Practice Problems in Advanced Nursing Practice


Issues relevant to advanced nursing practice include weak nursing leadership and the lack of role models, unclear role boundaries, and the lack of quality improvement in care delivery. Practice problems that arise are associated with patient safety (hospital-related pressures ulcers and challenges of drug administration) and cost-effectiveness of care. At the macrosystems level, implications of these problems include high incidence rates of hospital-acquired pressure ulcers and high rates of hospital readmissions caused by inappropriate medication use (Hugtenburg et al., 2014). The proportion of healthcare costs is thus expected to be great.

At the mesosystem level, the effects of the described practice problems are limited to the scope of a particular local setting and represented by the need for local hospitals and nursing homes to develop protocols and preventative measures. At the microsystems level, the given issues influence healthcare professionals who are expected to lead the change successfully and patients who experience high costs of medical treatment and service, as well as poor patient outcomes related to patient safety. This is especially the case for the elderly who are at high risk of developing hospital-acquired pressure ulcers and having drug-related problems that follow hospital discharge.

Translation Science

Stakeholder engagement is crucial for closing the gap between research production and research use. It is stakeholders who lead the intervention following a chosen knowledge translation model. Activities in which stakeholders may be engaged include setting priorities, conducting research, communicating research findings, leading the change, and applying disseminating strategies. Ethical considerations that serve as a relevant base for translation science include principles of utility, nonmaleficence, respect for autonomy, and justice (Bærøe, 2014). These principles have been derived from classical ethical theories of principlism and meta-bioethics.

Theoretical approaches become widely utilized to guide the process of research translation and determine why the change implementation succeeds or fails. Understanding the differences between these approaches is important in translation science. Conceptual frameworks denote structure or plan consisting of descriptive categories, and translation models serve as conceptual guides that offer a complete picture of the knowledge translation process. Change models, in turn, describe steps needed to facilitate and implement change within an organization. It should be stated that all these approaches are theoretical and descriptive.

Compared to change and translation models, conceptual frameworks are more detailed and feature a clear structure for the achievement of a specific outcome. Models, though, do not have a defined structure and are more related to the theory as they provide a rough definition of practice. For example, the Ottawa Model of Research Use and Lewin’s Change Model provide only a series of steps for knowledge translation and change implementation. The difference between the Ottawa Model of Research Use and Lewin’s Change Model is that the first one is used in evidence translation, whereas the second one is used in change management.

Interprofessional Team in Evidence Translation

The interprofessional team consists of healthcare professionals, such as physicians, nurses, pharmacists, therapists, and others. Successful translation of evidence should be supported by interprofessional collaboration and communication. Healthcare professionals can be involved in the development of a plan and delegate tasks with consideration of members’ qualifications. The most commonly recognized challenges related to evidence translation include the lack of access to new evidence, the lack of qualified human resources, and the lack of resources to apply evidence. Among other barriers, one could mention the lack of motivation of the personnel and poor time management.


  1. Bærøe, K. (2014). Translational ethics: An analytical framework of translational movements between theory and practice and a sketch of a comprehensive approach. BMC Medical Ethics, 15(1), 71-78. doi:10.1186/1472-6939-15-71
  2. Hugtenburg, J., Ahmad, A., Mast, R., Dekker, J., Nijpels, G., & Elders, P. (2014). Identification of drug-related problems of elderly patients discharged from hospital. Patient Preference and Adherence, 8, 155-165. doi:10.2147/ppa.s48357
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