Background: The advanced practice nursing role has been characterized as task sharing between physicians and nurses, and commonly is a part of national or health system schemes to expand healthcare access and/or to improve efficiencies. However, lack of regulatory uniformity can lead to inconsistent qualifications, competencies, and a limitation of expansion of healthcare services, based on regulated scope of practice. Methods: The SWOT analysis technique (strengths, weaknesses, opportunities, threats) was used to assess the current state of advanced practice nursing worldwide, with specific focus on regulation, education, licensure, and practice. Data were collected broadly from peer reviewed, governmental and regulatory sources, as well as grey literature. Results: Key regulatory elements that frame advanced practice nursing vary significantly by country and region and remain dynamic. However, practice and educational models are outpacing regulatory standards in all six WHO regions. Overall, advanced practice nursing is expanding at an accelerated pace in order to meet population and health system needs, despite weaknesses of the regulatory system, or threats from systems that are not ready to accept innovative strategies. Conclusion: Advanced practice nursing is an innovative role that is progressing broadly in response to the global drivers of an aging population, workforce shortages, the increasing prevalence of non-communicable disease, and the need to develop system-based efficiencies for cost containment. The role is developing organically, driven by local needs, but still lags in terms of the formal regulatory legitimization in many countries. Notably, it is being buoyed by the global movement toward universal health coverage.
Enhanced primary care management of common mental and substance use disorders is a key healthcare target. Though primary care may be well placed to achieve this target, a greater understanding of the prevalence and profile of common mental and substance use disorders in primary care settings is needed. We searched the MEDLINE database (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) to provide an update on biomedical literature describing the prevalence of common mental and substance use disorders in European general practice. Following 'PRISMA' guidelines, seventeen studies were kept for qualitative synthesis. Prevalence, profile, screening instruments, associated co-morbidities and gender distribution were tabulated. Depending on the screening method, the prevalence of common mental and substance use disorders ranged from 10.4% (Luxemburg) to 53.6% (Spain). Mood disorders were the most common. High co-morbidity with anxiety and somatisation hindered early identification and management.The continuing burden of common mental and substance use disorders, coupled with poor identification described in the updated EU biomedical literature, suggests that the unmet need for health care -identified by the World Health Organization a decade ago -remains unmet.Understanding prevalence of common mental and substance use disorders, associated morbidity, and the extent to which general practice represents an important catchment mechanism, can enhance their management at this level. General practitioners should be trained in accurate screening. Short screening instruments for general practitioners should be unified and promoted.
History taking and physical examination of patients who present with cardiac pain are not generally regarded as part of an emergency nurse's role in the UK. However, a good knowledge of the anatomy of the heart and cardiac disease, and the ability to undertake effective cardiovascular examination, could enable nurses to highlight adverse findings earlier in a patient's journey and improve patient outcomes. This article reviews the anatomy of the heart and cardiovascular disease, and describes how to pick out the subjective and objective information from patient histories and cardiac examination to make differential diagnoses.
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