Advanced nursing practice in the Nordic countries

Health care services are undergoing major change and reform, with restructuring and re-engineering taking place world-wide. Many factors have influenced these changes. They include: (1) the use of high technology with the increased possibility of medical interventions, (2) people living longer and thus the number of older people needing health care increasing, (3) changes in family structure with more single parent families, more women working and fewer children, (4) increased costs for health and welfare and (5) increased efficiency in hospitals with patients being discharged earlier and thus requiring more intense care and treatment at home or in the community. The impact of high technology in hospitals and community and primary health care settings is very costly and knowledge intensive. Many individuals and families now learn how they can contribute to their care. Because of this, health care providers in all settings are being asked to generate creative strategies that will promote quality, decrease cost and improve patient and family satisfaction with health outcomes and community services. The management of care, especially outside the hospital, is complex and requires nurses prepared with new knowledge. The nursing faculty at the Institute of Nursing Science, University of Oslo, Norway, recognized the need to prepare nurses for advanced clinical practice with a primary health care emphasis. This is the first university-based advanced clinical nursing programme at the graduate level in Norway. The programme focuses on three areas of study based on theoretical and research knowledge of nursing science, including patient phenomena of concern for nursing, clinical action and decision making theories, and the role of the nurse working in complex clinical practice. Journal of Clinical Nursing 1998; 7: 257–264