Symposium on Advanced Nursing Practice Mexico City, October 6, 2016

Transcription

1 XV Colloquio Panamericano de Investigacion en Enfermeria Symposium on Advanced Nursing Practice Mexico City, October 6, 2016 Denise Bryant-Lukosius, RN PhD Associate Professor, School of Nursing and Co-Director Canadian Centre for APN Research (CCAPNR) McMaster University, Hamilton, Ontario, Canada D. Bryant-Lukosius,

2 Share experiences and lessons learned from a Canadian context and the School of Nursing at McMaster University about advancing nursing roles in primary health care (PHC) Describe collaborations between PAHO and WHO Collaborating Centres to move the APN agenda forward in PHC in Latin America and the Caribbean (LAC) D. Bryant-Lukosius,

3 Registered nurse with the expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice Role characteristics are shaped by the context and/or country where the APN works A master s degree is recommended for entry level

4 Clinical Nurse Specialist (CNS) Nurse Practitioner (NP) D. Bryant-Lukosius,

5 1970s Kergin Report: Need for expanded nurse roles in PHC in Canada McMaster and other universities start programs to prepare nurses with expanded roles as early NPs for isolated settings and family practice Pilot projects including the Burlington RCT of NPs 1980s Closure of NP education programs, despite research evidence about their effectiveness D. Bryant-Lukosius,

6 1990s Primary Health Care Reform is a provincial/national policy priority Ontario government funds needs assessment about NP roles for PHC 10 university consortium for post-baccalaureate PHC NP education in Ontario 2000s Shift to NP education at the Master s level despite lack of government support National NP competencies developed to guide licensing/regulation and curricula National Chair in APN (Dr. DiCenso) Built capacity in developing PhD prepared APN faculty and researchers Conducted decision-maker linked and policy relevant research Developed evidence-based tools such as the PEPPA Framework to guide the effective use of CNS and NP roles (Bryant-Lukosius & DiCenso, 2004) D. Bryant-Lukosius,

7 2010 to Special Edition on APN in the Canadian Journal of Nursing Leadership (CJNL) profiles research from the APN Chair Program 2011 launch of the Canadian Centre for APN Research (CCAPNR) at McMaster Expand internationally and focus on Models of Care and Skill Mix as policy priorities, and lead work to optimize RN, NP, and CNS roles in team-based PHC CCAPNR faculty are editors of 2016 Special Edition on APN in CJNL Substantive progress in the education, regulation, deployment, and numbers of NPs in PHC, but full health systems integration has yet to be achieved D. Bryant-Lukosius,

8 Strong nursing leadership at clinical, academic and policy levels is essential to continually drive the introduction, effective development and integration of APN roles Formal policies to support APN role implementation such as legislation, regulation, competencies and education, lag behind the informal introduction of the roles Health systems integration evolves slowly and iteratively over time Takes time to overcome existing policies that are barriers to APN roles (e.g., physician fee for service) D. Bryant-Lukosius,

9 A systematic approach to introducing APN roles is essential to design the right roles to address population health, nursing practice, and health system needs PEPPA has been used in Canada and over 16 other countries to successfully design, implement and evaluate APN and other advanced health provider roles (Boyko, Carter & Bryant-Lukosius, 2016) D. Bryant-Lukosius,

10 Backbone of rural, northern, and remote healthcare Primary providers for at risk and hard-to-reach populations in urban settings Increase access to care underserviced communities through NP-led interprofessional teams D. Bryant-Lukosius,

11 In 2005, Health Canada introduced CNS roles for 600 First Nations and Inuit communities across the country (Veldhorst, 2006) To address unmet health needs, improve the recruitment/retention of nurses, and improve the quality of nursing care in high risk areas: Maternal and Child Health Mental Health and Addictions Chronic Disease Management Diabetes D. Bryant-Lukosius,

12 A standardized, coordinated and collaborative approach to APN education among universities was necessary to address resource and policy issues and reduce variability in practice Ontario NP Education Consortium Established standardized education across10 universities Shared the costs and scarce faculty resources Developed NP faculty and expertise across the province Cohesive lobby group to advocate for policy changes related to NP education D. Bryant-Lukosius,

13 Integrated knowledge translation that engages policy makers and administrators in research increases their awareness, understanding and uptake of best practices for using APN roles to impact on priorities for health care improvement D. Bryant-Lukosius,

14 Pan-Canadian collaboration through the APN Chair Program and CCAPNR has been effective for: building and sustaining APN faculty for education and research generating evidence to influence policies and practices maintaining momentum and profile establishing a national network of nurse leaders and advocates to address policy issues and role implementation barriers D. Bryant-Lukosius,

15 The world is a small place. International collaboration and partnerships benefits APN role development in countries with established roles and where they are new or just emerging. D. Bryant-Lukosius,

16 2015 McMaster summit 2016 University of Michigan hosts meeting on developing APN competencies McMaster and PAHO host a webinar series on APN role development, education and regulation PAHO establishes pan-country advisory committee to develop APN role competencies D. Bryant-Lukosius,

17 Further academic collaboration to align APN roles with policy priorities for UHC and UA to health in Latin America Illustrates APN outcomes and how the roles can be used to address health care inefficiencies Cost savings gained through the introduction of APN roles can be used to offset the costs of UHC D. Bryant-Lukosius,

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19 McMaster University has a long history in APN role education, research and development Much progress has been made to increase access to high quality PHC services in Canada through improved APN role deployment Continued efforts are required to produce and better use evidence to support full APN role integration D. Bryant-Lukosius,

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