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Advanced Nursing Practice in the care of older people and it’s impact on quality of care
Vicky Williams
Consultant Nurse in Gerontology
University Hospitals Coventry and
Warwickshire NHS Trust
Coventry
UK
What is Advanced Nursing Practice?
‘a level of practice delivered by registered nurses who have acquired
an expert knowledge base, complex decision making skills and
clinical capabilities for expanded collaborative practice. The
achievement of an appropriate masters’ degree is essential at the
outset of achieving this status. Specific characteristics are shaped by
the context of practice, but demonstrate autonomous and
collaborative working. Clinical leadership is at the heart of
Advanced Clinical Practice and adjusts the boundaries of
practice, pioneering and innovating to ensure timely response to
changing needs. This is underpinned by advancing clinical practice
research and education to enrich professional practice, and provide a
significant contribution to health policy development and
management.’
Gray (2015) After UKCC (1995), ICN (2002), DoH (2010)
Gerontology
• The care of people with diseases prevalent in old age and the
complexities of ageing and frailty
• Often conditions which by themselves may be easy to
manage/treat are complicated by frailty and a reduction in
physiological function
• Patients that are at increased risk of harm are reliant on high
quality nursing care more than any other intervention for a positive
outcome
So……How do we “advance practice” in gerontology nursing?
The vision: The four pillars of Advanced Practice
• The clinical role Identification and response to need and prevention of deterioration
• The management/leadership role An enabler, challenger and supporter
• The education role Equipping of colleagues with necessary skills
• The research/innovator role Developing practice, knowledge and services
The Clinical role
The vision – unwell older people have complex needs and multi factorial influence on their clinical condition. Nursing has a massive impact on outcome for these patients. Advanced level nurses have a greater impact on outcome.
• The complexity of frailty: Geriatric giants!
– Falls
– Immobility
– Incontinence
– Cognitive Impairment- Delirium/ Dementia Isaacs (1992)
• The focus - ‘Care’ not ‘Cure’ – can things be “fixed”
• What do our patients need? What are the gaps?
Leadership and Management role
• Clinical Leadership and management
• Inspiration / role modelling
• Support and guidance
• Role development
• Consultant Nurse – strategic developments/influence
• Governance – CAEs/ RCAs, complaints – themes
and trends
To do a common thing uncommonly well brings success’
Henry J Heinz (1992)
Education role
Clinical Education
Day to day influence – professional challenge
Role modelling/ teaching- ‘from practice for practice’
Building confidence
Develop recognition skills
Understanding frailty and its management
Training plan, career pathways, degree pathways, personal development
Networking/liaison – MSc Advanced Nursing Practice Programme,
Competency development
Generic/ Speciality
Advanced practice
Research and innovation
• Research agenda
• Evaluation of advanced practice impact
• Developing strategy Advancing practice
• Service innovation
• ANP service: Community outreach / ED in-reach
• Trust wide and beyond
• Conference presentations – ANP roles and gerontology as a speciality
How does that work in practice?
• ANP assessments - what is happening to the patient – current
plan – nursing, medical, social, psychological
• Head to toe assessment – what do we find – physiological review
as well as nursing intervention review. Did we expect to find this?
• Review of interventions and documentation – risk assessments,
medication concordance and efficacy – are achieving what we set
out to?
• Plan and communication – as a team how can we improve our
care?
Identification of themes and trends – feeds into education strategy,
identifies development needs of ANP, identifies needs of patients that
are/are not being met and requirements for innovation, education or
research.
The ANP role in Gerontology
• Models and facilitates high quality clinical care
• Inspires and informs practice through Education
• Responsive visible Leadership - supports and enables professional
growth
• Innovation and research at the heart of continuing improvements
ANPs offer clinically based roles that can provide high quality nursing and
clinical care, clinical leadership and education reflective of patient need
and responsive to challenges faced whilst providing motivation and
inspiration to the whole multidisciplinary team
References
• Department of Health (2010) Advanced Level Nursing: A Position Statement. London: DH
• International Council of Nurses (2002) Definition and characteristics for nurse practitioner/advanced practice nursing roles. Geneva: ICN Geneva
• Isaacs, B (1992) The challenge of Geriatric Medicine. Oxford: Oxford University Press
• Nursing and Midwifery Council (2005) Advanced Nursing Practice- Council Strategy. Available from http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/The-proposed-framework-for-the-standard-for-post-registration-nursing---February-2005/ Accessed 20/09/15
• UKCC (1994) The future of professional practice- the Councils standards for education and practice following registration. London: UKCC
• Warren, M. (1984) Comprehensive Geriatric Assessment. Journal of American Geriatric Society 32, 253-258
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