Advanced Practice &Advanced Practice &Clinical AssessmentClinical Assessment

Where are we today?Where are we today?Linda McKeeCardiothoracic Nurse PractitionerWestern Infirmary, Glasgow

HistoryHistory

Development of advanced nursing practice Development of advanced nursing practice in UK – fragmented and poorly in UK – fragmented and poorly documented.documented.

Early experimental appointments were Early experimental appointments were made due to a shortage of junior doctors.made due to a shortage of junior doctors.

Advanced practice roles however have Advanced practice roles however have continued to evolve.continued to evolve.

HistoryHistory

Many differing titles, roles and remitsMany differing titles, roles and remits

Often leading to confusion within the Often leading to confusion within the profession, allied professions and the profession, allied professions and the public.public.

HistoryHistory

UKCC(1994) defined Advanced Practice UKCC(1994) defined Advanced Practice as:as:

“ “ adjusting the boundaries for the adjusting the boundaries for the development of future practice, pioneering development of future practice, pioneering and developing new roles responsive to and developing new roles responsive to the changing needs and with advancing the changing needs and with advancing clinical practice, research and education clinical practice, research and education enrich professional practice as a whole”enrich professional practice as a whole”

Advanced Practice of the PastAdvanced Practice of the Past

Little formal education Little formal education

On the job training On the job training

Often by medical colleagues Often by medical colleagues

Based on others perceptions of what was Based on others perceptions of what was required.required.

DevelopmentsDevelopments

Formal training programmes introduced for Formal training programmes introduced for advanced practice – university linked advanced practice – university linked qualifications.qualifications.

NMC have acknowledged the need for NMC have acknowledged the need for advanced practice to be officially advanced practice to be officially recognised as a qualification on the recognised as a qualification on the registerregister

NMC RegistrationNMC Registration

Discussions ongoing between the NMC, Discussions ongoing between the NMC, Department of Health and educational Department of Health and educational institutions to clarify educational and legal institutions to clarify educational and legal requirements for Advanced Practice requirements for Advanced Practice registration.registration.

Advanced Practice registration should be Advanced Practice registration should be a reality by August 2006.a reality by August 2006.

Clinical AssessmentClinical Assessment

What is involved?What is involved?

Includes history taking, Includes history taking, physical examination and physical examination and patient management. patient management.

Further training explores Further training explores specialist skills such as specialist skills such as advanced cardiac, advanced cardiac, abdominal, respiratory abdominal, respiratory and neurological and neurological assessment.assessment.

Ongoing Professional DevelopmentOngoing Professional Development

Work place Work place practice is also practice is also essential to help essential to help reinforce newly reinforce newly acquired expertise.acquired expertise.

Support from Support from medical peers in medical peers in relation to practice.relation to practice.

CourseCourse

15 week course 15 week course

One week intense top to toe clinical examination One week intense top to toe clinical examination tutorialtutorial

Weekly clinical examination practice sessionsWeekly clinical examination practice sessions

Case study with 2 OSCE stationsCase study with 2 OSCE stations

Benefits to PatientBenefits to Patient

Access to immediate examination, review Access to immediate examination, review and possible intervention.and possible intervention.

Builds relationship of trust with Advanced Builds relationship of trust with Advanced Practice Nurse.Practice Nurse.

Increased patient satisfactionIncreased patient satisfaction

More holistic care to the patient. More holistic care to the patient.

Benefits to NurseBenefits to Nurse

Ability to systematically examine patient Ability to systematically examine patient and identify potential problems.and identify potential problems.

Ability to deliver or initiate immediate care.Ability to deliver or initiate immediate care.

Increased autonomy.Increased autonomy.

Actual practice instead of advised practice.Actual practice instead of advised practice.

AwarenessAwareness

Limitations of professional/personal Limitations of professional/personal experience and competence.experience and competence.

When to make an appropriate referral.When to make an appropriate referral.

The need for ongoing clinical practice The need for ongoing clinical practice development. development.

The FutureThe Future

Changes to cardiothoracic medical staffing Changes to cardiothoracic medical staffing and training.and training.

Increasing emphasis on advanced practice Increasing emphasis on advanced practice roles within cardiothoracic surgery roles within cardiothoracic surgery departments.departments.

Further development of additional Further development of additional specialised practice i. e. surgeons specialised practice i. e. surgeons assistants.assistants.

Challenges for the FutureChallenges for the Future

Continuing development of clinical skillsContinuing development of clinical skills

Ensuring standards for best practiceEnsuring standards for best practice

Clear guidelines for advanced practice Clear guidelines for advanced practice roles.roles.

Research and audit.Research and audit.

A Familiar Situation ??A Familiar Situation ??

InformationInformation

www.pduk.netwww.pduk.net

www.etu.sgul.ac.uk/cso/index.htmwww.etu.sgul.ac.uk/cso/index.htm

http://omeweb2.ucdavis.edu/doctoring/doctoringhttp://omeweb2.ucdavis.edu/doctoring/doctoring

http://medicine.ucsd.edu/clinicalmed/links.htmlhttp://medicine.ucsd.edu/clinicalmed/links.html

http://echt.chm.msu.edu/videolect/viewvideos.htmhttp://echt.chm.msu.edu/videolect/viewvideos.htm