Research progress in nursing subspecialization

Fang Wang,Li Yuan,Zhen-Zhen Xiong,Rao Li

Division of Endocrinology and Metabolism,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China

Review Article

Research progress in nursing subspecialization

Fang Wang,Li Yuan*,Zhen-Zhen Xiong,Rao Li

Division of Endocrinology and Metabolism,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China

A R T I C L E I N F O

Article history:

Received 11 April 2016

Received in revised form

18 April 2016

Accepted 19 April 2016

Available online 5 October 2016

Nursing

Science

Subspecialty

Quality care

Clinical practice

With the rapid development of medical departments in recent years,nursing subspecialization has increased in prominence and performance.This highly subspecialized division of labor system not only improves the quality of nursing care but also promotes the development of nursing science.Today, developing nursing subspecialization has become the direction and strategy for the development of clinical nursing practice in many countries.

?2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1.Introduction

Subspecialization refers to professional refinement and the further refinement of professional classifications based on traditional simple medical professional categories.This is a new subject and talent management approach.1Until now,medical subspecialty development had to follow a business division of labor that was greater and more refined.Therefore,the development of subspecialties was irresistible.In 2011,nursing was approved as a first-level discipline by the State Council;the secondary and tertiary disciplines and subspecialties of nursing will also be increasingly clarified and refined,similar to clinical medicine. Therefore,nursing development inevitably requires nurses to have clear professional directions so that nurses can have goals and plans for further learning and research.This can improve their professionalabilities,thus providing more specialized and personalized general nursing care for patients.In addition,nursing and medicine integrate,overlap,and develop cooperatively.This truly embodies the autonomy and independence of nursing as a first-level discipline.In this paper,the research progress of nursing subspecialty is summarized as follows.

Modern medicine is developing and changing rapidly,and individuals'understanding of medicine is also transforming from a simple to a more refined subject.The traditional simple division of subjects could not have satisfied people's awareness and demands for medicine.2As a result,some large global medical centers have carried on the segmentation of related subjects,namely medical subspecialties.Such division reflects people's awareness of the transformation of medicine from old scientific concepts to new disease concepts.3With the rapid development of medical subspecialties in the second half of the 20th century,global nursing entered an accelerated specialized development stage.The level of nursing discipline specialization has increased significantly,thus making the nursing theoretical system and clinical practice more independent.It has also caused nursing to become more integrated into medicine.4,5With the rapid development of medical diagnosis and treatment technology,medical technology has become more advanced,and the demand of patients for nursing services is improving constantly.To make nursing jobs and medical technology levels synchronized and display nurses'professional abilities to the fullest,developing nursing subspecialties has become the direction and strategy for the development of clinical nursing practice in many countries.6

2.The necessity of nursing subspecialization

In 2009,the national conference of nursing management proposed to carry out the whole quality nursing service and improvethe quality of nursing care to improve the clinical nursing service mode.Medical disciplines in the world are gradually subspecialized,and medical subspecialties are the inevitable result of the growing medical knowledge and advanced technology.7The division of nursing subspecialties is the key to the construction of nursing science and the way for nursing technology to be highly refined and specific.Guan8thought that nursing science can strive for survival and development within health care reform only by the timely changing of ideas,seizing opportunities,developing high quality nursing service,expanding nursing service scope and paying attention to the development of the basics of specialized nursing.It is therefore necessary to develop nursing subspecialties. In comparing medical subspecialties,nursing subspecialties are important for improving nurses'professional technology and stepby-step approach to international standards after our country joined the WTO.1

3.The current research of nursing subspecialties at home and abroad

3.1.The research progress of nursing subspecialties abroad

In foreign countries,almost every nursing department has subspecialized divisions,nearly every subspecialty is represented, including psychiatric,surgery,critical care,and emergency,nurse anesthesiology as well as general staff or“bedside”nurses.9With the development of medical technology,the division of nursing subspecialties has increased in quantity and quality and some new nursing subspecialty terms are gradually appearing.As early as in 2001,the United States identified subspecialty nurses in the field of sexual assault identification(SANEs),which is one such subspecialty in the field of forensic nursing and is responsible for providing the best forensic nursing care and assistance with justice.10In 2007,a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialtybased services(SUBs)and a new urgent surgical care(USC).11To improve the nursing knowledge,a new nursing subspecialty of clinical nursing researcher has appeared.12In recent years,foreign countries have set up corresponding curricula for specific nursing subspecialties.13The American Nurses Association(ANA)took the lead in developing nursing subspecialty certification exams; certified nurses and advanced practicing nursescan obtain recognition for their subspecialty expertise in specified fields through these subspecialty examinations.However,the actual specific roles of subspecialties are not well known.14Although nursing subspecialty has rapidly developed,the number of experts in nursing subspecialties are relatively lacking.According to an American study,15many specific medical fields lack specified personnel and many medical personnel lack the expertise in medical subspecialties.

3.2.The management of nursing subspecialties abroad

Taking the example of diabetes subspecialty,16management of diabetes mellitus is a complex issue and is best addressed using a team approach with physicians,dietitians,nurses and certified diabetes educators.

Current foreign trends dictate delivering diabetes education in the outpatient diabetes clinic and managing hospitalized diabetic patients via a team of diabetes educators.The task force in achieving the mission of diabetes expertise among staff nurses included a core group of staff nurses,a clinical nurse specialist,a nurse educator specialist and a nurse manager.All members aimed to increase their own knowledge in this area and were committed to improving the care of diabetic patients.Nurses from the task force attended a diabetes curriculum and diabetes conference. Clinical nursing educational workers(CNEs)are unique as one of nursing subspecialty,the main purpose of which is to meet the ongoing clinical nurse education demands.This role is very importantin the developmentofnursing subspecialties.17Research18has shown that nurses'job satisfaction and retention are closely related with the leadership style of nursing management;positive dynamic transformation and transaction leadership styles are effective.Moreover,foreign nursing leaders often open related subspecialty curricula for certified nurses and set up task forces to train subspecialty nurses.It is also very effective to open nursing subspecialty curricula in developing countries,which can improve the quality of nursing care.19Nursing management should be diversified,dynamic and drawn from the leadership styles and management skills in business culture that would make management valuable.20

3.3.The research progress of nursing subspecialization in China

The level of nursing specialization is not high in our country.It is still in its embryonic stage of scheme comparison,lacking high quality specialized nurses.Onlya few institutions are trying to start advanced nursing training projects.21,22In recent years,the cultivation of professional nurses is becoming more and more important in our country.However,it only involves diabetes,ICU, colostomy and other fields.23,24The development of nursing subspecialties will need a large number of particular specialized nurses.Specialized nurses'working limits in nursing specialties and professional practice ability can be improved by attending trainings and continuing education in their expertise in addition to the basic nursing knowledge and skills.25The development of specialized nursing directly affects the development of nursing subspecialties in our country.By searching documentation,we can see that our country is carrying out the implementation of nursing subspecialization step by step.Although our nursing subspecialties areonlyattached to theoperation,endocrinemetabolism, ophthalmology,emergency and so on,the achievement is obvious. Li et al26and Hong et al27found that nurses and doctors cooperated well when operating.Doctors'satisfaction has improved significantly,thus making them communicate well with the ward nurses. Perioperative care has improved and the nursing ability and the level of academic research has also improved after establishing the subspecialized nursing team in the department of orthopedics. Therefore,the establishment of a subspecialized task force is the effective mode to cultivate modern highly specialized operating nurses.Ding et al28and Wu et al29showed that establishing the ophthalmology subspecialized nursing group has significantly improved nursing quality,patients'satisfaction and nurses'professional ability.Therefore,an ophthalmology subspecialty can effectively promote the development of specialized ophthalmic nursing.Yang et al30-32found that the implementation of a nursing subspecialty in the endocrine metabolism department could improve nurses'core competence and patients'satisfaction with quality care;reduce nurses'adverse events;and enhance nurses' theoreticalknowledgeand skillsassessment.Therefore,the establishment of a subspecialized nursing group can promote the development of the nursing department and the cultivation of nursing experts conducive to the development of quality care.Xia et al33had found that the establishment of an emergency nursing subspecialty team could effectively increase the rate of successfully treating critical patients and improving patients'satisfaction with nurses.In conclusion,nursing subspecialty not only provide a direction for professional development,but also the comprehensiveness and professional knowledge of these clinical nurses can also be integrated into the entire professional human resource baseand subspecialized segment knowledge to improve the overall development of specialized nursing.

3.4.The management of nursing subspecialty in China

Ourcountryhasset upasubspecializednursing teamonthebasis of medically subspecialized group.With the development of the medical subspecialty,the hospital determines all the medical groups according to the major leading medical subspecialty group.The department then accepts and treats the related patients suffering from different diseases,and the subspecialty of diseases leads nursing science to carry out the group of related subspecialties.34The key to subspecialized management is the management by leaders with expertise in the various subspecialties.35It is the subspecialized leaders that implement the quantitative assessment and dynamic management,making the rights and obligations of each subspecialty clear.Applying the idea of evidence-based practices in nursing management,this is not only needed in our daily routine care but also sublimates nursing theory and practice.This is applied to the nursing practice of other clinical diseases,thus promoting the development of specialized nursing science36whose future is to promote the development of nursing subspecialties.

The core of nursing subspecialized teams is the experienced qualified nurses who lead the young nurses in learning and carrying out nursing work.This is not only beneficial to cultivating professional nurses but also makes nurses'major goal and nursing developing direction clear,which can display nurses'abilities tothe fullest.37The subspecialized management is the key to developing nursing subspecialties.Therefore,to develop the nursing subspecialty better,subspecialized management should be made important by the nursing managers.

4.The future trend towards developing nursing subspecialization in China

With the rapid development of medical subspecialties,doctor-nurse integration will certainly be a future trend towards developing medical subspecialization.At present,many nurses have transformed from basic work to towards nursing subspecialties combined with doctors'work.38Currently,some local hospitals have gradually applied doctor-nurse integrations and have found that this method not only improve satisfaction between doctors and nurses,but can also stimulate nurses'research will and improve nurses'research knowledge with the guidance of doctors.39The prospect of developing nursing subspecialties is broad,it is bound to generate a group of nursing talent nursing subspecialty fields in the future.

In conclusion,nursing subspecialization is an inevitable trend in medical development.Developing nursing subspecialties is of great importance,and the nursing subspecialty in our country is gradually moving toward internationalization.In our country,there is still an existent weakness in the field.All nurses should put joint effort in to build nursing subspecialization with Chinese characteristics.

Conflicts of interest

All contributing authors declare no conflicts of interest.

1.Guo HY,Wang XY.Simple introduction to the subspecialty of general hospital. Zhejiang Med J.2007;29:1225-1243(in Chinese).

2.Wang X,Jiang S,You C.Cultivating postgraduate of medical subspecialty.China Higher Med Educ.2008;1:29-30(in Chinese).

3.Brennan MF,Debas HT.Surgical education in the United States:portents for change.Ann Surg.2004;240:565-572.

4.Hamric AB,Spross JA,Hanson CM.Advanced nursing Practice;an integrated approach.2nd ed.Philadelphia:Saunders Company;2000:3-32.

5.American Nurses Association.Scope and Standards of Advanced Practice Registered nursing.Washington:American Nurse Publishing;1996:1-2.

6.Liu Y,Tian FL,Huo XR,et al.Clinical usage of advanced practice nurses. Chin Nurs Manag.2011;11:15-18(in Chinese).

7.Toyota BD.The impact of subspecialization on postgraduate medical education in neurosurgery.Surg Neurol.2005;64:383-391.

8.Guan JY.The application of SWOT in analyzing nursing care and providing better service to patients.Sichuan Med J.2011;32:2041(in Chinese).

9.Joel Heikes E.When men are the minority:the case of men in nursing.Sociological Q.1991;32:389-401.

10.Kent-Wilkinson A.Forensic nursing educational development:an integrated review of the literature.J Psychiatr Ment Health Nurs.2011;18:236-246.

11.Wood L,Buczkowski A,Panton OM,Sidhu RS,Hameed SM.Effects of implementation of an urgent surgical care service on subspecialty general surgery training.Can J Surg.2010;53:121-125.

12.Samborski C,Neimanis D,Paquette AD,Hernandez L,Klaes K,Rudnicki K. A nursingworkforceprogram toadvanceknowledgeandskillsfor nurses implementing cancer clinical research.Clin J Oncol Nurs.2014;18: 119-121.

13.Avery R,Clauss H,Danziger-Isakov L,et al.Recommended curriculum for subspecialty training in transplant infectious disease on behalf of the American Society of Transplantation Infectious Diseases Community of Practice Educational Initiatives Working Group.Transpl Infect Dis.2010;12:190-194.

14.Freed GL,Dunham KM,Lamarand KE,et al.Pediatric nurse practitioners:roles and scope of practice.Pediatrics.2010;126:846-850.

15.Ng KL,Yazer J,Abdolell M,Brown P.National survey to identify subspecialties at risk for physician shortages in Canadian academic radiology departments. Can Assoc Radiol J.2010;61:252-257.

16.Greene H,de Ruiter HP,Atkins N,et al.Diabetes expertise:a subspecialty on a general medical unit.Medsurg Nurs.2002;11:281-283.

17.Coates K,Fraser K.A case for collaborative networks for clinical nurse educators.Nurse Educ Today.2014;34:6-10.

18.Kleinman C.The relationship between managerial leadership behaviors and staff nurse retention.Hosp Top.2004;82:2-9.

19.Wilimas JA,Donahue N,Chammas G,Fouladi M,Bowers LJ,Ribeiro RC.Training subspecialty nurses in developing countries:methods,outcome,and cost.Med Pediatr Oncol.2003;41:136-140.

20.Stockwell DC,Pollack MM,Turenne WM,Slonim AD.Leadership and management training of pediatric intensivists:how do we gain our skills?Pediatr Crit Care Med.2005;6:665-670.

21.Zhu JC,Zhang ZJ,Jiang XL,Shen SQ.Study on the development of clinical nurse specialist in China.J Nurs Adm.2004;4:1-4(in Chinese).

22.Liu HM,Zhou XR,Li XZ.The overview and issues of developing nurses specialist in our country.Chin Nurs Res.2004;20:20-21(in Chinese).

23.Guo YH.The current status and trend of developing nurse specialist.Chin Nurs Manag.2004;4:19-20(in Chinese).

24.Li YJ,Zhou CL,Zhang LY.The training,qualification and management of nursing specialist.Chin J Prac Nurs.2006;22:51-52(in Chinese).

25.Wei G,Li WH.Thinking of cultivation of specialized nurses and its Countermeasures.Chin Nurs Res.2006;20:2424-2425(in Chinese).

26.Li YP,Xiong SJ,Yang XR,Ye C.Effects of nurses specialization on nursing quality in operation room.West Chin Med J.2007;22:160(in Chinese).

27.Hong Y,Huang WX.Probe into establishing the sub-professional nursing groups of orthopedic surgery in operating room.J Nurs Adm.2010;10:898-899 (in Chinese).

28.Ding TY,Gao QQ,Sun JL,Han SS,Li X.Practice of ophthalmological subprofessional nursing group:management and effect appraisal.J Nurs Sci. 2012;277:19-21(in Chinese).

29.Wu Y,Wang XL,Yu WC,Kang L,Ma X.To build a new responsibility of holistic nursing mode according to discipline subspecialty grouping and its practical effect.Chin Nurs Res.2014;28:738-740(in Chinese).

30.Yang XL,Yuan L,Wu RH,Ye ZW,Xiong ZZ,Liu M.Study for the effect of subspecialty nursing mode in department of endocrinology and metabolism on nurses'core competencies.J Nurs Train.2012;27:2142-2144(in Chinese).

31.Luo YP,Yu F.The application effect of the sub-professional leader ward round in the endocrine and metabolism ward nursing activities in the quality system. Med Info.2014;27:276(in Chinese).

32.Yuan L,Xiong ZZ,Ye ZW,et al.The model and time of building nursing subspecialty in endocrine and metabolism department.Chin J Prac Nurs.2012;28: 87-89(in Chinese).

33.Xia JL,Wang XJ,Jiang F.Application study on establishment of subspecialty group model for emergency nursing.Chin Med Herald.2013;10:142-144 (in Chinese).

34.Chen J,Wu XL,Fu XM,Wan QF.Influence of development of nursing subspecialty on capacities of clinical nursing teachers.Chin Nurs Res.2012;26:86-89 (in Chinese).

35.Ding GR.Simple introduction to the management of medical subspecialty. Gansu Sci Tech.2005;21:199-200(in Chinese).

36.Wu YM.The application of evidence-based nursing in lower limb fractures in clinical nursing.Public Med Forum Mag.2010;14:16-17(in Chinese).

37.Yang XL,Yuan L,Wu RH,Ye ZW,Xiong ZZ.Application effects of subspecialized nursing mode in high quality nursing activities.Chin Nurs Res.2014;28: 3044-3045(in Chinese).

38.Qin Y.Deepen the doctor-nurse integration and improve the level of wound treatment.West Chin Med J.2013;28:809(in Chinese).

39.Liu Y,Liu YY.Practice and effect of the doctor-nurse collaborating model in improving nurses'clinical research ability.J Nurs Adm.2011;11:273-274 (in Chinese).

How to cite this article:Wang F,Yuan L,Xiong Z-Z,et al. Research progress in nursing subspecialization.Chin Nurs Res. 2016;3:121-124.http://dx.doi.org/10.1016/j.cnre.2016.10.002

*Corresponding author.

E-mail address:1409933235@qq.com(L.Yuan).

Peer review under responsibility of Shanxi Medical Periodical Press.

http://dx.doi.org/10.1016/j.cnre.2016.10.002

2095-7718/?2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons. org/licenses/by-nc-nd/4.0/).