1 / 34

Advanced Practice in Diabetes.

2. Definition of Advanced Nurse/Midwife Practitioner (Ireland). Grounded in the theory and practice of nursing/midwiferyIncorporates other related research, management and leadership theories and skillsTo encourage a collegiate, multidisciplinary approach to quality patient/client careANP/AMP roles developed in response to patient/client need and healthcare service requirements at local, national and international levelANPs/AMPs must have a vision of areas of practice that can be developed 30050

holland
Download Presentation

Advanced Practice in Diabetes.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Advanced Practice in Diabetes. Helen Burke Advanced Nurse Practitioner (Diabetes) University College Hospital Galway.

    2. 2 Definition of Advanced Nurse/Midwife Practitioner (Ireland) Grounded in the theory and practice of nursing/midwifery Incorporates other related research, management and leadership theories and skills To encourage a collegiate, multidisciplinary approach to quality patient/client care ANP/AMP roles developed in response to patient/client need and healthcare service requirements at local, national and international level ANPs/AMPs must have a vision of areas of practice that can be developed beyond the current scope of practice and a commitment to the development of these areas

    3. 3 Criteria for Approval as ANP Be a registered nurse or midwife on An Bord Altranais’ live register; Be registered in the division of An Bord Altranais register for which application is being made (in exceptional circumstances which must be individually appraised, this criterion may not apply) Be educated to masters degree level (or higher). The post-graduate programme must be in nursing/midwifery or an area which is highly relevant to the specialist field of practice (educational preparation must include a substantial clinical modular component(s) pertaining to the relevant area of specialist practice) Have a minimum of 7 years post-registration experience, which will include 5 years experience in the chosen area of specialist practice Have substantive hours at supervised advanced practice level. Have the competence to exercise higher levels of judgement, discretion and decision making in the clinical area above that expected of the nurse/midwife working at primary practice level or the clinical nurse/midwife specialist; Demonstrate competencies relevant to context of practice; and Provide evidence of continuing professional development.

    4. 4 It is estimated that 194 million people worldwide have diabetes with this figure expected to double by 2025. IDF (2003) described diabetes alongside global warming ,emerging diseases and environmental pollution as one of the worlds biggest environmental disasters. “The effect of Aids in the last 20 years will be repeated by diabetes in this century”

    5. 5 The alarming increase in diabetes is as a result of ageing populations, dietary changes, reduced physical activity and other unhealthy and behavioural patterns. A new trend of increasing cases of type 2 diabetes in children and adolescents is emerging. These patients are likely to have kidney and cardiovascular disease much earlier in life, adding to the health economic burden (IDF 2003) The financial and social burden of diabetes will be intolerable if measures are not taken to address this disease.

    6. 6 Diabetes Day Centre University College Hospital Galway. Services provided focus on diagnosis, treatment and patient education. The centre facilitates many sub-specialist clinics/services to enhance care for patients with diabetes. Specialist clinics. Young Adults clinic/Combined nephrology and diabetes service/Combined obstetric and diabetes service and pre-pregnancy service / Obesity clinic/Annual review/foot clinic. Services provided include. Podiatry, Dietetics ,Psychology, Phlebotomy ,DAFNE, ,Telephone support service, Group education and Retinal screening. Paediatric/Adolescent Diabetes services are provided from the Paediatric unit/outpatients department. Transitional service.

    7. 7 Getting Started

    8. 8 Rationale for ANP in Diabetes. Develop clinical career pathway for an experienced nurse in Diabetes Care. Provide clinical leadership Enhance the quality of service delivered by the multi-disciplinary team to patients with diabetes Provide more timely, but safe, service leading to improved patient satisfaction Release physician time to deal with increasing acute workload

    9. 9 Process. Service applies to have the post approved as an ANP/AMP post ( Job Description/Site Preparation) The nurse/midwife applies to be accredited as an ANP/AMP to the approved post( individual accreditation)

    10. 10 My Journey. 2001-Establishment of the Diabetes Day Centre. 2001-Appointment of Professor of Medicine/ Endocrinology 2002- The development of the ANP/Diabetes was discussed formally with nursing/medical management. The intention to develop the post was discussed with relevant stakeholders. (Consultants ,laboratory, nursing colleagues, dietetics, general practitioners). 2003- Commenced the Masters in Health Science/Advanced Practice at NUI Galway. 2004- Approval for post for ANP/Diabetes included in service plan.

    11. 11 2005- preliminary job description submitted to NPDU. 2005- Completed Masters in Health Science/ Completed supervised clinical hours. Multidisciplinary Working group established for candidate ANP’s in UCHG/Mayo general/Portiuncla to discuss role development for the 3 sites/UCHG/Mayo General/Portiuncla Hospital Commenced work on site preparation. 2006- June/Site visit from National council. August- submitted Job portfolio. September received accreditation from the National Council.

    12. 12 Site Preparation Review of National policy documents relevant to diabetes services. Review of research data pertaining to diabetes.( DCCT/UKPDS/ Diabetes Care: Securing the Future). Review of service Adult and Paediatric need. ( 7,000 patient visits 2005). Audit current activity of service Service need established Client group & caseload identified Identify outcome measurement Stakeholder ‘BUY IN’ Demographics of region.( Fastest growing city in Europe, Student population, Tourism, 50% of boards population under 30 years, Higher percentage of people over 65 years =14% national average 11%, Large rural population. Predictions for Future diabetes services based on demographics and epidemiology studies. (DFI 2003)

    13. 13 Developing the Role while doing the masters. Supervised Clinical Hours. Meetings with Relevant Stakeholders. Meetings with Nursing Management to discuss site preparation. No Structured time to commence site preparation.

    14. 14 Job description Detailed job description containing details of the role and responsibilities of the post, reporting relationships, reflecting the required experience and education as specified by the National council. Incorporate definition of ANP role, together with core competencies for the role. Autonomy in Clinical Practice. Expert Practitioner. Pioneering Professional and Clinical Leadership. Research.

    15. 15 Clinical Supervision Major commitment required by clinical mentor/supervisors. Clinical Supervision by Professor of Endocrinology/Paediatrics. Planned supervision and Clinical skills assessment.

    16. 16 Selling The Role. To ensure successful integration of the role employers and the ANP must give consideration to how best integrate the role in the context of the multidisciplinary team and the effect of the role on the work of other health care professionals. We spoke about the role and met with other health care professionals and departments that we would be referring patients to. Article in Newsletter.

    17. 17 Service needs addressed by post. Education-Patients with Diabetes have many education needs. Therefore the health education component of the ANP role is central to the empowerment of patients/families. Specialised clinics. The benefits for specialist clinics for complicated groups have been well established and demonstrated( NICE 2004) The ANP has been central to the development of these clinics. We optimise care at clinics by attending to the special needs of these group of patients. Young Adults/Annual Review.

    18. 18

    19. 19 Paediatric/Adolescent Clinics. The diabetes service at UCHG provides a structured multidisciplinary service to this cohort of patients and their families. The ANP is actively involved in providing and optimising patient and family care Implemented transitional care for adolescents transferring to adult services. Service for schools Involved in the implementation of a support clinic BRUCIE Programme One home visit post discharge Implementation of NICE guidelines for the care of children/adolescents with diabetes Parent support workshops.

    20. 20 Linking Primary to secondary care. Involved in the development of a shared care scheme in the Galway area. Involved in the Development of Diabetes guidelines for the HSE West. Provide education programmes/workshops for GPS/Practice nurses/public health nurses. Involved in the development of the DESMOND Programme( hospital/community) Deliver the diabetes component of the Diabetes module for practice nurses NUI GALWAY/

    21. 21 Advanced Nurse Practitioner Caseload Patients with Type 1 and Type 2 Diabetes. New onset Diagnosis. Existing patients. New Type 2 clinic/GP referral. Children 0-13 years. Adolescents 13-18 years. Support clinic/BRUCIE Programme Young Adults 18-26 years. Annual Review clinic. MDI Programmes. Group education programmes. Referral OPD IN-PATIENT Service. Adult/Paediatric. Maternity Services. Dietetics Social Work Department Primary care Podiatry. Health Promotion.

    22. 22 Advanced Nurse Practitioner Scope of Practice/Diabetes. Independent practice Assess patients with diabetes. Diagnose. Physical examination/Patient history/ Laboratory investigations. Treat. Insulin Therapy/oral hypoglycaemic Therapy/antihypertensive agents/statins Discharge to GP or to other specialist clinics Referral pathway to appropriate service. Dietetics/ ophthalmology /nephrology/ vascular/ podiatry/ health promotion. Education –Patient/ other health care professionals involved in diabetes care. Consultancy

    23. 23 Guidelines for Practice Collaboratively agreed (Nursing management/Consultants/ Paediatrician/Nurse Practitioner) Evidence based. Standard approach to managing clinical presentations for the diabetes department. Regularly reviewed by Consultants/ANP.

    24. 24 Education Activity Clinical teaching & clinical supervision. In-service education medical & nursing staff. Lecture on various post-graduate programmes in 3rd level institutions.

    25. 25 Consultancy Provide nursing consultancy service to multi-disciplinary team members. Provide consultancy to primary care services. Provide Nursing consultancy on DSAG (Diabetes services advisory group) Authority/clinical nursing expertise for diabetes care Provide support to specialist area’s outside diabetes engaged in ANP role development

    26. 26 Research & Audit Identify Research Projects. MIND Study , Evaluation of MDI Programmes Audit of paediatric services. Audit of group education programmes. Clinical focus to research. Evidence for care Audit of service need ( case mix/Patient activity levels.

    27. 27 Case Scenario. Jane -21ys. Type 1 diabetes 10 years. Poor glycaemic control during adolescence, HBA1C 10-12%. June 2006- Hba1c 12.4%. Complications- right background diabetic retinopathy, left pre-proliferative retinopathy. Microalbuminuria (Ramipril 10mg/nocte). Symptomatic of hyperglycaemia, tired, thirsty, weight loss ,irritable and fed up. Attending young adults clinic.

    28. 28 ANP INPUT Empowered Jane to become involved in her care and decide on her treatment choices/ decisions. Changed insulin Therapy ( 4 injections/daily /novorapid/lantus) Twice monthly visits to ANP. 3monthly visits to young adults clinic. Telephone support weekly Referred to dietician Psychologist. Referral to ophthalmology. Will be followed up yearly. No laser treatment required. Hba1c September 9.1%. December 7.8% February 7.8% Jane feels much better, not symptomatic of hyperglycaemia and happier that she is assuming control and self managing her diabetes. Referred back to young adult service will be seen 2 monthly. Continue telephone support/weekly.

    29. 29 Case Study. Jack-Age 68 yrs. Diagnosis type 2 diabetes 1986. Attending G.P. Services. Treatment- Glucophage 850mgs/tds. Diamicron 80mgs/bd. Complications- Coronary Artery disease. MI 2003. Coronary Artery by-pass 2003. Diabetic Neuropathy. Diabetic Retinopathy Referred to Diabetes Service 2005. Attending annual review clinic. HBA1c 9.4%.

    30. 30 Commenced on Lantus once daily. Remains on Glucophage 850mgs /tds. Referred to dietician. Referral to ophthalmology. Referral to chiropody( Community chiropodist) Telephone support twice weekly x 2 weeks, then weekly x 2 weeks for advice on insulin dose adjustment. Group education. Continue telephone support weekly or Jack e-mails blood glucose readings. HBA1c March 8.0% Referred back to annual review clinic.

    31. 31 Putting things into perspective. The aim of diabetes care must be to ensure the best outcomes for patients, bearing in mind the risks associated with poor glycaemic control. Risk of complications associated with a 1% rise in HBA1c levels. Event Increase in risk of event. Diabetes related death.------------------------21%. Myocardial infarction.--------------------------14%. Peripheral vascular disease.------------------ 43%. Microvascular disease.--------------------------37%. Cataract extraction.-----------------------------19%.

    32. 32 Reality of Advanced Practice Autonomy. Confidence. Job satisfaction. Opportunity to develop new ANP Services. Increased Workload. Appointment of CNS to cover workload. Lack of Secretarial Support. Space/Equipment. Site Preparation Co-ordinator. Inclusion of module on Guideline and Policy development and Site Preparation in Masters Programme. Difficult to have dedicated time for research/audit. Nurse Prescribing.

    33. 33 Career Pathway Structured Focused. Rewards talent & expertise in practice

    34. 34 Job Satisfaction. “The main reason I love my job is that I am dealing with and have time to spend with patients. I particularly like the fact that I have time to spend with children , adolescents and young adults who may be experiencing difficulties with their diabetes and this input may make a difference to their overall management. Patient empowerment is essential and I value and encourage patient input regarding their treatments choices. The fact that I can make decisions with patients about their care, assess, treat and discharge them satisfied and happy means a lot to me in terms of how I do my work”

    35. 35

More Related