School of Nursing and Midwifery. MMedSci / PGDip General Practice Advanced Nurse Practitioner (NURT101 / NURT102)
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1 School of Nursing and Midwifery MMedSci / PGDip General Practice Advanced Nurse Practitioner (NURT101 / NURT102) Programme Outline
2 Programme lead Dr Ian Brown. Lecturer Primary Care Nursing Programme administrator Andrea Lowery Postgraduate Teaching Lead Mac Macintosh School of Nursing and Midwifery address: Barber House Annex University of Sheffield School of Nursing and Midwifery 3a Clarkehouse Road Sheffield S10 2LA 2
3 Programme background Future general practice primary care Health and social care services in our communities are facing great challenges. Increasing pressures are real and have multiple causes. For example, healthcare needs are more complex as people live longer into older age. It is also clear that many health problems require innovative approaches to be effective for prevention, self-management and reduction of costly hospital admissions. The NHS recognises the importance of general practice and general practice nursing if these challenges are to be met. It also recognises that changes to the models of service delivery are required with increasing emphasis on work between general practices and integration with social care. In this context the skill mixes and roles of nurses must also develop for sustainable improvements in healthcare delivery. The MMedSci General Practice Advanced Nurse Practitioner (GPANP) programme is designed to respond to the changing skill mix required in future primary care. This includes new roles for nurses in advanced clinical practice. Advanced practice Advanced roles in nursing have been a positive but essentially unregulated development over two decades. Associated with this has been a plethora of titles and educational routes to advanced practice. The opaque preparation and weak clarity of titles is magnified by the diversity and small organisation innovation of general practice. Currently we do not have an NMC regulated template or educational standards for a General Practice Advanced Nurse Practitioner. 3
4 However, in the last few years useful clarification has been led by Health Education England (HEE) to set out the generic preparation, competencies and ambit of advanced clinical practice roles. Much of this work has focused on generic Advanced Care Practitioners (ACPs) and it has drawn on experience of secondary care and particularly emergency and urgent care settings. It provides an essential framework and a consensus about the postgraduate training components and competencies required for advanced clinical practice. The application in general practice for nurses has to be considered further. General practice is not simply a site for a single episode mini A&E service staffed by imported ACPs with an emergency care background. Key features for general practice nursing include an ongoing relationship with the person and a holistic generalist perspective on the person s health needs. Much of what is effective as consultation-based interventions is predicated on an ongoing therapeutic relationship between patient and practitioner. A generalist and holistic perspective integrates prevention and health promotion and supports person-centred self management rather than an episode oriented approach to care. Potential fragmentation of the service experience for patients is a danger in introducing secondary care and emergency care models to general practice. Furthermore, the experience of workforce development shows that training and embedding new roles is more costly than taking established roles and training to new skills. It also shows that the professional background and setting of the ACP are critical to the role potential regardless of generic standards for preparation. Practice nursing has particular strengths in sustaining relationships with patients as a holistic generalist with integration of prevention and self-management approaches. For all these reasons the design of the programme is to up-skill practice nurses into advanced roles with the flexibility for future primary care. The programme therefore supports development of a generalist rather than compartmentalised or specialist in service delivery. Experienced practice nurses with advanced practice skills can fulfil an essential role in the skill mix landscape, particularly in smaller general practice teams and for emerging roles between general practices in new models of service delivery. In summary, our MMedSci GPANP is a new development fully based on the most recent policy work on advanced clinical practice and on primary care workforce development. Indeed, this is the first programme designed specifically for practice 4
5 nurses to develop to advanced practice roles within future general practice. A steering group comprising key stakeholders from NHS commissioning and clinical service delivery (including ANPs working in general practice) has informed and supported this development. The programme draws on the following policy and guidance for development of advanced practice and for GPN roles in future general practice. Baird, B., et al. (2016). Understanding Pressures in General Practice. London: King's Fund. Buchan, J., I. Secombe and A. Charlesworth (2016). Staffing Matters; Funding Counts. London: Health Foundation. Health Education England Primary Care Workforce Commission (2015). The Future of Primary Care: Creating Teams for Tomorrow. London: Health Education England. Health Education England (2015). District Nursing and General Practice Nursing: Education and Career Framework. London: NHS Health Education England. Health Education England (2017). The General Practice Nursing Workforce Development Plan. London: NHS Health Education England. Health Education England (2017). Advanced Clinical Practice. (Links to ACP development work from: ) House of Commons Health Committee (2016). Primary Care. London: House of Commons. NHS England (2016). General Practice Forward View. London, NHS England. NHS England (2016). Leading Change, Adding Value. London: NHS England. NHS England (2017). A Ten Point Plan for General Practice Nursing. London: NHS England. Queen s Nursing Institute (2016). General Practice Nursing in 21st Century: A Time of Opportunity. London: Queen's Nursing Institute. RCGP General Practice Foundation (2015). General Practice Advanced Nurse Practitioner Competencies. London: Royal College of General Practitioners. Royal College of Nursing (2017) Credentialing for Advanced Level Nursing Practice. London: Royal College of Nursing. South Yorkshire and Bassetlaw (2016) Sustainability and Transformation Plan. Available: 5
6 Programme outline The programme is part time and designed to support nurses in their primary care workplace as they develop advanced practice roles. Nurses undertaking the programme must be in at least 15 hours practice per week and must have the clear support from their general practice employing organisation. Typically the programme modules involve attendance at University a half to one day per week and there is a mix of classroom and online learning. There is an expectation of a parallel 3 6 hours protected time for practice learning supported by an appropriate mentor. Throughout the programme learning activities and recommended clinical and other experience with the mentor are set out across modules. The student builds evidence of experience and competence achievement with a portfolio for a role in future general practice. Programme aims and learning outcomes* The programme addresses core competencies relating to advanced practice, including: Clinical competence as a generalist (Clinical) Leadership and collaborative practice (management) Improving quality and developing practice (research) Developing self and others (education) These pillars and associated competencies are integrated within a practice focused programme structure. The programme will enable a nurse: To develop a systematic critical understanding of the knowledge required for an advanced practice role and appreciation of the processes whereby knowledge is appropriately evaluated and implemented in primary care development To gain mastery of person-centred care, holistic health assessment, diagnostic reasoning, and evidence based health interventions, including prescribing and referral, across a broad range of primary care conditions commensurate with a generalist advanced practice role To evaluate primary care practice critically and demonstrate creative application and judgement in the use of evidence to develop a caring and collaborative response to the needs of patients * Both NURT 101 and NURT 102 6
7 Knowledge and understanding outcomes Critical evaluation of sources of evidence and appraisal of evidence for primary care practice Appropriate creative application of evidence to clinical practice scenarios, including patients with complex needs, and to development of collaborative primary care Comprehensive understanding of theory and research evidence in relation to effective use of the consultation, person-centred care and health interventions in primary care Creative application and judgement of an evidence based response to consultation development for patients with different types of needs, including those with mental health issues Comprehensive knowledge and understanding of applied pathophysiology for generalist roles in primary care Mastery of person-centred care, holistic health assessment and diagnostic reasoning for acute and long term conditions commensurate with the advanced practice role Critical evaluation of the impact of pharmacokinetics and pharmacodynamics on the individual and the implications for prescribing practice Critical evaluation of the relevant legislation and policy and its application to the extended role in assessment, diagnosis and prescribing within advanced practice Critical appraisal of sources of information and decision support systems in holistic assessment and prescribing practice Comprehensive understanding of theory and research evidence in relation to effective collaborative service provision in primary care in response to patient needs Creative application and judgement in reviewing an evidence based response to leadership, change and quality assurance in developing collaborative primary care Critical awareness of reflective practice including creative analysis of learning needs and strategies for personal practice development and mentoring of others 7
8 Skills and other attributes Acquires and critically evaluates evidence and applies the information to own clinical practice context Promotes and uses an evidence based approach to practice development within a primary care team approach Is able to practice autonomously in assessment of needs and the planning and implementing primary care for patients within scope of practice Can communicate compassionately within a person-centred consultation and integrate evidence to shared decisions about assessment and care Can accurately assess, apply clinical reasoning, diagnose, co-ordinate and monitor patients in their care as an advanced practitioner Can evaluate information effectively and is able to creatively use evidence to support effective patient care and service development Can disseminate knowledge and mentor and motivate others in developing a responsive and learning primary care team Can liaise, refer and communicate effectively with others in developing collaborative response to patient needs Can contribute constructively to activities to monitor service quality and decisions about service development Has the capability to identify issues requiring development and the ability to lead work with others to innovate and move practice forward Reflects on and monitors own practice and can identify need for change and respond constructively to feedback Accepts personal responsibility for professional development, maintaining competence and lifelong learning as an advanced practitioner 8
9 Teaching and learning strategies A wide variety of teaching methods and strategies will be utilised to provide stimulation and to ensure the varying learning styles of adult learners are met. This includes the following: Lectures: Guided study which provides a structured opportunity to disseminate information, this is the medium by which students access the main knowledge base. Seminars: either staff-led or student-led used throughout the programme and designed to reinforce information imparted through lectures by allowing students to work through, analyse, understand and respond to that information. They are used to enable students to make the link between theory and clinical practice. Group tutorials: are meetings arranged between a lecturer and a small group of students in order to clarify a particular problem experienced by the student(s) in the understanding of material or to support the student(s). Individual tutorials: are meetings arranged between a lecturer and an individual in order to clarify a particular problem experienced by the student(s) in the understanding of material or to support the student(s) in the process of preparation for a seminar or assessment. Independent Learning: is used to assimilate and clarify material explored in lectures, to prepare for seminars and assessments and to generally examine literature pertinent to the module outcomes. Reflection: Students are encouraged throughout their learning to reflect on their own clinical area and their own practice. This approach encourages critical and analytical thought and changes to practice. Supported Clinical Practice: This is negotiated with relevant nominated mentors from the area of practice to enable the development of practice through supervision and assessment towards the development of a portfolio of evidence. Online content: will be available to students in the form of 'learning packages' equivalent to topic lectures. Students will supplement this material with tutordirected reading and interaction with student-led exploration of relevant publications. Tutor-directed on-line tutorials will be supplemented by on-line discussion groups and 'chat rooms'. Academic tutor support: students will be provided with a personal tutor who supports them using a variety of approaches including tutorials, telephone tutorials or face to face tutorials, for the duration of the programme. 9
10 Assessment The taught units for this programme use a variety of formative and summative assessment methods to test progress towards and achievement of the knowledge and skill outcomes: Multiple Choice Questions (MCQs) and Short answer exam questions are employed both for formative assessment of the students developing knowledge and for summative assessment to test knowledge understanding and creative application to advanced practice in primary care. Objective Structured Clinical Examinations (OSCE) for both formative and summative assessment to examine students abilities to effectively undertake person-centred care, holistic health assessment, diagnostic reasoning and therapeutic intervention across a range of clinical situations appropriate to a primary care generalist. Oral presentations for formative and summative assessment of the student s ability to demonstrate the integration of knowledge, critical understanding for an appropriate creative application to advanced practice scenarios and case studies Written assignments ( words) for formative and summative assessment of the student s ability to demonstrate review of literature evidence, integration of knowledge, critical reflection and appropriate creative application to advanced practice Learning logs and reflective portfolio development including competency evidence for the general practice advanced nurse practitioner role. Portfolio development and support in practice The student will develop a Portfolio to store and organise evidence of learning and development in reaching competence as a General Practice Advanced Nurse Practitioner. Over the programme the student will develop evidence of progress towards the programme learning outcomes and competence as a primary care expert generalist. These are examples of the type of evidence: Personal learning plans and reflections on overall progress Self-assessments of your stage of competence in advanced practice Practice logs and reflections on knowledge and skills Observations / shadowing of experienced practitioners Case based discussions with your mentor 10
11 Practice based feedback and assessments from patients and others on knowledge, skills and practice, including OSCEs The student will include a variety of patient backgrounds, conditions and needs within their portfolio development. For example, in relation to: Long term conditions as well as acute presentations Groups and individuals with both simple and complex needs across age ranges Public health and prevention competencies as would be expected within the remit of a generalist nurse working in a general practice The student will include reflection and learning across the range of competencies for advanced practice. Specifically: Clinical competence as a generalist Leadership and collaborative practice Improving quality and developing practice Developing self and others Mentor support in practice The Portfolio will include evidence of clinical practice experiences and feedback from others on progress. It is essential that it includes feedback from an appropriate mentor. At the outset of the programme the student will establish a mentor (or mentors) for support and supervision in developing learning opportunities within practice. For the programme the mentor should be someone who is: an already experienced practitioner with the competencies to support a student develop to advanced practice our expectation is that this will be a GP or an experienced ANP able to maintain a supportive and nurturing relationship to help with progress able to help the student self-assess and facilitate learning and development able to provide formative feedback on progress and contribute in some modules to summative assessment able to make appropriate judgements and advise about competent practice 11
12 Programme structure The programme of study can be completed in not less than two years and not more than five years on a part time basis for those entering with the degree or equivalent relevant study and experience. During year one of the programme students will undertake three core units focussed on developing an evidence based approach and expertise in person-centred consultation and advanced assessment / clinical reasoning. Semester 1, September 2017 Evidence based practice (SNM 660) 15 credits Consultation and effective person-centred primary care (SNM668) 15 credits Semester 2, February 2018 Advanced clinical assessment (SNM 670) 30 credits In year two students will undertake two core units and one optional unit. A prescribing qualification is essential for advanced practice. Those without a prescribing qualification will undertake SNM 624. Those with an M level prescribing qualification can count this towards the qualification via Recognition of Prior Learning (RPL). Those with a prescribing qualification at Degree level will undertake SNM 667 to obtain 30 credits. Semester 1, September 2018 EITHER Independent Nurse Prescribing (SNM 624) 30 credits (RPL against SNM 624 for 30 credits if already have masters level prescribing qualification) OR Effective advanced practice for independent prescribers (SNM 667) 30 Credits Semester 2, February 2019 Complex needs and primary care development (SNM 669) 15 credits Subject to availability and approval of the programme lead the student can choose an optional unit from those available. For example: Mentorship and learning in primary care (SNM667) 15 credits Legal and Professional Issues in Healthcare (on-line) (SNM633) 12
13 Education and Teaching for Health Care Professionals (online) (SNM661) Leadership and change management in health care (15 credits) SNM639 Research Methods (15 credits) SNM663 Managing heart failure as a long term condition (SNM611) 15 credits Managing stroke as a long term condition (SNM612) 15 credits Managing diabetes as a long term condition (SNM614) 15 credits Managing respiratory diseases as a long term condition (SNM615) 15 credits Palliative and end of life care (SNM644) 15 credits Completion of the 120 credits of taught units enables the student to gain the PGDip General Practice Advanced Nurse Practitioner (NURT 102). Or if they wish to progress to the full MMedSci (NURT 101) the student will continue to year three. In year three students who wish to progress to MMedSci will undertake: Critical Development of Clinical Practice. 60 credits (SNM637) This will require engagement with both theory and practice and will include a review of the literature with a plan for a development in their own area of practice. Knowledge and skills for MMedSci (NURT 101) award Assessment will be through submission of a 12,000 words assignment that will focus on an area of primary care clinical practice development that is of interest to the student. The assignment will require the student to demonstrate a comprehensive and systematic critical analysis of the underpinning evidence and its appropriate creative application to their practice development situation. Knowledge and understanding Critically explore an issue or problem pertinent to their area of practice with a defensible rationale for methodological approach and evaluation of evidence Creative application and integration of evidence to provide a defensible response to an issue for primary care practice and robust recommendations for development 13
14 Skills and other attributes Can conduct a systematic and critical review of the literature focused on primary care development Able to analyse practice issues in depth and develop robust recommendations for primary care development 14
15 APPENDIX: MARKING CRITERIA FOR ASSIGNMENTS Marking standards Precise descriptors Distinction Critical insight Literature Excellent originality and creativity exhibited Excellent critical engagement with an extensive range of appropriate literature. Referencing follows the guidelines. Theory/practice Critically evaluates current research and outstandingly; utilises relevant scholarly material in the discipline. Communication ideas of Demonstrates the ability to apply these in order to enhance practice. Articulate, coherent, logical progression of argument/thesis illustrating creativity and depth Merit Critical insight Literature Theory/practice Communication ideas of Very good evidence of originality and/or creativity Critical engagement with a range of appropriate literature. Referencing follows the guidelines. Critically evaluates current research: utilising relevant scholarly material in the discipline. Demonstrates the ability to apply this in order to enhance practice Well structured argument/thesis that demonstrates creativity and depth. Pass Critical insight Literature Theory/practice Communication ideas of Shows evidence of original and creative thought Evidence of engagement with appropriate literature Referencing follows the guidelines Critical analysis evident with evidence of developing skills of critical evaluation; utilises relevant sources of evidence. Demonstrates the ability to critically reflect on practice Argument has appropriate structure and develops logically 15
16 Note: Postgraduate fail mark is below 50% Clear Fail Critical insight Literature Inconsistent originality or creativity Lacks familiarity with key literature. Referencing does not always follow the guidelines. Theory/practice Considers current research and scholarship in the discipline. Communication ideas of Demonstrates limited awareness of their application in the enhancement of practice. Arguments demonstrate understanding of the topic. There is a lack of clarity in their articulation. Failed in all aspects 0-25 Critical insight Literature No originality or creativity Little or no familiarity with key literature. Referencing inadequate. Theory/practice Little or no awareness of current research and scholarship in the discipline. Communication ideas of Demonstrates little or no awareness of their application in the enhancement of practice. Arguments demonstrate little or no understanding of the topic. There is little or no clarity in their articulation. A grade of 0 is awarded if the assignment is greater than +/- 10% of the word limit 16
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