Advanced practice Majid Al-Maqbali Riyadh Sept 2013
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Transcript of Advanced practice Majid Al-Maqbali Riyadh Sept 2013
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Establishing the Nurse Practitioner Role in Oman
Dr. Majid Al Maqbali, RN, PhD
Director of Nursing & Midwifery AffairsMOH(HQ) - Oman
September 17, 2013
Leading Through Change Excellence Beyond Limits17&18th September 2013 / 12-13th Dhu Al-Qada 1434
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Objectives:
Develop awareness about the process of
developing a new role in a health system
Appreciate the role of using evidence,
stakeholder’s opinions, and international
models in developing new roles in nursing
Recognize the model of scholarship, practice,
and leadership in transforming nursing
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Advanced Nurse Practitioner
“ A registered nurse who has acquired the expert
knowledge base, complex decision making skills
and clinical competencies for expanded practice,
the characteristics of which are shaped by the
context and /country in which she or he is
credentialed to practice. A master’s degree is
recommended for entry level” (ICN, 2002)
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Driving Forces In Oman
Service Driven – ‘Shortfall’ in Doctors both
numbers and specific expertise .
Emerging Health problems due to lifestyle
changes e.g. Diabetes, hypertension.
People are living longer and are more likely to
develop long term conditions requiring specialist
care.
The global trend of moving care closer and deeper
in the community
Clinical career pathway for nurses to stay at
the bedside.
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Methodology: Triangulated Approach
1. Gathered data on specific advanced practice skills
practiced by nurses, service configuration, practice
standards, education process and professional regulation.
2. Assessed the perceptions of Health Care Professionals.
3. Seek the advice and support of the experts in the field
(WHO Consultants, Academics, Health Administrators,
and Decision makers).
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Consultancies: Dr. Tesfamicael Ghebrehiwet, ICN
Brainstorming and focus groups:
Profession is ready.
The role has to be legitimized.
Epidemiologic and demographic
Imperatives.
Public acceptance.6
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Consultancies: Madrean Schober
Site visits and discussions in the health centers: suggested a more in-depth evaluation.
Workshop with key multidisciplinary stakeholders: SWOT analysis of the current situation - identification of common health problems, client characteristics, settings, scope of practice, educational preparation, facilitating factors and hindrances.
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Our Process: Needs Analysis
Build on the work of Schober– Site visits, focus groups,
workshop.
Data gathering and analysis from Primary Healthcare setting.
Nursing stakeholder focus groups discussions
A review of International literature on Nurse Practitioners /
Advanced Practice.
Perceptions of health professionals on the ANP role in Oman
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Findings
The infrastructure in the country is well positioned to
progress towards development and implementation of
ANP.
Nurses are functioning in an extended role due to the
demand and need for care.
Legitimizing the role with appropriate training and
supervision will surely serve as an innovative way of
ensuring quality of care, system efficiency, and cost
effectiveness.9
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Statistical analysis: 60 % of the nurses working in primary
health care centers
Nurses, 95% of whom were diploma trained, were carrying out
these tasks without the necessary education and legal
authority
56% of the PHC nurses who practice this role have less than 5
years of experience that is alarming
Nurses are prescribing drugs that are not permissible by them
including broad spectrum antibiotics for which they are not
legally authorized10
Findings
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The doctor patient ratio in primary health care is much
lesser than the doctor patient ratio in the hospital,
resulting in a population being underserved by doctors.
The emergent needs appear to be twofold:
Extended nursing role - Provision of local professional
development to upgrade nursing education for those nurses
already functioning in an extended capacity.
Developing a program for advanced nurse practice within the
country based on the local needs (Schober & Affara, 2012). 11
Findings
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Findings (Focus Group):
Internationally the role, responsibilities, titles, and
educational preparation of Nurse Practitioners is not
standardised.
International Council of Nurses have defined a role
and recommend a ‘Masters’ preparation (I.C.N, 2002)
We need a clear definition of ‘Advanced Practice’ for
Oman’s context. 12
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Internationally minimum educational preparation is a Bachelor
degree.
Curriculum development – Local – ‘v’ – Abroad.
Clinical Practice and Assessment to be done in Oman as Omani
nurses are registered to practice.
The need to address preventative health strategies – health
promotion – health education rather than just ‘curative’ strategies.
The role of Consultants / Senior specialists as mentors and assessors
of Advanced practice.
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Findings (Focus Group):
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Internationally most cited reason for implementing
Advanced Practice is Physician shortage (USA, UK
Netherlands, France, Switzerland).
Internationally Nurse Practitioners provide similar outcomes
of care to Medical staff (Horrocks, et al. 2002).
Currently there is a global shortage of nurses - planning one
profession to replace the work of another needs careful
thought (Simoens et al. 2005).
Findings (Focus Group):
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Workforce planning to meet population needs –
move from curative to preventive strategies &
management of chronic illnesses.
Current service gaps include – Palliative care,
community mental health, care of the elderly, and
discharge planning (Focus groups Muscat).
Findings (Focus Group):
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The appropriate duration of clinical experience required
as a pre-requisite for the ANP role is at least 4 years.
Specific skills required by the ANP as expressed were
emergency life saving skills and implementing treatment
regimen.
Critical thinking skills and skills to work autonomously
were considered the most important decision making
skills of an ANP.16
Perceptions of health care professionals
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The most important roles of the ANP include history
taking, physical assessment, acting in emergency
situation, critical thinking and engaging in knowledge
generating activities.
The core competencies required for the ANP role included
communication skills, knowledge generating skills and
assessment skills.
There should be one ANP for each Wilayat/District.17
Perceptions of health care professionals
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Perceptions of health care professionals
ANP’s could be trained locally with clinical placements
to meet the country’s needs in a cost effective way .
The major issues that could be addressed by the ANP’s
include health promotion, managing acute /severe
illnesses and disability limitation and rehabilitation.
ANP’s should work within a multi-professional team
communicating across professional boundaries.
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Perceptions of health care professionals
Introducing the ANP role will enable physicians to
spend more time with acutely ill and sicker patients.
The public will accept the role of the ANP in the health
care system as part of the multidisciplinary team.
Doctors should be involved in the clinical
preceptorship and theoretical preparation of the
ANP’s.
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Suggested Model of Practice
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Conclusion
O: Ownership (Health care providers, decision makers,
government, and public)
M: Model
A: Accept everybody’s point of view and use them
(participatory leadership)
N: Nursing is caring21
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References:
Directorate of Nursing and Midwifery Affairs, (2011b) Advanced Nursing Practice – A data collection process to assess the situation nationally; DNMA, Ministry of Health, Sultanate of Oman
Horrocks S, Anderson E, Salisbury C, (2002) Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ; 324(7341): p 819–23.
International Council of Nurses, (2002) Definitions and characteristics for nurse practitioner / advanced practice nursing roles. www.icn.ch/networks_ap.htm [Accessed Feb 23rd 2011]
Schober, M. (2007) Development of Advanced Community Nursing / Nurse Practitioner Roles & Educational Programs in Oman, World Health Organisation; short term consultancy.
Simoens S, Villeneuve M, Hurst J. (2005) Tackling Nurse Shortages in
OECD Countries. OECD Health Working Papers No. 19, English, 59 pages, doi: 10.1787/172102620474
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