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The Strong Model of Advanced Practice Applied to a Workplace Setting

The Strong Model of Advanced Practice Applied to a Workplace Setting


The main objective of rural and remote nursing practice is to ensure the delivery of quality healthcare services in the context of general health practice. Nursing practice plays a complementary role through the provision of variety of services, which range from clinical care and service coordination to ensuring the maintenance of good health through screening, health education and health promotions for individual members and the society (Milstead, 2013). This paper aims at analyzing the Strong Model of Advanced Practice in relation to the problems encountered by a small rural community in Queensland.

Description of the rural community in Queensland

The small rural community in Queensland has a population of about 600 people. This population is inclusive of the people living in a township and neighboring farming community. It is important to note that mining companies that harvest gas and oil also occupy the area. This area has a small health center that accommodates 10 beds. The health center also has outpatient facilities and six permanent aged care beds that are all occupied.

The main problem in this health care center is that it is isolated from referral services. It is also incompetent in the provision of appropriate care to all patients. The restricted nature of sufficient health care facilities compels patients to travel long distances to seek appropriate treatment. In situations where patients from Queensland requirement follow up treatment and assessment, they are compelled to remain in the large towns that have sufficient health care facilities.

Community health services with the small rural town are limited. This is because the facility only provides aged care services such as Blue care and home care services. The area also has staff education problem. This is because staffing in the health care center is minimal. It is often difficult for the existing staff to obtain the appropriate time to attend courses and conferences. The long distance that the members of staff must cover is to attend these sessions are impediments considering that most of the staff have families to take care of.

Analysis and evaluation of the Strong Model (1994)

The Strong Model provides a framework, which depicts the patient as the central focus. The model consists of five spheres of practice and three conceptual filaments. The adoption of this model was to provide guidance to nurse practitioners (Ackerman et al, 2000). A defining feature of the Strong Model is that advanced practice model functions in each of the five spheres of practice: publications and professional leadership, research, education, direct comprehensive care and support of system (Ackerman et al, 2000). This function is often aimed at improving the well-being of patients. The conceptual strands, which include scholarship, empowerment and collaboration, are essential in unifying and influencing every domain of practice (Ackerman et al, 2000). The Strong Model asserts that an individual may begin his or her practice as an expert in clinical activities. In the process of providing health care services, the conceptual strands will play an essential role in improving his or her experience in the domain of nursing practice (Ackerman et al, 2000).

Direct Comprehensive care

This domain of practice has an overwhelming support as an essential parameter for advanced nursing practice. This is based on the assumption that it is the responsibility of the nurses to have a direct engagement with the patient. For any form of advancement to be witnessed in the practice of nursing, it is important for the nurses to build a relationship with the patient and work on strategies of improving on health care provision (Ackerman et al, 2000). Through this domain, nurses realize that their expertise in comprehensive patient’s care demonstrates the specialty that advanced nursing practice offered to patients (Ackerman et al, 2000). Limited number of staff to provide sufficient care to those in the small rural community in Queensland is a contributing factor to the deteriorating health conditions in the community. These nurses are few to have a direct relationship with every patient.

Support of systems

This domain is essential as it contributes to quality performance of the institution in nursing. Ackerman et al (2000) contend that the domain consists of the promotion of innovative patient care and the facilitation of optimal progression of patients through an efficient health care system. The staff in the rural community does not demonstrate any dedication to the support of the health care system. Their operations are focused towards the maintenance of the status quo rather than the expansion of the health facility.


This domain according to Ackerman et al (2000) involves the improvement the caregiver’s knowledge base to enable him or her to disseminate knowledge on update scientific practices to the public. This is realizable through the incorporation of a wide scope of education in areas such as public health. The staffs at the rural health care center in Queensland have to cover long distances to improve on their education on their areas of expertise. This discourages them to find appropriate time off to attend courses and conferences.


This is the domain the supports the generation of knowledge that can be integrated into the existing knowledge about clinical practice. The emphasis here according to Ackerman et al (2000) is to ensure the creation and support of a culture that strives at finding the better ways of providing sufficient care in nursing practice. In the case of the healthcare center in Queensland, the facility does not have the apparatus to improve on its health services considering that it is challenged in terms of expertise and resources to conduct effective research on the possible ways of improving its services.

Publication and professional leadership

This domain encompasses all the professional activities that allow for the dissemination and sharing of knowledge within the area of expertise. It is important for nurses in their practice to be in constant communication with their peers concerning updated information on how to provide health care services to their patients (Ackerman et al, 2000). The fact that the health center in Queensland is small and withdrawn from the urban society means that it does not receive publications from professional peers at the appropriate time. This makes it complex for the Strong Model of Advanced Practice to operate efficiently in this area.

How well is the patient/client voice heard in the Strong Model?’

The Strong Model is a patient centered framework. This means that in all the initiatives that health practitioners instigate, they must focus on the best ways that patients can access health services (Roussel, 2013). As a patient centered framework, the Strong Model is consistent with the basic tenets of primary care. Its domain of direct comprehensive care is considered as essential in the sense that it encourages the development of a relationship between the patient and the nurse (McGloin & McLeod, 2010). Through this relationship, the medical practitioner is able to understand the concerns of a patient considering the fact that physical health is often dynamic and requires adequate expertise to solve (Hamric et al, 2014).

Through this interaction, the practicing nurse is able to involve the other domains and conceptual strands to ensure that sufficient health care services are made available to satisfy the increasing needs of the patient (Roussel, 2013). In conducting research concerning the best ways to improve health care services, the findings are often based on the views presented by the sampled patients (Hamric et al, 2014). This will inform the publications, support systems and the curriculum used in providing education to existing and future nurses. The level of professional expertise in any facility is highly dependent on patients’ needs in the community (Fitzpatrick et al, 2003).

Analyse and discuss the statement by Chang, Gardner, Duffield and Ramis (2011) and the relevance (or not) of the issues outlined in relation to your practice context.

Chang et al (2011) contend, “Many of the issues surrounding the introduction of advanced nursing positions have resulted from the ‘ad hoc’ implementation of poorly defined new roles receiving inconsistent professional and organizational support.” The advanced practice nurse (APN), as a profession, emerged due to the dynamic health care needs and the requirements of workforce. In addition, societal forces such as technological changes in health care delivery contributed to the evolution of this professional field (Mirr & Zwygart-Stauffacher, 2010). The positive effects of this advancement in positive care include patient satisfaction, health enhancement, less hospital admissions and less time spent in health wards by patients. Furthermore, advancement in healthcare brought with it economic savings as the natural consequence.

Despite the introduction APN roles, there are areas that experienced challenges in the implementation process and this resulted in the conceptualization of barriers to sufficient utilization of these roles (Mirr & Zwygart-Stauffacher, 2010). The Strong Model of Advanced Practice was considered as having a potential to provide a definition to the activities of practice nursing responsibilities. Originally, this tool was designed to develop the practices of nurses while finding a point of integration with the five domains of the practice (Bryant-Lukosius et al, 2004).

The view by Chang et al (2011) is relevant to the issues in the practice of nursing especially in the health care facility in Queensland. One major issue is that the advanced practice of nursing roles has had influence from the government of Australia and other societal factors such as rising demand for health care and workforce shortage (Chang et al, 2011). Despite the attempts by the nursing profession to meet these demands, the new roles have been proliferated by inadequately defined roles of the nursing practice. In Queensland for instance, the roles of a nurse have been regulated by other advanced roles such as clinical support specialists, which are not only poorly defined but also potentially under-utilized.

The introduction of innovative roles of nurses without sufficient definition and support is a contributing factor to the blurring of behavior and responsibilities, which in turn is considered as a contributor to role duplication, conflict and confusion. This is considered as a risk to the health of patients (Bryant-Lukosius et al, 2004).


It is important that the body in charge of implementation of innovative nursing roles to initiate relevant educational programs and infrastructure that will provide necessary support and maintenance of an understanding (Chang et al, 2012).

There is need for the increase in the number of staff in the small health care facility. This will help in solving the problem of supply and demand of health practitioners. However, this is a necessary but not sufficient solution to the staffing problem as it requires that the management of these professionals is empowered to deal with the increasingly complex needs of the patients’ population (Curley & Vitale, 2011).

There is need for the development of a structure for the advanced practice nurses, to satisfy the needs of the patients. The process of creating this framework would articulate and provide a clear definition of the roles of nurses, the scope of these roles and create a network of nurses working in different settings (Bryant-Lukosius et al, 2004). Such a network would improve the relationship between these professionals thereby improving the nature of interaction and sharing of ideas (Chang et al, 2012).

In the implementation of a framework that clearly defines the roles and responsibilities of nurses, it is important, to realize that individual components of the framework will vary according to the settings in which the health care facilities are based (Curley & Vitale, 2011). This means that the development of a national definition of nursing roles may prove tedious. However, the objectives of nursing roles should be uniform irrespective of the setting (Butts & Rich, 2011).


Nursing as a profession requires an expert to base all his or her operations on the well-being of a patient. The rural community in Queensland has a small healthcare facility that faces many challenges that prove hard to solve using the Strong Model of Advanced Practice. The issues in this health facility are not only in under staffing but also in the low levels of expertise. The health care facility is excluded and this leads to low levels of interaction with other health experts in other regions. There is need for a framework that redefines the roles of nurses and increase levels of interaction by improving on communication infrastructure.


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