Defining what we mean by ACP seems a good place to start when looking at existing evidence regarding ACP. In my systematic literature 30 out of the 44 papers included findings related to the definition of ACP, nomenclature used when referring to ACP roles and titles, and the scope of the ACP role or practice. All noted that there continues to be a proliferation of nomenclature/ titles used to describe ACP and ACP roles. However, what emerges is a broad consensus on the definition, conceptual models, and features of Advanced Clinical Practice across different professional, clinical speciality, health service and geographical contexts.
These commonly reflect the 4 pillars, (Research, Education, Leadership and Clinical Practice), knowledge, skills and attributes, (capabilities including education and experience) and context (workforce and governance and accountability) as set out in the Multi-Professional Framework for ACP in England.
Some alternative conceptual models are presented which provide a ‘finer-grading’ of the definition and scope of ACP which do reflect the existing ‘4 pillar’ framework but also draw particular attention to aspects, such as the administration features of the role, that may not be as overtly described elsewhere. Other models proposed give some variation from the more simplified ‘4 pillars’ framework which can be seen as a set of tasks to ‘tick off’ to fit the definition of an ACP. These include recognition of the integrated subroles, skills and processes, contextual pre-requisites and outcomes of ACP and the significance of autonomy and clinical expertise as central attributes. Alternatively a continuum of predominately clinical orientation to predominately managerial orientation for innovative nursing roles is proposed, with ACPs working at some point on this continuum. However, this can often overlap with other roles (such as clinical nurse specialists) and so is not clearly defined.
Some papers focussed on developing a snapshot of the current status of ACP. These tended to only provide a picture of ACP within a sub-set under the broader definition of ACP by focussing on:
- a particular profession, (although research that focussed on or included professions other than nursing was rare; only 9 out of the 44 papers included non-nurses in their sample).
- geographical area or particular service
- clinical specialty
- one of the 4 pillars of ACP
From the papers I reviewed the scope of ACPs does vary to some extent and this is influenced by a number of factors including the original purpose for developing the role, regulation boundaries on scope, education preparation, organisational context in which the ACP operates, origins or purpose of the role and personal attributes of role holders. This leads to ‘localisation’ of ACP which then impacts on the ‘professional jurisdiction’ and scope of practice for ACPs.
International comparative studies highlight that despite the varied definitions, nomenclature, scope and regulation globally, ACP continues to be increasing and developing in a range of health care settings.
In conclusion existing research shows that ACP is diverse and growing. The definition of ACP broadly coalesces around the four pillars of clinical practice, education, leadership/ management and research. However there is a powerful element of localisation in the way ACP is operationalised and experienced.