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Mini Review | DOI: https://doi.org/10.31579/2693-4779/147
1 Professor and Master's Supervisor in Psychology and Medicine, Hangzhou Normal University,31121, Zhejiang, China.
2 Graduate Student, School of Nursing, Hangzhou Normal University, China.
3 President, Compasses Network Tech. Co., Ltd, Hangzhou, Zhejiang, China.
4 Hangzhou Linping Fifth People’s Hospital, Zhejiang, China.
5 IBMC of Chinese Academy of Science, Hangzhou, Zhejiang, China.
*Corresponding Author: Shiming Tang, Professor and Master's Supervisor in Psychology and Medicine, Hangzhou Normal University,31121, Zhejiang, China.
Citation: Shiming Tang, Yan Wang, Chengsheng Xu, Wang Yan, Chengsheng Xu; (2023), The Core Competencies of APN – A Study of WOCN in China, Clinical Research and Clinical Trials, 8(1); DOI:10.31579/2693-4779/147
Copyright: © 2023, Shiming Tang. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 10 July 2023 | Accepted: 22 August 2023 | Published: 16 September 2023
Keywords: advanced practice nurse; core competencies; wound; stoma; specialist nurse
This paper introduces the core competencies of an advanced practice nurse and describes the current status of training of wound stoma specialist nurses and its job content. It highlights the main impact factors are role development, workload, overall quality and hospital management and thus suggests to unify education and training and qualification standards, strict job management, specific and clear job responsibilities and scope, and actively guide the direction of specialized career development.
1.The core competencies of an Advanced Practice
Nurse (APN)
The International Council of Nurses (ICN) defines an advanced practice nurse (APN) as a registered nurse who possesses in-depth specialist knowledge, decision-making skills on complex issues and extended clinical time aptitude. [1]. The Hong Kong College of Specialist Nursing has developed the core competencies of the Advanced Practice Nurse in the following seven areas: managing complex patient health problems, enhancing the therapeutic relationship between nurse and patient, effective leadership and teamwork, enhancing and improving quality assurance, managing and negotiating innovation in nursing services and ways to innovate effectively, strengthening general professionalism and advanced practice, and enhancing personal qualities. [2]. The National Nursing Development Plan (2021-2025) states that strengthening the training of nurses is one of the main tasks of the 14th Five-Year Plan and requires the establishment of a nurse training system that is oriented to job needs and focused on job competencies. [3]. With the development of nursing education, the demand for quality nursing care and the upgrading of the health care system, the training and development of advanced practice nurses has been emphasized in the nursing work. [4].
2. The current status of training of wound stoma specialist nurses
Eskes et al., consider a wound ostomy specialist nurse (WOCN) to be a specialist nurse who has routinely completed a course in wound or stoma outreach and provides specialist support to patients with complex wounds or stomas during clinical care and to determine a correct treatment plan. [5]. The naming of wound stoma incontinence specialist nurses is not uniform worldwide, with stoma care nurses, stoma treatment nurses (enterostomy
treatment nurses, ET) and wound stoma incontinence specialist nurses (wound, stoma and incontinence nurses, WOCN), etc. The name ET was changed to WOCN in 1992 and is used today. [6]. Willis M showed in a study that: wound stoma specialist nurses are able to make evidence-based selection of consumables and devices for wound treatment, providing professional assistance to colleagues, assisting clinicians with treatment, and reducing the cost of using medical consumables.[7]
WOCN in China started late, have lower academic qualifications, are less developed, the management of the position is immature and there is no unified qualification body or standard yet. [8]. The minimum education level of wound stoma specialist nurses in Europe and the United States is a bachelor's degree, and most specialist nurses in hospitals hold a master's degree or above, while the minimum education level of wound stoma nurses in China is a specialist, and although the education level has improved in recent years, the average education level is still lower than that in Europe and the United States. [9]. The management of APN in China is mostly based on status management, with emphasis on teaching rather than use, and the duties of professional nurses are not clearly defined and do not play their proper role. This situation makes hospitals only rely on experience to manage APNs, lacking theoretical guidance, which to a certain extent hinders the development of WOCN. [10].
3. The job content of our wound stoma specialist nurses
The main roles of WOCN in China are currently broadly divided into three categories: clinical practitioners, educators and consultants, and researchers and managers. Yang X. Hong et al. [11]. found through a study on the core competencies of WOCN in Chongqing: they have certain competencies in dealing with wound stoma incontinence, etc., but the core competencies of each dimension need to be strengthened.
The main tasks of WOCN in clinical practice include stoma care, chronic wound care and incontinence care, and their core competencies are mainly reflected in the management of complex health problems of patients. Stoma care includes preoperative positioning and care of the stoma, preoperative preparation and psychological counselling of the patient, postoperative observation and care of the stoma and health guidance and health education of the patient. [11]. Chronic wound care includes prevention and care of pressure sores, diabetic foot, postoperative wound infection, fistula leakage, arteriovenous ulcers and fluid leakage. Incontinence care includes prevention and management of perianal skin problems, pelvic floor muscle training and bladder function training for patients with facial incontinence and urinary incontinence [13-16].
Educators are the main role of WOCN, whose core competencies are mainly in dealing with complex health problems of patients and enhancing the therapeutic relationship between nurses and patients. WOCNs are required to provide different levels of knowledge to different groups, such as patients, staff, families and caregivers, students and colleagues. The increased volume and availability of medical information from newspapers, websites and the media often confuse and frightens patients, and the WOCN educates and informs individuals, thereby fostering a better understanding of the issues. teachers and are responsible for national/provincial/municipal continuing education programmes in their field, etc. [17].
As researchers and managers, their core competencies are mainly in strengthening and improving quality assurance, managing and negotiating innovations in nursing services and ways to innovate effectively, strengthening general professionalism and advanced practice, and enhancing personal qualities. In clinical nursing, WOCN are required to conduct relevant nursing research, summarize nursing experiences, write scientific articles, explore new areas of their specialty and promote the development of the discipline.[18]. At the same time, they are seriously responsible for nursing consultation in relevant hospital departments, nursing consultation and management work. the strong professionalism and independence of WOCN have won the understanding and trust of healthcare professionals and patients.[19]
4.Factors affecting the development of wound stoma specialist nurses in China and countermeasures
The main factors that have an impact on the development of wound stoma specialist nurses in China are role development, workload, overall quality and hospital management. [20].
In terms of role development, WOCN in China started late, the management of their positions is still immature, and there is a lack of clarity about the scope of nursing and the content of role practice. [21]. It is necessary to improve the relevant curriculum and education system, to clarify the scope of nursing work, to continuously train WOCN to improve their leadership and critical thinking skills, to continuously learn new knowledge, and to exercise and expand their role functions. [22]. It is also important to focus on the development of clinical practice skills and to integrate theory and practice.
At present, the number of WOCN in China is far from meeting clinical needs, and WOCN in domestic clinics have to devote themselves to both clinical practice and research and innovation work, with a large workload. The working hours of WOCN should be reasonably arranged, and the staff allocation situation should be based on the condition of patients and the degree of patient demand for nurses. [23]. Community nurses can also be trained, and specialist nurses can be encouraged to attend community lectures and participate in free social consultations to gradually increase the number of specialist community WOCN.
The overall quality of WOCN in China is not strong. In terms of academic level, most WOCN in foreign hospitals have reached a master's degree, and the lowest has reached a bachelor's level. Few WOCN groups in China have master's or doctoral degrees, and most are mainly college and bachelor's degree holders which to a certain extent also limits the nursing level and career development of WOCNs in China. [24]. It is recommended that APN courses be added to the compulsory nursing curriculum to provide a good foundation for nursing staff whose career development is APN, and that the entry criteria for WOCN should be progressively developed or post-entry training should be strengthened to improve the academic level of talents and promote professional development. A phased WOCN education programme should be developed, focusing on improving work competencies and helping WOCN to clarify their professional development path and determine their career direction.
In terms of hospital management, China has not yet unified clear standards on how to make assessments for specialist nursing positions, and the incentive mechanism for specialist nurses in domestic hospitals has yet to be improved. [25]. Hospitals do not pay enough attention to the management of specialist nurse positions, and there are no clear responsibilities and scope of work, and the work of specialist nurses lacks management support and quality control by relevant departments. Most nurses work as part-time specialist nurses, and the scope of their work is not clear. [26]. It is necessary to strictly manage the positions, make the scope of job responsibilities specific and clear, and help WOCN plan their career development pathways and provide career development paths. The WOCN should be provided with appropriate specialist nurse allowances at different levels and incentives should be used appropriately to mobilize their professional motivation, initiative and creativity.
The development of wound stoma specialist nurses in China is facing unprecedented opportunities and there is an urgent need to improve the training system for wound stoma specialist nurses. It is recommended that the relevant national departments should do a good job of unifying education and training and qualification standards, strict job management, specific and clear job responsibilities and scope, and actively guide the direction of specialized career development. Cultivate high-quality WOCN, establish a sustainable wound stoma specialist nursing team, and promote the development of wound stoma specialist nursing construction in China with the core competencies of advanced practice nurses.
This paper is one of the partial achievements of 2023 Collaborative Education Project for Industry and Education Cooperation between Micro-Port (Group) Co. and Ministry of Education《Self-help psychological health education》
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
