FOCUSING ON APN THROUGH A FOCUSING ON APN THROUGH A GRADUATE PROGRAMGRADUATE PROGRAM

Raisa GulRN, RM, BScN, MHA

Assistant Professor and Director, Diploma Programme

Aga Khan University, School of Nursing

PRESENTATION FLOWPRESENTATION FLOW

Brief Overview of the CountryBrief Overview of the Country↓↓

Nursing ProfessionNursing Profession↓↓

Challenges of MScN Program &Challenges of MScN Program &Integration of Advance Practice in Nursing Integration of Advance Practice in Nursing

(APN)(APN)↓↓

Potential Impact Of APNPotential Impact Of APN

PAKISTANPAKISTAN 56 Years56 Years of i of independencendependence

Population of 140 Million; 68% Rural and 32 % UrbanPopulation of 140 Million; 68% Rural and 32 % Urban Population growth 2.2%Population growth 2.2% Poor public health facilitiesPoor public health facilities Literacy 40% Literacy 40% Health care access, strong rural urban disparities Health care access, strong rural urban disparities IMR, 95 per 1000 live birthIMR, 95 per 1000 live birth MMR, 200-700 per 100, 000 MMR, 200-700 per 100, 000 Double disease burden: infectious diseases , Double disease burden: infectious diseases ,

Hepatitis (TB) and Hypertension, diabetes, cancers, Hepatitis (TB) and Hypertension, diabetes, cancers, mental Health problemsmental Health problems

Estimated # of Doctors = >100’000 ; Nurses 33’000 Estimated # of Doctors = >100’000 ; Nurses 33’000 so, 1 nurse: 3-4 doctorsso, 1 nurse: 3-4 doctors

ABOUT THE COUNTRYABOUT THE COUNTRY

NURSING IN PAKISTANNURSING IN PAKISTAN

Have Nurses, Lady Health Visitors and Midwives Have Nurses, Lady Health Visitors and Midwives Entry to nursing education is grade 10-12Entry to nursing education is grade 10-12 Nurses are confined to hospitals, 20-30 patients/nurseNurses are confined to hospitals, 20-30 patients/nurse Predominant use of students for services Predominant use of students for services Quality of nursing education is lowQuality of nursing education is low Nursing Education, diploma and post basic diploma Nursing Education, diploma and post basic diploma Demand for higher education by employer is low Demand for higher education by employer is low

except at AKUHexcept at AKUH Opportunity for higher education is limitedOpportunity for higher education is limited Limitation of nursing leadership and physicians’ Limitation of nursing leadership and physicians’

dominance in Health Care System.dominance in Health Care System.

AGA KHAN UNIVERSITY SCHOOL OF AGA KHAN UNIVERSITY SCHOOL OF NURSING : NURSING : VISION Of THE CHANCELLORVISION Of THE CHANCELLOR

Promotion Of NursingPromotion Of Nursing

Begin with SON in 1980 as a “break through”Begin with SON in 1980 as a “break through” Had an expatriate director and national faculty with Had an expatriate director and national faculty with

post –basic diploma post –basic diploma 23 years later, have national Dean and Directors23 years later, have national Dean and Directors All faculties with at least undergraduate degree, but All faculties with at least undergraduate degree, but

also Masters and PhDsalso Masters and PhDs Programmes developmentProgrammes development: :

1980 –General Nursing Diploma 1980 –General Nursing Diploma 1988-Post RN BScN 1988-Post RN BScN 1997 – BScN1997 – BScN2001- MScN2001- MScN

First program in the country

CHALLENGES OF CHALLENGES OF ESTABLISHING MScNESTABLISHING MScN

a) Conceptual Phasea) Conceptual Phase::Creating awareness, ownership and approvalCreating awareness, ownership and approval

Physicians, it takes nurses away from the Physicians, it takes nurses away from the “real work” “real work”

Employer & university Administration, how Employer & university Administration, how will they be different…do we need to spent will they be different…do we need to spent more money?more money?

Nurse Leaders, sense of insecurityNurse Leaders, sense of insecurity

Contd…Contd…

Strategies:Strategies: Communication, rationalization with Communication, rationalization with

current trends in nursing educationcurrent trends in nursing education Success of the developed CountriesSuccess of the developed Countries Assuring for strong consideration to Assuring for strong consideration to

enhance clinical knowledge, i.e. 22/59 enhance clinical knowledge, i.e. 22/59 credits (37 %) as core courses in the credits (37 %) as core courses in the curriculumcurriculum. .

b) Planning Phaseb) Planning Phase

Approval of the Board, concern for Approval of the Board, concern for resources both human and financialresources both human and financial

Strategies:Strategies: Faculty development plan, Faculty development plan,

sponsorship for graduate studies sponsorship for graduate studies Expatriate faculty, visiting and short Expatriate faculty, visiting and short

term contractsterm contracts Collaboration with other universities Collaboration with other universities

abroad, Sheffield University and abroad, Sheffield University and MinnesotaMinnesota

2. Curriculum composition, specialist 2. Curriculum composition, specialist

versus generalist Masterversus generalist Master

Took generalist approach, with emphasis on Took generalist approach, with emphasis on Research and Clinical Practice due to:Research and Clinical Practice due to:

Limited pool of nurses with BscN at the national level Limited pool of nurses with BscN at the national level Diversity of potential candidates for MScNDiversity of potential candidates for MScN Envisaging greater impact through developing Envisaging greater impact through developing

leadersleaders

3. Developed transition programme in 3. Developed transition programme in view of the national needsview of the national needs

MScN CURRICULUMMScN CURRICULUM

Nursing Practice ResearchEducation ElectivesManagement

Total Credit hours – 59

c) Implementation Phasec) Implementation Phase

Availability of expatriate faculty , 9/11/2001Availability of expatriate faculty , 9/11/2001 Undesirable effects of Faculty development Undesirable effects of Faculty development

planplan Variation in employer’s demandVariation in employer’s demand Visa and licensure issues for students’ Visa and licensure issues for students’

advance clinical practicum abroadadvance clinical practicum abroad Students perspectives, program credibility, Students perspectives, program credibility,

cost benefits analysiscost benefits analysis Pool of potential students further Pool of potential students further decreaseddecreased

affecting enrollment in MScN.affecting enrollment in MScN.

StrategiesStrategies

Pooling of resources within the Pooling of resources within the university: university:

Inter departmental collaborationInter departmental collaboration Physicians as preceptors for Physicians as preceptors for

Advance clinical PracticumAdvance clinical Practicum Visiting and Sessional facultyVisiting and Sessional faculty

Our Experience of Advance Our Experience of Advance Clinical PracticumClinical Practicum

Students’ comments :Students’ comments :““Culturally it is appealing, will have more Culturally it is appealing, will have more

respect.”respect.”““Our role of counseling and teaching was very Our role of counseling and teaching was very

much appreciated.”much appreciated.”

““50% of patients need counseling and teaching 50% of patients need counseling and teaching to cope with their diagnosis.”to cope with their diagnosis.”

“ “ patient were receptive to get examined or patient were receptive to get examined or advised by a nurse.”advised by a nurse.”

ContdContd……

““Doctors were learning from us and we learned from Doctors were learning from us and we learned from them” this “Will definitely impact nurses’ image.”them” this “Will definitely impact nurses’ image.”

““If we identified what was missed out, they [Physician] If we identified what was missed out, they [Physician] were appreciative rather then defensive.”were appreciative rather then defensive.”

““Me and my preceptor have begun to work on research Me and my preceptor have begun to work on research project.”project.”

Physician remarked “I am afraid if you have a clinic Physician remarked “I am afraid if you have a clinic next to me. I will loose my patients to you.”next to me. I will loose my patients to you.”

Students, Patients and Students, Patients and Physicians perspectivesPhysicians perspectives

Chance of independent decision makingChance of independent decision making Application of knowledge, especially Application of knowledge, especially

counseling and patient education counseling and patient education Enhancement of assessment skillsEnhancement of assessment skills Projects nurses strengths and potential, Projects nurses strengths and potential, Source of mutual and enrich learning Source of mutual and enrich learning

experienceexperience Strengthening Nurse- Physician collegiality Strengthening Nurse- Physician collegiality Enhance awareness among public about the Enhance awareness among public about the

scope of nurses’ workscope of nurses’ work..

Advance Practice in Nursing (APN)Advance Practice in Nursing (APN)Concept to implementationConcept to implementation

Need a visionNeed a vision Availability of human and financial resourcesAvailability of human and financial resources Educational preparation of nurses at Educational preparation of nurses at

graduate levelgraduate level Creation of systems to recognize the APN Creation of systems to recognize the APN

rolerole Requires credentialing and licensure by the Requires credentialing and licensure by the

regulatory body of nursing in the country. regulatory body of nursing in the country. Note: Importance of the decision maker should Note: Importance of the decision maker should

never be overlookednever be overlooked

CONCLUSIONCONCLUSION

Although the issue of role creation and Although the issue of role creation and Licensure by Pakistan Nursing Council Licensure by Pakistan Nursing Council for Advance Practice in nursing (APN) for Advance Practice in nursing (APN) yet to be addressed, the potential yet to be addressed, the potential Impact of APN in Pakistan appears Impact of APN in Pakistan appears promising with greater awareness and promising with greater awareness and outcome in future.outcome in future.

Chances for APN role are bright in the Chances for APN role are bright in the private sector, but it will take time for private sector, but it will take time for acceptance in the public sector.acceptance in the public sector.

ACKNOWLEDGMENTACKNOWLEDGMENT

Graduate Nursing Committee, Aga Khan Graduate Nursing Committee, Aga Khan University School of NursingUniversity School of Nursing

Madrean SchoberMadrean Schober

THANK YOUTHANK YOU