Malaysia is a heterogenous, multi-ethnic society with a population of 30
million, of which 74% reside in urban areas. Since gaining independence, the
main priority of health policy makers is to provide and enhance the delivery of
health care for the disadvantaged communities, namely the rural populations:
women, children and the disabled. The Ministry of Health is the main healthcare
provider in Malaysia. There has been much development in the healthcare system
of Malaysia from the time of independence; starting from the development of the
two-tier system and its subsequent transformation to a three-tier system, as well
as the extension of healthcare delivery into rural areas in Sabah and Sarawak
through the implementation of mobile teams and the Flying Doctor Service (FDS).
The improvement in health status of the general population, particularly in
rural settings is remarkable and in line with the Tenth Malaysian Plan on the
road to Vision 2020. However, the current shift in disease burden from
communicable to chronic non-communicable conditions continues to undermine
these efforts. As a result, deficiencies in healthcare delivery and the health
status of populations still exist, albeit more rampant in rural populations. We
propose the implementation of Advanced Practice Nursing (APN) in the community
as a solution to bridge gaps in health care provision in rural areas in line
with Vision 2020. An advanced practice nurse is a specialty-specific registered
nurse with an expert knowledge base and clinical competencies for extended
practice. Modelled on Australian and Norwegian systems, advanced practice
nurses are recruited directly from rural communities, with a better understanding
of the population, and access to the local cultural norms, such as traditional
healers. APN training is still in its infancy in many developing countries.
Evidence from other similar models has proven that the care provided by
specialised nurses results in higher patient satisfaction, greater access to
health care, improved outcomes and cost effectiveness. APN compliment the care
provided by physicians; reducing doctors’ workload, patient waiting times and
providing care in the convenience of the patients’ homes. To succeed in
improving health care outcomes by APN, the utilisation of evidence based
practice, audits, guidelines, and escalation of specialist care at hospitals
and continuous medical education are essential.
Cite this paper
Veerasingam, N. , Al-Musawi, M. and Selvarajah, P. (2016). Community-Based Advanced Practice Nursing (APN): The Road to Vision 2020. Open Access Library Journal, 3, e2606. doi: http://dx.doi.org/10.4236/oalib.1102606.
Martin, L.A., Neumann, C.W., Mountford, J., Bisognano, M.
and Nolan, T.W. (2009) Increasing Efficiency and Enhancing Value in
Health Care: Ways to Achieve Savings in Operating Costs per Year. IHI
Innovation Series White Paper. Institute for Healthcare Improvement,
Cambridge, MA.
(Available on www.IHI.org)
David, H.P., Garg, A., Bloom, G., Walker, D.G., Breiger, W.R.
and Rahman, M.H. (2008) Poverty and Access to Health Care in Developing
Countries. Annals of the New York Academy
of Sciences, 1136, 161-171. http://onlinelibrary.wiley.com/doi/10.1196/annals.1425.011/full
Nerminathan, V., Adlan, W. and Nerminathan, A. (2014) Hospital at Home: Sustainable Healthcare in Developing
Countries through Reducing Average Length of Stay in Hospitals. International Journal of Management and Sustainability, 3,
51-61.
Gardner, G., Chang, A. and Duffield, C. (2006) Making Nursing Work: Breaking through the Role
of Confusion of Advanced Practice Nursing. Journal pf Advanced Nursing, 57, 382-391. http://dx.doi.org/10.1111/j.1365-2648.2007.04114.x
Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D.,
Wong, F. and Beauchesne, M. (2014) Addressing Issues Impacting Advanced Nursing
Practice Worldwide. The Online Journal of Issues in Nursing, 19,
4.
Alexandersen, O., Jorgensen, E., Osteras, J. and Hasvold, T. (2004) Medisinerutdanningen i Tromso—Sikrer
den legerekrutteringen I Nord-Norge? (Medical Education in Tromso—Does
It Secure the Recruitment of Doctors in North Norway). Tidsskrift for den Norske L？geforening, 124, 2107-2109. (In
Norwegian)
Cleland, J.,
Johnston, P.W.,
Walker, L. and Needham, G. (2012)
Attracting Healthcare Professionals to Remote and Rural medicine: Learning from
Doctors in Training in the North of Scotland. Medical Teacher, 34, e476-e482. http://dx.doi.org/10.3109/0142159x.2012.668635
Gaski, M., Abelsen, B. and Hasvold, T. (2008) Forty Years of Allocated Seats for Sami Medical
Students—Has
Preferential Admission Worked? Rural and
Remote Health, 8, 845.
Fisher, K.A. and Fraser, J.D. (2010)
Rural Health Career Pathways: Research Themes in Recruitment and Retention. Australian Health Review, 34, 292-296. http://dx.doi.org/10.1071/AH09751
Council on Graduate Medical Education (1998) Tenth
Report, Physician Distribution and Health Care Challenges in Rural and
Inner-City Areas. CGME, Rockville, 23.
Playford, D.,
Wheatland, B. and Larson, A. (2010)
Does Teaching an Entire Nursing Degree Rurally Have More Workforce Impact than
Rural Placements? Contemporary Nurse, 35, 68-76. http://dx.doi.org/10.5172/conu.2010.35.1.068
Andersen, A. (1989)
Desentralisert sykepleierutdannning organisert som deltidsutdanning
(Decentralized Nursing Education Organized as Part-Time Education). Report,
Tromso University College, Tromso, Norway. (In Norwegian)
Ugochukwu, C.G., Nnabuenyi, A.I. and Ndubuka, C.C. (2015)
Advanced Practice Nursing Challenges in Developing
Countries: Perception of Nurses in Selected Health Care Facilities in South
East Nigeria. In: Nurses and Midwives: Agents of Change,
Commonwealth Nurses Federation, London. http://www.commonwealthnurses.org/conference2014/Documents/ChikaUgochukwu.pdf
Manahan-Roberge, C. and Lavoie, J.G. (2008) Who Stays in Rural Practice? An International
Review of the Literature on Factors Influencing Rural Nurse Retention. Online Journal of Rural Nursing & Health
Care, 8, 42-53.
