2/18/2016 THE ROLE OF NURSE PRACTITIONERS IN LONG-TERM CARE DISCLOSURES OBJECTIVES

Transcription

1 THE ROLE OF NURSE PRACTITIONERS IN LONG-TERM CARE Nanette Lavoie-Vaughan, DNP, ANP-C East Carolina University Tomika Williams, PhD (c), AGPCNP-C, RN-BC East Carolina University DISCLOSURES Nanette Lavoie-Vaughan and Tomika Williams do not have conflicts of interest to disclose. OBJECTIVES Compare and contrast levels of care for geriatric patients Define the roles of the NP in long-term care Identify the barriers to practice Identify the benefits of practice Discuss the future roles of the NP in long-term care 1

2 LONG-TERM CARE IS Definition: A facility that provides rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living. Long-term care facilities include nursing homes, rehabilitation facilities, inpatient behavioral health facilities, and longterm chronic care hospitals. WHAT DO THE NUMBERS SAY? Statistics per CDC Number of nursing homes: 15,700 Proportion of nursing homes with for-profit ownership: 68.2% Number of licensed beds: 1.7 million Number of residents: 1.4 million TYPES OF SETTINGS (IN WHICH LTC SERVICES ARE PROVIDED) Includes the following settings: -assisted living facilities (ALF) -group homes -continuing care retirement centers (CCRC) -skilled nursing facilities (SNF) (nursing homes) -programs of all-inclusive care of the elderly (PACE) 2

3 THIS IS NOT THE HOSPITAL.!!! Daily provider visits a myth Daily vital signs Calorie specific diets (1800 ADA) Onsite pharmacy Management chronic illnesses and end-of-life care ALLIED HEALTH SERVICES AVAILABLE Respiratory therapy Nutritionist/Dietician Wound Care Pharmacy Psychiatry SUPERVISION VS. COLLABORATION What does this look like in the LTC setting? Productivity: Driving time between facilities; Amount of time spent on indirect care activities; The efficiency of the clinician; The efficiency of the facility at carrying out orders; and The clinician's need for second opinions or consultations. 3

4 NP RESPONSIBILITIES IN LTC SETTINGS.. Take calls from facilities or practices Assess patients with a change in condition Provide a documented assessment of patients NP RESPONSIBILITIES IN LTC SETTINGS Maintain on-going and up-to-date patient info Provide current updates on patients conditions Coordinates referrals NP RESPONSIBILITIES IN LTC SETTINGS Address pharmacy recommendations Speak/meet with patients and families to address concerns Performs procedures in the setting as delineated by collaborative practice agreement Participates in ongoing education of long-term care staff 4

5 COMMUNICATION Key to getting things done within these settings Consider whom you are communicating with and their scope of practice (LPN, Med tech, CNA, etc) Communicating with physicians may be via phone vs. face-to-face Communicating with facility staff enhance quality patient care BARRIERS TO/OF PRACTICE Referrals Transportation On-Site Testing Paper Charting BENEFITS TO/OF PRACTICE Continuity of Care Chronic Disease management Complex cases Increased time with patients 5

6 FUTURE TRENDS Health Care Director role..held by advanced practice nurse!! Use of technology in LTC QUESTIONS REFERENCES AMDA Ad hoc Work Group on the role of the attending physician and advanced practice nurse. (2011). Collaborative and supervisory relationships between attending physicians and advanced practice nurses in long-term care facilities. Journal of the American Medical Directors Association, 12, doi: /j.jamda Donald, F., Martin-Misener, R., Carter, N., Donald, E., Kaasalainen, S., Wickson-Griffiths, A.,... DiCenson, A. (2013). A systematic review of the effectiveness of advanced practice nurses in long-term care. Journal of Advanced Nursing, 69(10), doi: /jan

7 REFERENCES Long-term care facilities statistics Bakerjian, D. (2008). Care of nursing home residents by advanced practice nurses: a review of the literature. Research in Gerontological Nursing, 1(3), Philpot, C., Tolson, D., & Morley, J. E. (2011). Advanced practice nurses and attending physicians: a collaboration to improve quality of care in the nursing home. Journal of the American Medical Directors Association, 12(3), doi: /j.jamda REFERENCES Rogers, G. (2011). Gerontological NPs as healthcare directors in nursing homes. The Journal of Nurse Practitioners, 7(2), doi: 10/10.16/j.nurpra Tak, S. H., Benefield, L. E., & Mahoney, D. F. (2010). Technology for long-term care. Research in Gerontological Nursing, 3(1), doi: / Tomika Williams CONTACT INFORMATION williamstomi14@ecu.edu Nanette Lavoie-Vaughn lavoievaughann@ecu.edu 7