Developing roles, skills and competencies of nurses in Irish Acute Medical Units

Transcription

1 Developing roles, skills and competencies of nurses in Irish Acute Medical Units Richard Walsh. D.O.N. Lead, Nat. Acute Medicine Programme Avilene Casey. Exec. Performance Improvement Lead Unscheduled Care Margaret Gleeson. Group Chief Director of Nursing and Midwifery Eithne Coen. AMP & Project Officer, Nursing and Midwifery Planning and Development Unit, HSE South National Acute Medicine Programme, R.C.P.I. / H.S.E. Irl

2 Overview Introductions Position of Nursing Background to N.A.M.P. Ireland Developing the Skills and Competency Directory Questions

3 Governance & Key Stakeholders Dept. Of Health Director General HSE Dir. Clinical Strategy and Programmes Dir. Acute Hospitals Nursing Services Director Nat. Clinical Advisor Group Lead National Acute Medicine Programme Acute Hospitals D.O.N Clinical Leads H.S.C.P Prog. Manager A.M.N.I.G.

4 National Acute Medicine Programme Time to be seen: Nurse 20mins. Senior Dr. 1 hr Quality Access 6 hrs from arrival to admit or discharge Cost Reducing AVLOS and overnight admissions

5 Implementation

6 Nursing Services 2010: 8 AMU across 33 acute hospitals 2012: Formation of A.M.N.I.G. 2013: 32 of 33 Hospitals have adopted model re-organisation of Hospitals 2016: 32 Hospitals participating in NAMP > 350 nurses and additional HCA s > 2 ANP Candidates

7 Skills and Competency Directory

8 The Process

9 Skills & Competencies Development

10 What do Patients Want A nurse who Is knowledgeable, skilled & competent Has a caring & humane attitude Puts the patient first Deliver a high standard Is adequately trained Possesses up to date and expert knowledge Maben & Griffiths (2008)

11 Values Person centred care partnership Relationship based connection, empathy, respect, consideration Holistic care totality physical, emotional & psychosocial wellbeing Respect for diversity & culture Education, self reliance, & independence Co-ordinating other professionals, technology environment Knowledge based care

12 Role Scope & Function Initial & continuous assessment & care Managing the clinical environment & resources Facilitating team cohesion Patients rapid transition Bed management & flow ( Myers & Lees 2013, Corbally et al 2014)

13 Challenges Diversity of experiences Lack of uniformity Dearth of knowledge re AMN Nascent & emergent Influences national & international

14 Determination Checklist Focus 1. Systematic assessment 2. Chest pain 3. Breathlessness 4. GI conditions 5. Neurological deficit 6. Comprehensive assessment older persons 7. Urology 8. Mental health 9. Generic 10. Discharge 11. Intravenous acces (Myers & Lees, 2013)

15 Extract of Findings Skill Core Specialist Advanced Triage All 37% Plain Film 58% 37% 5% VQ scan 73.5% 16% 10.5% History taking 100% 10.5% Neuro exam 31.5% 37% 21% Interpretation ABG 21% 30% 21% Interpretation of cardiac monitoring 47% Ausculation, palpation, percussion, resp & cardio exam, ABG, S&L, Clinical pathways e.g. Stroke Diabetes

16 Development Core skills Scope of Practice Outcome Clinical judgement & clinical reasoning skills & competencies Further exploration of expanded & advanced roles Education Confidence Leadership & management skills

17 Competencies Encapsulate through behaviours the ability to: Practice safely & effectively (measured) Fulfil his/her responsibility & accountability ( determined through regulation, legislation, authority & standards of practice) Know his/her Scope of Practice ( determined through personal accountability & responsibility, self awareness & self management)

18 6 Domains Professional values & the conduct of the nurse Nursing practice & clinical decision making Knowledge & cognitive skills Communication & interpersonal skills Management & team working Leadership potential & professional scholarship (NMBI 2015)

19 Skills determination check list e.g.

20 Competence domain e.g.

21 Next Steps

22 References / Acknowledgements Acute Medicine Programme (2013) Acute Medicine Programme Overview. National Clinical Programme, Health Service Executive, Dublin, Ireland. Bord Altranais agus Cnaimhseachais na heireann (NMBI) (2016) ) Post-registration Nursing and Midwifery Programmes Standards and Requirements. Nursing and Midwifery Board of Ireland, Dublin, Ireland. Corbally M., Macri G. & Hawkshaw S. (2014) An examination of the role and activities of nurses caring for patients who are admitted to a model 4 hospital as part of the National Acute Medicine Programme Final Report. Dublin City University, Dublin, IrelandLees L. & Hughes T. (2009) Implementing a patient assessment framework in acute care. Nursing Standard 24 (3) Lees L.(2013) Patient Transfers Principles for the Safe Transfer and Handover of Patients from Acute Medical Units, Society for Acute Medicine. The Society for Acute Medicine, London, UK Maben J. & Griffiths P. (2008) Nurses in Society: starting the debate. National Nursing Research Unit King s College London Florence Nightingale School of Nursing and Midwifery London. Available at nnru@kcl.ac.uk, accessed May 7th 2013 Myers L. & Lees L. (2013) An integrated career and competency framework for registered nurses in acute medicine. The Society for Acute Medicine. London, UK.

23 @Avilene