Advanced practice nursing and multi-professional collaboration from a person-centered perspective

Transcription

1 Advanced practice nursing and multi-professional collaboration from a person-centered perspective Lisbeth Fagerstrom Rector at Åbo Akademi University in Vaasa, Finland Professor in Caring Science at Åbo Akademi University Affiliated Professor in Nursing at University of Southeast-Norway lisbeth.fagerstrom@abo.fi 1 lisbeth.fagerstrom@usn.no

2 Experiences of developing APN in the Nordic countries Evaluation of advanced nursing practice in Western Finland Research project in Finland : APN new models for quality development and efficiency of the care and treatment of patients with acute and chronic health problems Evaluation of the first NP in Sweden Research project funded by the Norwegian Research Council , 1,13 milj : Providing person-centred healthcare - by new models of advanced nursing practice in cooperation with patients, clinical field and education. 2

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5 APNs COMPLEMENTARY AND/OR SUPPLEMENTARY ROLES APNs in complementary roles for new innovative healthcare services Treatment and care by doctors APNs supplementary roles 5

6 A DIALECTIC SYNTHESIS OF CARING AND CURING IN NURSING The advanced practice of nursing builds on the foundation and core values of the nursing disccipline (Hamric 2009, p 75) 6

7 Laurent et al Nurses as substitutes for doctors in primary care. Cochrane study. The aim was to investigate the impact of nurses working as substitutes for primary care doctors on: patient outcomes; processes of care; and utilisation, including volume and cost. Totally 18 randomised trials were included and the impact of nurses working as substitutes for doctors was evaluated. 7

8 RESULTS Nurse-led primary care may lead to slightly fewer deaths among certain groups of patients, compared to doctor-led care. Blood pressure outcomes are probably slightly improved in nurse-led primary care. Patient satisfaction is probably slightly higher in nurse-led primary care. 8

9 Little or no difference between nurses an doctors in the number of: prescriptions and attendance at accident and emergency units tests and investigations hospital referrals hospital admissions The effects of nurse-led care on the costs of care are uncertain.. 9

10 The Person-Centred Nursing Framework (McCormack & McCance 2010) Patientcentred care Peoplecentred care 10

11 Person-Centred Processes in nursing Working with patients beliefs and values Shared decision-making Engagement Having sympathetic presence Providing holistic care 11

12 The process according to the PEPPA framework (Bryant-Lukosius & Dicenso, 2004) 1. Define patient population and describe the current model of care 2. Identify stakeholders and recruit participants 3. Determine need for a new model of care 4. Identify priority problems and goals to improve models of care 5. Define new model of care and APN role (incl. stakeholder consensus) 6. Plan implementation strategies - Identify outcomes, identify implementation plan and collect baseline data - Identify role facilitators and barriers (stakeholders awareness of role, APN education, administrative support and resources, regulatory mechanisms, policies and procedures) 7. Initiate APN role implementation plan - Begin role development and implementation - Develop APN role policies and protocols - Provide education, resources and support 8. Evaluation APN role and new model of care A continuous circle of improvements 12

13 Multi-professional cooperation is something more than task-shifting Closely related concepts: Interprofessional, multiprofessional, interdisciplinary, and multidisciplinary Collaborative practice in health-care occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, careers and communities to deliver the highest quality of care across settings. (WHO s Framework for Action on Interprofessional Education and Collaborative Practice 2010) 13

14 Multi-professional collaboration in APN A collaborative relationship includes: a commitment to mutual goals, a jointly developed structure, shared responsibility, mutual authority and accountability for success and sharing resources and rewards. Collaboration is a dynamic, interpersonal process in which two or more individuals make a commitment to each other to interact authentically and constructively to solve problems and to learn from each other in order to accomplish identified goals, purposes, or outcomes. The individual recognize and articulate the shared values that make this commitment possible (Hansson & Spross, 2014). 14

15 Characteristics of effective collaboration between APNs and physicians Collegiality Communication Shared goals Independence in tasks (Spross 1989, Hughes and Mackenzie 1990, Hanson and Spross 2014) 15

16 BUILDING THE TRUST BETWEEN NP AND THE DOCTOR A STUDY FROM SWEDEN I think I was a bit doubtful in the beginning. I did not know what it meant... if we would lose our role or what would happen then. But,I understood very quickly that this would be positive, that it was another resource (GP).... in a nurse-based centre you notice that the nurses are much more meticulous about precisely following what is [delineated], whereas the GPs work more hazardly... (GP). Lindblad E, Hallman E-B, Gillsjö C, Lindblad U, Fagerström L Experiences of the new role of advanced practice nurses in Swedish primary health care A qualitative study. International Journal of Nursing Practice 16,

17 Critical factors for development: organizational structure and culture, legislation and regulation, evaluation, marketing The Nordic model of APN Central competency domains: 1. Direct clinical praxis 2. Ethical decision-making 3. Coaching and guidance 4. Consultation 5. Cooperation 6. Case management 7. Research and development 8. Leadership Master education is recommended The nurse-patient relationship including four central theoretical nursing perspectives Including health assessment of undiagnosed health problems and 17clinical decision making

18 Advanced practice nursing in primary health care in Scandinavia from a multiprofessional and older persons perspective The aim was to explore, from a multiprofessional and older persons perspectives, what is perceived as challenging in care of older persons in primary health care in Scandinavia, and to further elucidate the content and organizational preconditions for new NP models. A qualitative design was conducted in 2014, and the setting of the study was primary healthcare in the Nordic countries involving Sweden, Norway, Denmark, and Faroe Islands. Boman, Glasberg, Levy-Malmberg, Fagerström Thinking outside the box : Advanced practice nursing in primary health care in Scandinavia from a multiprofessional and older persons perspective. In review. 18

19 Methods Five students (2 from Sweden, 1 from Norway, 1 from Denmark, 1 from Faroe Islands) of a Nordic Master Module in Advanced Geriatric Nursing (45 ECTS), were involved in the project. Each student interviewed 5 persons: one older person, one nurse, one nurse leader, one physician and one politician in the region they were working; totally 25 interviews were conducted. Data analyses by Kvale & Brinkmann (2009) 19

20 Results 20

21 Boman et al Nurses understanding of a developing nurse practitioner role in the Norwegian emergency care context: A qualitative study. Nordic Journal of Nursing Science. DOI: / Table 2. Summary of the results 21

22 Hansen, Bing-Johnson, Boman, Fagerström Barriers and opportunities in implementing Nurse Practitioners in Norwegian Primary Health Care (in review) The overall aim of the main project is to contribute to new models of organizing, managing and delivering highquality healthcare services to persons in need of healthcare, and thereby contribute to a person-centered and effective healthcare 22

23 Data material from 11 meeting with stakeholders (nurse leaders, collagues, GPs and members of Norwegian nurse association) 23

24 Thank you for your attention! 24