Advanced Practice Nurse -- Singapore Straits Times 26 August 2009

http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_421209.html
http://health.asiaone.com/Health/News/Story/A1Story20090827-163858.html

Cool... there's finally some publicity on the works of Advanced Practice Nurses (APN) in Singapore.
A few important points adding to this newspaper report. Nursing can never substitute Medicine. Or rather, they are really 2 different professions. Just like a Civil Engineer and an Architect. 2 different professions with the same focus: provide quality health care.

When we say that a certain population of patients with Chronic Diseases can be seen by the Nurse instead of a Doctor, we actually mean that these patients will benefit much more from seeing a mid-level practitioner. The focus of APN is very much still to provide nursing care that is to promote self management.

There is a spectrum of patients with chronic diseases. On one end of the spectrum, there is a group of patients who require intensive medical attention and treatment. On the other end of the spectrum, you have relatively well patients who require very little medical attention. For this group of patients when the medical management is already maximized,what is left to sustain the optimal level of current health is self care. Self management aspect for this group of patients thus becomes a greater emphasis to medical treatment. Nurses who are trained to provide self-care education and health education are commonly known as Nurse Clinicians in the various specialties.

In the middle of these 2 groups, there is a group of patients who require quite a bit of everything. These patients are usually generally not relatively well yet, but at the same time they need to be engaged in usually much complex self care monitoring or activities in order to optimize the medical treatment. Seeing an APN will benefit this group of patient much more. With the additional knowledge and skills to develop working diagnoses, assess patients' current health status, and the ability to detect changes that potentially will become medically hazardous, APNs serve the role in providing this delicate balance. The approach to these patients is still very much from a nursing focus. There is a lot of patient engagement in an APN consult.

It is important to remember that Advanced Practice Nurse is to advance nursing practice. The fundamental is still nursing practice which is rooted in promoting health through patient education, self management, family nursing and holistic well-being.