[IPA in primary care: a new gateway to the healthcare system]

In France, the supply of healthcare services remains insufficient to meet the growing needs of the population, which has prompted the legislator to authorize direct access to certain professionals, in particular advanced practice nurses (APNs) working in coordinated practice structures. This article details an innovative multi-professional pathway in a nursing home, where the APN takes direct charge of people without a general practitioner, with the aim of improving their access to care and reintegrating them into the healthcare system.

[Territorial gradation, multi-professionality and IPA: new levers for monitoring Parkinson's patients]

The rapid increase in the number of Parkinson's patients in the population is raising questions about the organization of expert resources. The creation of advanced practice nurses is likely to have an impact on this public health issue, as is the implementation of multi-level care gradation and the prospects for paramedical development.

[Working in a CSAPA, care through relationships]

In a medical-social setting, the work of addiction care providers is somewhat unusual. Drawing on the teachings of Carl Rogers and his person-centred approach, and Hildegard Peplau and her theory of care based on the interpersonal relationship, this article explores the possibilities of welcoming a user to an addictology care, support and prevention center that is trying to rethink its operations at a time when advanced practice nurses are being deployed.

[A survey of psychiatry and mental health IPAs]

A survey was conducted in June 2022 among the graduate RPNs in the field of psychiatry and mental health. 48 people responded and gave their views on their implementation and job satisfaction. The results were generally positive.

[Role of a stabilized chronic pathology RPN in mental health]

While our health care system is compartmentalized by specialty, the implementation of an advanced practice nurse mentioning stabilized chronic pathologies in a public mental health institution may seem ambitious. However, it is interesting, for patients suffering from a mental pathology, for caregivers practicing in psychiatry and for the institution, to integrate it into the care pathway.

[IPA exercise at extreme ages of life, differences or similarities?]

Advanced practice nursing is intended for children, adolescents, adults and the elderly. In the field of mental health, this population-based approach allows advanced practice nurses to apply all of their skills for individualized and adapted care. Whether these professionals work in child and adolescent psychiatry or in psychiatry for the elderly, their practices have many similarities.

[Three examples of IPA implementation in medical-psychological centers]

The Paul-Guiraud Hospital Group has three advanced practice nurses (APNs) specializing in psychiatry and mental health who work in different medical-psychological centers. Supported by the institution, each APN project has been thought out by a multi-professional team within the structures, according to their specific needs.

[Evidence-based practice and nursing: intramuscular injection in psychiatry]

Intramuscular injection is a frequent technical procedure in psychiatry. In France, nurses who perform this care do not have official guidelines for good practice. The advanced practice nurse is a field actor who can promote evidence-based practice to improve the quality of care for the benefit of the patient.

[Supporting the frail elderly: from resilience to reducing hospitalizations]

The frail elderly population will most certainly continue to grow in the coming years. Consequently, the number of hospitalizations and the iatrogenic dependence linked to them will increase. In this context, it seems interesting to question frailty. Indeed, accompanying, in ambulatory care, these patients towards a resilient behavior is one of the roles of advanced practice nurses, which it would be judicious to deepen in order to decrease the recourse to hospitalization.

[Thinking about care to enhance its meaning]

Advanced nursing practice is one of the avenues proposed by politicians to meet the new needs of people being cared for in a rapidly changing healthcare system. It is therefore interesting to conceptualize the theoretical foundations of these new practices, in order to reveal their meaning. To do this, we will discuss some of the missions of the advanced practice nurse, whose primary objective is to provide high-quality care. We will then demonstrate that the evolution of nursing care, which allows professionals to deploy their skills and gain in responsibility, is indeed at the service of the cared-for person.

[Advanced practice nursing as a complement to primary care physician practice]

Two advanced practice nurses (APNs) who graduated in France propose a feasibility perspective on their future multiprofessional practice in primary care. A retrospective exploratory study of 9 physicians was carried out on 396 consultations according to reasons and patient profiles. Slightly more than 22% of the consultations could be oriented strictly towards IPA. Approximately 60% of IPA consultations would fall under the heading of parallel therapeutic education.

[The advanced practice nurse and chronic renal patients]

In the course of his life, a patient with chronic kidney disease will have to hear the announcement of a diagnosis, live with a pathology for which there is no hope of cure, undergo a multitude of tests and, finally, choose a mode of substitution (dialysis and/or transplantation). The advanced practice nurse has a role to play in bringing added value to these patients. In this function lies a constant questioning of his practices, a development of his intellectual curiosity in the service of patients.

[New therapies in oncogeriatrics]

Cancer management is changing rapidly. Changes in practices are not all transferable to the elderly population, which is heterogeneous. The description of the intrinsic toxicity of anti-cancer treatments is insufficient in the elderly. Recent studies dedicated to the elderly incorporate composite evaluation criteria combining efficacy and toxicity with a broad definition including, among other things, loss of functional autonomy. These new data acquired, as well as new organisations integrating the new profession of advanced practice nurse in oncogeriatrics will enable us to better respond to the challenge of caring for elderly patients in the future.

[Nurses' feedback on advanced nursing practice in mental health]

Nurses will soon be able to develop advanced practice in mental health through a state certified diploma. This new role will see caregivers acquire other competencies, such as prescribing, and marks a development of the profession through the growth of nursing sciences. The evolution of practices and the clinical approach in care would gain from collaboration between advanced practice nurses undergoing training and qualified clinical nurse specialists. Based on feedback from nurses in the field, perspectives for collaboration and organisation are assessed in terms of the health challenges facing our society.

[Oral treatments for cancer]

Oral chemotherapy is a therapy which is increasingly prescribed in outpatient care but which should not be trivialised. The patient must be given information and education to ensure compliance and awareness of the side effects to share with the care team as soon as they appear.

[Leadership and advanced practice nurses]

Clinical leadership is expected of advanced practice nurses with regard to their scope of competencies. The effective implementation of this competency within the teams requires management support. It is a first step towards the reinforcement of clinical leadership in France.

[Advanced practice, a springboard for nursing leadership]

The introduction of advanced nursing practice in France is a necessity but also constitutes a challenge. The French National Order of Nurses has been a key player in this project. This experience has shown that the profession needs to mobilise itself and acquire the codes and skills needed to tackle the difficulties and obstacles. It must develop its ability to negotiate with stakeholders and with its leadership to move the profession forwards.

[Legal responsibility of the advanced practice nurse]

While the profession of advanced practice nurse has finally been codified, this new regulation raises issues. Today, nursing is no longer subject to altruistic ideology. Advanced practice nurses have real expertise which has consequences on their responsibility. It is essential to be fully aware of the legal framework in which they practise.

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THE STRATEGIES FOR DEPLOYING THE ROLE OF ADVANCED PRACTICE NURSE IN HOSPITALS.: Advanced practice is developing in France and is a real opportunity for patients, health professionals and for the health system as a whole. Advanced practice nurses will bring real added value in this context. The director of nursing has a key role to play in terms of communication and supporting the teams with the deployment of these new professionals on the wards.

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The recognition of advanced nursing practice is being met with great optimisim among patients. The care relationship will be enhanced by the creation of different partnerships between health professionals, patients and carers, which will ensure a better quality of initial and follow-up care. The patient will now be able to rely on the advanced practice nurse to guide them along a more global healthcare pathway. As a result, the care and support relationship will feel more human.

[Assessing the contribution of the advanced practice nurse]

An assessment of the impact of advanced practice will be presented to the French parliament in 2021. Advanced practice nurses must make use of this opportunity. Indeed, this assessment is likely to come with major challenges in terms of the reorganisation of the healthcare provision following the implementation of this new function. The definition of adapted indicators is essential.