researchers, nursing leaders and even other nurse educators. In teaching
students at various stages of their professional development, nurse educators design curricula and
develop programs of study, grade papers, participate in faculty meetings, prepare and deliver
lectures, advise students and perform many of the tasks associated with academic careers. Generally,
nurse educators deliver clinical courses that align with their specific fields of expertise, especially
related to the area of concentration or focus from their graduate nursing education program. These
fields of interest vary widely and include such subjects as psychiatric/mental health, oncology,
pediatrics, women’s health, family health and acute care.

3.RESEARCHER:-
 Nurse researchers are dedicated to advancing biomedical science, and work alongside other
scientists from fields such as bioengineering and pharmacology. Because most research studies
are funded through grant money, nurse researchers move between projects as funded studies
become available. From refining the biomedical applications for stem cells, to working on the
newest pain management treatments for cancer patients, the work performed by nurse researchers
is widely diverse, but always cutting edge. Nurse researchers perform a number of tasks, which,
depending on the project, may include:

 Designing and implementing studies.

 Collecting and analyzing data

 Reporting findings
 Writing grant applications
 Educating peers in academic or clinical settings
 Writing articles and research reports in nursing or medical professional journals or other publications
 Presenting findings at conferences, meetings, and other professional speaking engagements.

4 .ADMINISTRATOR;-

Nurse administrators might oversee an entire healthcare facility such as a nursing home or rehab

center, or they might help run a specific department within a hospital. They serve in a range of
positions as supervisors and first-line managers, middle managers, and top-level directors. APRN’s
including nursing administrators demonstrate a level of higher education, training and leadership
skills required for advancing into the upper levels of healthcare, such as Chief Nursing Officers,
offering a large opportunity for growth within the healthcare system.(Becoming a Nurse
Administrator). Nursing administrators are in contact with staff, physicians, and patients. A good
practice for any APRN is to lead by example, a good example of this would be arranging ethics
education for all staff members in all departments.

6. NURSE SPECIALIST:-
A clinical nurse specialist is a registered nurse with a Master of Nursing or equivalent or Doctorate
in Nursing. The CNSs practice reflects and demonstrates the characteristics and competencies
of advanced nursing practice. It is grounded in the values, knowledge, theories and practice
of nursing. The clinical nurse specialist (CNS), one of the 4 advanced practice registered nurse
(APRN) categories, has a unique role to play in contributing to high-quality patient care and system-
level change across multiple health care settings. CNS practice requires advanced knowledge and
skills, including specialty expertise, the ability to integrate new knowledge and innovation into the
system of care, the ability to consult and collaborate with all health professions, and the mentoring of
nursing staff to support and fully implement that new knowledge.

7. PRACTIONER:-
An Advanced Nurse Practitioner (ANP) is an experienced and highly educated
Registered Nurse who manages the complete clinical care for their patient, not solely any specific
condition. Advanced practice is a level of practice, rather than a type of speciality of practice.

Nature of Practice:-
 Integrates research, education, practice and management
 High degree of professional autonomy and independent practice
 Case management/own case load
 Advanced health assessment skills, decision-making skills and diagnostic reasoning skills
 Recognized advanced clinical competencies
 Provision of consultant services to health providers
 Plans, implements & evaluates programs
 Recognized first point of contact for clients

Regulatory mechanisms :– Country specific regulations underpin NP/APN practice:-

 Right to diagnose
 Authority to prescribe medication
 Authority to prescribe treatment
 Authority to refer clients to other professionals
 Authority to admit patients to hospital
 Legislation to confer and protect the title "Nurse Practitioner/Advanced Practice Nurse"
 Legislation or some other form of regulatory mechanism specific to advanced practice nurses
 Officially recognized titles for nurses working in advanced practice roles

8. NURSE EPIDEMIOLOGIST:-

A nurse epidemiologist is a nursing professional who focuses on making sure that patients receive
optimal care, but who also reduce overall infection risks and focus on prevention measures as well as
on infection control and direct patient nursing. Examine patients and determine potential presence of
infection. Nurse epidemiologists typically hold a bachelor's degree in nursing and a master's or
doctoral degree in public health. If you'd like to pursue a career as a nurse epidemiologist, you could
enroll in a program to earn a Bachelor of Science in Nursing. A nurse epidemiologist investigates
trends in groups or aggregates and studies the occurrence of diseases and injuries. The information is
gathered from census data, vital statistics, and reportable disease records. Nurse epidemiologists
identify people or populations at high risk; monitor the progress of diseases; specify areas of health
care need; determine priorities, size, and scope of programs; and evaluate their impact. They
generally do not provide direct patient care, but serve as a resource and plan educational programs.
They also publish results of studies and statistical analysis of morbidity and mortality. Examples of
practice settings are the Centers for Disease Control and Prevention in Atlanta, Georgia; public
health departments; and governmental agencies.
CORE COMPETENCIES/SKILLS NEEDED:-
■ Must possess mathematical and analytical ability
■ Knowledge of both infectious and noninfectious diseases
■ Desire to improve the health and well-being of populations
■ Ability to identify populations at risk
■ Knowledge of health policy
■ Must plan programs and health services

9. WOUND CARE NURSE:-

WOC nurses provide care for both chronic and acute wounds. An acute wound is a new wound, such
as a cut, scrape, bruise or incision that is most often a result of surgery or trauma. A chronic wound
is usually caused by a disease or condition such as an ulcer, cancer or diabetes and may not heal as
quickly as an acute wound. WOC nurses are primarily responsible for assessing and prescribing
appropriate wound care treatment. They may work in a variety of different healthcare settings,
including acute care, long-term care and home health. Wound care nurses uphold the same values as
nurses in other specializations the patient should always come first, and their comfort and recovery is
of utmost priority. But, for wound care nurses, providing optimal care for their patients often goes
 beyond providing necessary treatment. In order to help patients make a full recovery, WOC nurses
must be critical thinkers, educators and experts in patient care. First, a WOC nurse must
consider, “What is the best course of treatment for my patient?” There are several procedures
that can be used to treat a wound, and each patient’s situation is different. In addition to being well-
versed in wound care procedures, WOC nurses must be thorough in evaluating their patients and
must recommend treatments to facilitate timely wound healing. Many WOC nurses have several
years of experience as a registered nurse (RN) and may also choose to pursue a specialized degree, or
their MSN. For registered nurses and prospective nurses alike, WOC is a rewarding career specialty
that allows you to play an instrumental role in both ensuring optimal patient care and guiding your
patients to recovery.

10. POLICY MAKER;-

As a registered nurse have a education, experience, and perspectives that uniquely equip to
participate in policy formulation. Here are just a few ways can be involved:

 Learn how policy is developed. Seek out areas of policy you want to influence.
 Learn who is participating in policy development and make contact with them. Nursing organizations
and organizations such as AARP have multiple user-friendly internet sites that provide information
about participating in policymaking activities.
 Explore resources related to policy formulation.
 Investigate health policy agendas that local legislators have established for their terms in office.
 Look for opportunities to develop, advance, improve, or change health policies within an
environment (either micro or macro).
 Assess patient needs and formulate policy messages.
 Write white papers, position statements, newspaper editorials, and other informative correspondence
that educates the public and lawmakers about the needs.
 Foster relationships with stakeholders to advance policy agendas.
 Volunteer in policy-related activities including development meetings.
 Serve on committees, boards, and leadership groups that have decision-making power.
 Seek appointments to county health department boards and local government commissions to address
health needs.
 Participate in activities that advance health-policy driven agendas.

11. FORENSIC NURSE:-

Forensic nursing encompasses a body of specialty professions that serve unique and critical roles to
the health care and judicial systems. Forensic nurses might treat assault victims, investigate crime
scenes or provide health care in a correctional facility. If the idea of a forensic nursing degree
appeals to you, take a closer look at the aspects of each of the eight specialty areas described below:-

 Correctional Nursing Specialists:-

Correctional nursing specialists provide efficient, quality health care to individuals detained by the
courts, including those in jail, prison, juvenile offender facilities and other correctional institutions.
Within these facilities, correctional nursing specialists may tend to the sick, perform routine physical
examinations and administer medication to people with chronic needs
 Forensic Clinical Nurse Specialists:-
Forensic clinical nurse specialists hold a master’s or doctoral forensic nursing degree and use their
advanced training to serve as expert clinicians, teachers, researches, consultants and administrators in
 different forensic settings. They may work in emergency rooms, sexual assault examination
programs, psychiatric forensic treatment units or death investigation teams.
 Forensic Gerontology Specialists:-
Forensic gerontology specialists help investigate cases involving the abuse, neglect or exploitation of
elders and work to raise awareness regarding legal and human rights issues. These forensic nurses
typically work in hospitals, nursing homes and other facilities dedicated to caring for the elderly.
 Forensic Nurse Investigators:-
Forensic nurse investigators uncover the circumstances surrounding an unexpected or violent death.
Typically employed in a medical examiner’s or coroner’s office, forensic nurse investigators
examine the body, study the scene, assist in autopsies and collect medical and social history
information on the deceased in order to determine the exact cause of death. Forensic nurse
investigators often work with nurse coroners or death investigators.
 Forensic Psychiatric Nurses:-
Forensic psychiatric nurses specialize in managing offenders with psychological, social and
behavioral disorders. They assess and select patients for treatment, provide rehabilitative care and
supervise a patient’s actions within the community. In addition, forensic psychiatric nurses may
examine and treat criminal defendants and assist colleagues who have witnessed assaults or
experienced some form of emotional trauma.
 Legal Nurse Consultants:-
Legal nurse consultants aid attorneys working on civil cases where the law and medicine overlap.
Some of these situations might include medical malpractice, personal injury, workers’ compensation
and probate. Legal nurse consultants apply their forensic nursing education and clinical experience to
interpret, research and analyze the medically-related information relevant to a case or claim,
educating attorneys about medical facts and acting as liaisons between attorneys, physicians and
clients.
 Nurse Coroners or Death Investigators:-
Nurse coroners or death investigators apply their nursing skills to crime scene investigations. As the
first forensic professional to arrive at the scene of a suspicious death, a nurse coroner or death
investigator analyzes the scene and examines the body in order to approximate the time of death and
find medical clues that might explain the cause.
 Sexual Assault Nurse Examiners:-
Sexual assault nurse examiners offer compassionate, prompt care to victims of sexual assault.
Qualified through a specialized forensic nursing education, they assess and evaluate injuries that a
victim has suffered; locate, collect and package forensic evidence relevant to the crime; and provide
information or referrals regarding the victim’s continued care. In the court room, sexual assault nurse
examiners represent the victim, serving as expert witnesses who offer testimony based on their
documented evidence.
 Through their work and dedication, forensic nurses have a profound effect on the criminal justice
system and the public at large. A forensic nursing degree can lead to a career that makes a difference
to health of the patients, the victims whose voices they represent and the communities they improve
as a result of their expertise and compassion.

12. HOSPICE NURSE;-

Hospice care provides support and comfort to dying patients and their families, often in the patient's
home, but also in hospitals, hospice centers, nursing homes, and other long-term care facilities.
Hospice care provides support and comfort to dying patients and their families, often in the patient's
home, but also in hospitals, hospice centers, nursing homes, and other long-term care facilities. There
are four levels, each with a set Medicare reimbursement rate.
 Level One – Routine Home care:- The care is provided in whatever setting the person lives a home,
nursing home or assisted living center.
 Level Two – Continuous Care:-This name is a little bit misleading," Long said, because care is
provided eight out of 24 hours. It is used for patients who need to be continuously monitored for
short period for a condition such as terminal restlessness or a change in pain medication.
 Level Three – Respite Care:- Patient care is provided when a family needs a break. They may want
to go on vacation for a few days or to a wedding, Long said. The patient can go to a nursing home or
other inpatient facility or a nurse will stay in the home for up to five days.
 Level Four – Inpatient care:- Inpatient care can be provided in a hospice home, nursing home or
hospital. Patients must have symptoms that can't be controlled or pain that can't be managed. This is
highest reimbursement rate Medicare pays for hospice care and it's time-limited, Long said, usually
no more than seven days.

13. TRAVEL HEALTH NURSE:-

Traveling nurses have a wide array of duties to perform, such as administering medication and
preparing nutritionally-specific meals. Many nurses who travel to different locations also teach
family members and caretakers about proper patient and medical care. Typically, travel nurses work
short-term assignments as contract employees for healthcare staffing agencies. They are sent to
places where their specialties and skills are in demand, while the staffing company generally takes
care of their housing and other needs. Travel nurse assignments range from eight to 13 weeks.
However, details are often flexible, and shorter or longer assignments may be offered to meet your
specific needs. Onward travel nurses frequently have the option to extend assignments, too. A
traveling nurse is a healthcare professional who assists chronically-ill or homebound patients, or
helps medical facilities with staffing shortages. Along with the many duties associated with nursing,
individuals employed in this occupation must also travel from location to location, including patients'
homes. Some traveling nurses move between hospitals, clinics and schools. Education prerequisites
for this job vary, though a basic requirement is a nursing license.
Traveling Nurse Responsibilities
 Caring for patients who cannot leave their homes, traveling nurses administer medical care
and monitor patients' needs. Some school districts employ traveling nurses as a cost-cutting
measure to administer medication to specific students. A traveling nurse can work
independently, or for a health services organization.

INDEX
S.NO CONTENT PAGE.NO

1. Introduction about advance nurse practioner in 2

evidence based practice nursing

2. Characteristics of advance nursing practice and 3

evidence based practice
 3. Need for advance nursing practice in evidence based 4
practice

4. Model for evidence based practice 5

5. Explanation of model for EBP 6

6. Steps of implementing EBP 7-9

7. Role of advance nurse practioner in evidence based 10-16

practice nursing

8. Bibliography 17

BIBLIOGRAPHY
 PERRY’S & POTTER. Fundamentals of Nursing. South Asian Edition. Elsevier Publishers: 2015.
Pp=95-97.

 SONI. Text Book of Advance Nursing Practice. 1st Edition. Jaypee Publishers; 2013. Pp=3-5.

 Kumari Neelam. Advance Nursing Practice. 1st Edition. Jaypee Brothers Medical Publishers: 2013.
Pp=90-92.

 https://www.simplyhired.co.uk/search?q=travel+health+nurse&job

 https://www.simplyhired.co.uk/search?q=travel+health+nurse&pn

 http://culturalmeded.stanford.edu/pdf
 https://www.google.co.in/search?q=key+opinion+leaders+in+healthcare

 https://www.nutriciaresearch.com/how-we-work/nutrition-clinical-research/supporting-healthcare-
professionals

 https://www.google.co.in/search?q=evidence+research&source

 https://jada.ada.org/article/S0002-8177(18)30395-7

 http://culturalmeded.stanford.edu/pdf

 http://www.dtic.mil/dtic/tr/fulltext/u2/a371316.pdf#page=158

 https://www.google.co.in/search?q=evidence+research&source