NOTHING YET

G A U TA M A B U D D H A P N G | P N G I M G . C O M
 It takes a wise man to learn
from his mistakes, but an even
wiser man to learn from others.

G A U TA M A B U D D H A P N G | P N G I M G . C O M

— A Buddhist Proverb
Advanced
Practice
Nursing
IMPACT & CHALLENGES

PRESENTED BY | MR. KAMMOUS HAMZA S U P E RV I S E D B Y | P R . B A H L A O U A N B O U C H A I B

GENERAL PRACTICE NURSE P R O F E S S O R & C O R D I N ATO R O F T H E M A S T E R O F
M A S T E R A D VA N C E D P R A C T I C E I N A D VA N C E D P R A C T I C E I N E M E R G E N C Y M E D E C I N E
EMERGENCY MEDECINE ISPITS CASABLANCA
ISPITS CASABLANCA
 Introduction

Nurses have always been key to the health and well-being of individuals and communities, but
a new generation of nurse leaders is now needed.

F l a u b e r t J L , L e M e n e s t r e l S , Wi l l i a m s D R , e t a l . , e d i t o r s . T h e
Future of Nursing 2020-2030 (2021)
 Global Perspective

• Healthcare systems globally have experienced intensive changes, reforms, developments,

and improvement over the past 30 years.
• New opportunities are presenting themselves while multiple challenges still remain
especially in developing countries.
Durrani H. Healthcare and healthcare systems: inspiring
progress and future prospects (2016)

• Evolving nature of nursing roles beyond traditional boundaries.

 Moroccan Healthcare Landscape

• Despite progress in recent years (universal health coverage and improving key health
indicators), access to quality medical care remains a significant issue. The unequal
distribution of resources, inadequate funding, and healthcare worker shortages pose
substantial challenges.
Mahdaoui M, Kissani N. Morocco's Healthcare System:
Achievements, Challenges, and Perspectives. (2023)
 One Of The Responses

The implementation of APNs in the Moroccan healthcare system

 an evidence-based approach

A Systematic Review
Objectives Identifying key areas of impact associated with APN
roles

Understanding challenges to develop effective

implementation strategies.

Tailoring the information to inform the forthcoming

implementation of APNs in the Moroccan healthcare
system
Question Of Research
P Healthcare professionals, Patients

I Studies evaluating the impact of APNs and the challenges faced.

C Studies that provide comparative perspectives on different models of caring

O Quantitative or qualitative data on the impact of APNs in terms of healthcare outcomes,

patient satisfaction, and system efficiency, as well as identifying challenges faced

S Both quantitative and qualitative research studies, systematic reviews, and meta-analyses
Question Of Research

"What is the impact and what are the challenges associated with the
implementation of Advanced Practice Nursing (APN), and how can evidence-
based insights derived from a systematic review inform the forthcoming
integration of APNs?"
 Method

Databases Used
 Search Terms used

Advanced
Practice AND Impact OR Challenges
Nursing

OR Outcomes OR Barriers
OR Nurse Practitioner
OR Effectiveness OR Issues
OR Advanced Practice Nurse
OR Patient Satisfaction OR Obstacles
OR Clinical Nurse Specialist
OR Healthcare Quality OR Problems
OR APN
OR Cost-effectiveness OR Difficulties
OR APRN
 Search Terms used

("Advanced Practice Nursing" OR "APN” OR "APRN" OR "Nurse

Practitioner" OR "Clinical Nurse Specialist" OR ”Advanced Practice
Nurse”) AND (("Impact" OR "Outcomes" OR "Effectiveness" OR
"Patient Satisfaction" OR "Healthcare Quality" OR "Cost-
effectiveness") OR ("Challenges" OR "Barriers" OR "Issues" OR
"Obstacles" OR "Problems" OR "Difficulties"))
 Studies After 2000
Worldwide
Inclusion English
Quantitative, Qualitative, SR, Meta-Analyses
Free Full Text

Criteria

Certified Nurse-Midwife
Exclusion Certified Registered Nurse Anesthetist
Primary Care Settings
Results
Screening Process
Characteristic Study 1 Study 2 Study 3
Realities, scope, challenges, and

Title Screening Process

Barriers and facilitators to APN implementation
facilitators for NP
Organizational facilitators and barriers to APRN implementation in India

Authors Claire Torrens et al. Lori Schirle et al. Malar Kodi S, Suresh K Sharma

DOI 10.1016/j.ijnurstu.2019.103443 10.1097/HMR.0000000000000229 10.1016/j.ijnss.2021.03.003

Publication Type Journal Article Journal Article Journal Article
Design Scoping Review Integrative Review Review
Time Frame 2002-2017 Not specified Not specified
Geographic Scope Global U.S., Canada, Netherlands India
Number of Studies Included 54 30 Not specified

Focus APN role Organizational factors affecting APRN practice NP role in India

Facilitators: Autonomy, positive relations; NP role as a solution for doctor

Main Findings Team factors crucial; diversity in APN roles Barriers: Policy restrictions, poor relations shortage in India

Policy restrictions, poor relations, lack of

Key Barriers Team factors, individual factors, funding understanding of APRN role Not specified

Key Facilitators Collaboration, negotiation, supervision Autonomy, positive physician/APRN relations Not specified
Study Quality Assessment NIH Quality Assessment Tool, JBI Appraisal
Tools PRISMA-ScR framework Checklist Not specified
Setting Not specified Not specified Not specified
 Characteristic Study 4 Study 5 Study 6
Advanced practice nurse roles Advanced Nursing Practice in Nurse Practitioners in Orthopaedic
Title in Europe Austria Surgical Settings

Authors
Screening Process
John Unsworth et al.
DOI 10.1111/inr.12800
Publication Type Journal Article
Design Case Study Evaluation
Time Frame Not specified
Geographic Scope Europe
Number of Studies Included Not specified
Focus APN roles in Europe
Disparity in implementing APN importance of measuring APN Need for NPs in orthopaedic surgical
Main Findings roles in Europe
Mismatch in perceptions
Key Barriers during early implementation
Manela Glarcher, Katharina
Maria Lex
Brittany G Spence, Joanne Ricci, Fairleth
McCuaig
10.1016/j.zefq.2020.06.012 10.1097/NOR.0000000000000514
Journal Article Journal Article
Literature Search Literature Review
09/2019 to 01/2020 Not specified
Austria Not specified
Not specified Not specified
APN outcomes in Austria NPs in Orthopaedic Surgical Settings
Positive outcomes and
outcomes in Austria settings
National implementation and
evaluation strategies lacking in
Austria Not specified

Increased access, improved team

Tripartite approach between
managers, practitioners, and
Key Facilitators educators
Study Quality Assessment
Tools CPREQ
Setting European countries
communication, decreased length of
stay, improved quality of care, improved
Importance of measuring APN patient satisfaction, positive impact on
outcomes in research surgeon education
Not specified Not specified
Austria Orthopaedic surgical settings
On Going Review
 Key Findings
Impact

Improved Access to Healthcare

• APNs can fill gaps in healthcare delivery, especially in underserved or rural areas,
improving access to care.
• By providing timely and efficient care, APNs help reduce wait times for patients.
 Key Findings
Impact

Cost-Effective Care

• APNs are often cost-effective as they can manage certain aspects of care traditionally
handled by physicians, optimizing healthcare resources.
 Key Findings
Impact

Leadership and Mentoring

• APNs often assume leadership roles, contributing to the overall leadership capacity within
healthcare organizations.
• Experienced APNs may mentor and guide newer professionals, supporting their professional
development
 Key Findings
Challenges
Structural Challenges

• Lack of legal framework for nurse practitioner (NP) practices.

• Restrictive government legislation and regulations.
• Insufficiently trained nursing faculty and clinical facility to train NPs.
• Poor infrastructure (skill labs and clinical material) for the training of NPs.
• Scarce in preparation of nurses in bio-medical subjects at the undergraduate levels, such as
anatomy, physiology, pathology, pathophysiology & pharmacology, etc.
• Lack of clearly defined policy.
• Weak national-level nursing leadership/mentoring.
 Key Findings
Challenges
Functional Challenges

• No defined structure/jobs for NPs.

• Uncertainty of medico-legal responsibility
• Lack of quality mentoring and supervision.
• Reluctant or refusal of other health care workers to work collaboratively with NPs.
• No clear line of authority.
• Lack of prescribing authority.
 Key Findings
Challenges
Perceptual Challenges

• Lack of clear understanding of the nursing curriculum and training and advanced nurse
practitioner roles among management, including doctors and other health care team.
• Lack of trust in nursing capabilities to take up advanced nursing role.
• Lack of acceptance of the advanced nursing roles of NP by doctors and other health care
personnel.
• Perceived poor image of the nursing profession in society.
• Lack of awareness of NPs education among the public.
 Limitations and
risk of bias

Screening process by 2
Only one database was Only English studies persons at least
used
Limitations and
risk of bias
Conclusion

Big Challenges
Big Potential
Conclusion

Big Challenges
Big Potential

A Call To Action

Join us on the 24 December

Association Of Advanced Practice
Thank You!
 References
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing
2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve
Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. 9, Nurses Leading Change. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK573918/

Durrani H. Healthcare and healthcare systems: inspiring progress and future prospects. Mhealth. 2016 Feb 2;2:3. doi:
10.3978/j.issn.2306-9740.2016.01.03. PMID: 28293581; PMCID: PMC5344175.

Mahdaoui M, Kissani N. Morocco's Healthcare System: Achievements, Challenges, and Perspectives. Cureus. 2023 Jun
29;15(6):e41143. doi: 10.7759/cureus.41143. PMID: 37519608; PMCID: PMC10386871.

Sharma S.K. Nursing practice act:current scenario & future needs of India. Nurs J India. 2017;108(6)
https://www.researchgate.net/publication/330883294_Nursing_Practice_Act_Current_Scenario_Future_Needs_of_India 250-154. [
Google Scholar]

Putturaj M., Prashanth N.S. Enhancing the autonomy of Indian nurses. Indian J Med Ethics. 2017;2(4):275–281.
doi: 10.20529/ijme.2017.058. [PubMed] [CrossRef] [Google Scholar]

Nanda L, Lobo E. Public Health OpenAccess;2018.pp.13.https://medwinpublishers.com/PHOA/PHOA16000128.pdf (Nurse

practitioners –India’s answer to addressing access to healthcare). 2. [Google Scholar]

Sharma S.K., Kalra S., Kant R. Exploring role of independent nurse practitioners in prevention and management of NCDs in
India. J Indian Med Assoc. 2018 Aug;116(8):54–56.
https://www.researchgate.net/publication/331035275_Exploring_Role_of_Independent_Nurse_Practitioners_in_Prevention_and_M
anagement_of_NCDs_in_India
[Google Scholar]