title: Advanced midwifery practice: An evolutionary concept analysis.
abstract: OBJECTIVE
  the concept of 'advanced midwifery practice' is explored to a limited extent in the international literature. However, a clear conception of advanced midwifery practice is vital to advance the discipline and to achieve both internal and external legitimacy. This concept analysis aims to clarify advanced midwifery practice and identify its components.
  
  
  METHODS
  a review of the literature was executed using Rodgers' evolutionary method of concept analysis to analyze the attributes, references, related terms, antecedents and consequences of advanced midwifery practice.
  
  
  RESULTS
  an international consensus definition of advanced midwifery practice is currently lacking. Four major attributes of advanced midwife practitioners (AMPs) are identified: autonomy in practice, leadership, expertise, and research skills. A consensus was found on the need of preparation at master's level for AMPs. Such midwives have a broad and internationally varied scope of practice, fulfilling different roles such as clinicians, clinical and professional leaders, educators, consultants, managers, change agents, researchers, and auditors. Evidence illustrating the important part AMPs play on a clinical and strategic level is mounting.
  
  
  CONCLUSIONS
  the findings of this concept analysis support a wide variety in the emergence, titles, roles, and scope of practice of AMPs. Research on clinical and strategic outcomes of care provided by AMPs supports further implementation of these roles. As the indistinctness of AMPs' titles and roles is one of the barriers for implementation, a clear conceptualization of advanced midwifery practice seems essential for successful implementation.
  
  
  CONCLUSIONS
  an international debate and consensus on the defining elements of advanced midwifery practice could enhance the further development of midwifery as a profession and is a prerequisite for its successful implementation. Due to rising numbers of AMPs, extension of practice and elevated quality requirements in healthcare, more outcomes research exclusively evaluating the contribution of AMPs to healthcare becomes possible and desirable.
authors.affiliation: University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, U.Z. 5K3, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: Regine.Goemaes@UGent.be.
authors.forename: Régine
authors.initials: R
authors.lastname: Goemaes
authors.affiliation: University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, U.Z. 5K3, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: Dimitri.Beeckman@UGent.be.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Beeckman
authors.affiliation: University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, U.Z. 5K3, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: Jolgooss.Goossens@UGent.be.
authors.forename: Joline
authors.initials: J
authors.lastname: Goossens
authors.affiliation: School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Duke of Kent Building, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom. Electronic address: j.shawe@surrey.ac.uk.
authors.forename: Jill
authors.initials: J
authors.lastname: Shawe
authors.affiliation: University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, U.Z. 5K3, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: Sofie.Verhaeghe@UGent.be.
authors.forename: Sofie
authors.initials: S
authors.lastname: Verhaeghe
authors.affiliation: University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, U.Z. 5K3, De Pintelaan 185, B-9000 Ghent, Belgium; University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: Ann.VanHecke@UGent.be.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Hecke
mesh_terms: D007857:Leadership; D008880:Midwifery / Q000193:education / Q000379:methods*; D017009:Professional Autonomy; D024382:Professional Role; D012106:Research
keywords: Advanced practice nursing; advanced midwife practitioner; certified nurse midwife; concept analysis; midwifery