Transcript a celebration of ten years` work - ICN Nurse Practitioner / Advanced

Development of Advanced
Nursing Practice
in Hong Kong:
a celebration of ten years’ work
Frances Kam Yuet Wong
Professor & Associate Head
School of Nursing
The Hong Kong Polytechnic University
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Outline
• Factors that contribute to the development of Advanced
Nursing Practice (ANP)
• The scenario of practice by Nurse Specialists (NSs) in the
early 1990s
• The development of NS practice in the late 1990s to early
2000
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Factors Contributing to the
Development of
Advanced Nursing Practice (ANPs)
• Differentiation of nursing work
• Nexus of work and profession in a cost
containment environment
• Specialization of patient groups
• Enhancement of nursing education
(Wong, 1996)
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(1) Differentiation of Nursing Work
Proletarianization
Nursing work
 less skilled worker
Professionalization
Upgrading of nursing education
and autonomy
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(2) Nexus of Work and Profession in
a Cost Containment Environment
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(2) Nexus of Work and Profession in
a Cost Containment Environment
Human institution helps to
mediate between
Knowledge and Power
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(3) Specialization of Patients
• Chronically ill patients
become experts of their
own illnesses
• Increased level of
education
• Increased availability of
health knowledge in the
mass media and the web
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(4) Enhancement of Nursing
Education
• Over 50% nurses
possess a first
degree
• Many studying for
masters degree and
doctorate degree
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Scenario of Practice by NSs
in the Early 1990s
Identity searching
Being distinguished from RNs
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Scenario of Practice by NSs
in the Early 1990s
The main work involvement of NSs:
•
•
•
•
Client care
Patient education
Staff development
Quality improvement and research
Hospital Authority, 1996 and Wong, 1997
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NS vs RN
• Work is NOT subject
to routinization
• See clients by referrals
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(1) Work is Not Routinized
When I was working on the ward as an RN,
if the patient in the next bed has a physical
need, I needed to see him right away. This
interrupted the health education session.
Now I have the freedom to telephone
the patients for follow up, and put time
in cases which are of higher priority.
The satisfaction is greater.
(Wong 1998: 477)
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(2) Consultation by Referrals
Professional
Professional
A
B
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DMNS’ Notes
... The patient
demonstrated [basic skills
in using the] Novopen …
I would make an
appointment to see her [in
OPD]…
To practice Novopen skill
under supervision in ward.
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DMNS’ Notes
... The patient
demonstrated [basic skills
in using the] Novopen …
I would make an
appointment to see her [in
OPD]…
Dr’s Notes
… to practice
[injection] skill on
ward.
Home until ready.
To practice Novopen skill
under supervision in ward.
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Scenario of Practice in NSs in the
Early 1990s
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Scenario of Practice in NSs in the
Early 1990s
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Scenario of Practice in NSs in the
Early 1990s
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Scenario of Practice in NSs in the
Early 1990s
• 22 NSs appointed in 14 clinical areas in 1993
• Definition of nursing specialties was somewhat
arbitrary
• No credentialing and regulatory body to
scrutinize the qualifications of the NSs and
monitor their clinical competence
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The Development of NS
Practice in the Late 1990s
to Early 2000s
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The Development of NS Practice in the
Late 1990s to Early 2000
• Exemplary work of NS practice, with support of
research
• Service well recognized by the nursing peers and
doctors
• Nurse-led clinics
• The issue of regulation
• Room for the APN to be developed in the
community
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Exemplary Work - Research Evidence
• From Senior NS (SNS) Scheme by HA, HK
• Positive results of SNS from an independent
evaluation (HA, 1996; Wong, 2001)
• Economic downturn  position not established
Examples on cost-effective
and quality care by renal SNS
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Cost-effective Care (1)
Renal SNS
Erythropoietin Selfinjection Program
• 26 chronic renal
failure patients
• Saving 225 nurse
hours annually
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Cost-effective Care (1)
Renal SNS
Braunoderm Vs
Betadine Spray
• Same effect
• Braunoderm costs
HK$0.8 (0.0067 Hr)
•Betadine costs
HK$6.0 (0.233 Hr)
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Cost-effective Care (2)
• Senior Diabetes NS
• Seeing 108 poorly
controlled diabetic
patients
• 10 (9%)  physicians
• 98 (91%)  managed
by Senior Diabetes NS
(HA, 1996; Wong 2001)
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Leadership
Clinical Leader
Care Engineer
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Nurse-led Clinic
What is a nurse-led clinic
Initial assessment
by nurse
See doctor
See doctor
To nurse for education
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The Definition of A Nurse-led Clinic
A NURSE CLINIC is a
formalized and structured health care delivery mode
involving a nurse and a client.
THE CLIENT is an individual and his/her family
with health care needs that can be addressed by the nurse.
THE CONSULTATION is initiated
through referrals from nurses, doctors or other health care
professionals.
THE NURSE has demonstrated advanced competence
to practice in the specific health area.
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The Definition of A Nurse-led Clinic
THE NURSE functions independently and/or
interdependently with other health care team members
for at least 80% of his/her work involvement.
HE/SHE is supported by a multidisciplinary team,
and can make referrals to other health care professionals
to address the health care needs of the clients.
THE MOST important and key interventions are
nursing therapeutics which encompass
assessment and evaluation, treatment and procedures,
health teaching/counseling, and case management.
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The Definition of A Nurse-led Clinic
THE NURSE CLINIC differs from the doctor clinic in
its less reliance on the use of medications,
but the employment of a holistic approach
in addressing the needs of the clients and their families.
THE NURSE determines the duration of each
consultation and the time lapse between consultations
according to clients’ needs.
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Future Development
To link professional recognition
with practice
To expand the scope
of practice of APN
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Linking Professional Recognition
with Practice
To develop a certificate process to validate and
standardize the qualifications and practice
competencies of the advanced practice
– To protect the public’s health
– To ensure the credibility of advanced practising
nurses
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Expanding Scope of APN
Neoplasm
93,999
Respiratory system
121,637
Genitourinary system
119,720
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Expanding Scope of APN
Pregnancy, childbirth
and puerperium
90,753
Digestive
System
90,293
Circulatory System
90,753
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Expanding Scope of APN
? Adequate coverage for high volume patient groups
14 NSs
Diabetic, ICU
Obs & Gyn
11-12 NSs
Geriatric
Operating theatre
Renal
10 NSs
Hospice
Neonatal ICU
4 NSs
Coronary (4)
8 NSs
Stoma
5 NSs
Respiratory /
pulmonary
Total = 195 NSs
in 38 specialties
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Expanding Scope of APN
• Nurse practitioner (NP) in primary care
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Expanding Scope of APN
• NPs focus on primary care: family, adult,
pediatric or obs & gyn -- life stages
– Assessment, promotion of health and
prevention of illnesses
– Health areas: school, factory, community,
GOPD and A&E
• NSs focus on well-defined health conditions
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Conclusions
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Journey to the West
Chapter 27
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