FOCUSING ON APN THROUGH A GRADUATE PROGRAM

1. FOCUSING ON APN THROUGH A GRADUATE PROGRAM Raisa GulRN, RM, BScN, MHAAssistant Professor and Director, Diploma ProgrammeAga Khan University, School of Nursing

2. PRESENTATION FLOW Brief Overview of the Country ↓ Nursing Profession ↓ Challenges of MScN Program & Integration of Advance Practice in Nursing (APN) ↓ Potential Impact Of APN

3. PAKISTAN56 Years of independence

4. ABOUT THE COUNTRY • Population of 140 Million; 68% Rural and 32 % Urban • Population growth 2.2% • Poor public health facilities • Literacy 40% • Health care access, strong rural urban disparities • IMR, 95 per 1000 live birth • MMR, 200-700 per 100, 000 • Double disease burden: infectious diseases , Hepatitis (TB) and Hypertension, diabetes, cancers, mental Health problems • Estimated # of Doctors = >100’000 ; Nurses 33’000 so, 1 nurse: 3-4 doctors

5. NURSING IN PAKISTAN • Have Nurses, Lady Health Visitors and Midwives • Entry to nursing education is grade 10-12 • Nurses are confined to hospitals, 20-30 patients/nurse • Predominant use of students for services • Quality of nursing education is low • Nursing Education, diploma and post basic diploma • Demand for higher education by employer is low except at AKUH • Opportunity for higher education is limited • Limitation of nursing leadership and physicians’ dominance in Health Care System.

6. AGA KHAN UNIVERSITY SCHOOL OF NURSING : VISION Of THE CHANCELLORPromotion Of Nursing • Begin with SON in 1980 as a “break through” • Had an expatriate director and national faculty with post –basic diploma • 23 years later, have national Dean and Directors • All faculties with at least undergraduate degree, but also Masters and PhDs • Programmes development: 1980 –General Nursing Diploma 1988-Post RN BScN 1997 – BScN 2001- MScN First program in the country

7. CHALLENGES OF ESTABLISHING MScN a) Conceptual Phase: Creating awareness, ownership and approval • Physicians, it takes nurses away from the “real work” • Employer & university Administration, how will they be different…do we need to spent more money? • Nurse Leaders, sense of insecurity

8. Contd… Strategies: • Communication, rationalization with current trends in nursing education • Success of the developed Countries • Assuring for strong consideration to enhance clinical knowledge, i.e. 22/59 credits (37 %) as core courses in the curriculum.

9. b) Planning Phase Approval of the Board, concern for resources both human and financial Strategies: • Faculty development plan, sponsorship for graduate studies • Expatriate faculty, visiting and short term contracts • Collaboration with other universities abroad, Sheffield University and Minnesota

10. 2. Curriculum composition, specialist versus generalist Master Took generalist approach, with emphasis on Research and Clinical Practice due to: • Limited pool of nurses with BscN at the national level • Diversity of potential candidates for MScN • Envisaging greater impact through developing leaders 3. Developed transition programme in view of the national needs

11. MScN CURRICULUM 5 % Total Credit hours – 59 10 % 7 % 37 % 41 %

12. c) Implementation Phase • Availability of expatriate faculty , 9/11/2001 • Undesirable effects of Faculty development plan • Variation in employer’s demand • Visa and licensure issues for students’ advance clinical practicum abroad • Students perspectives, program credibility, cost benefits analysis • Pool of potential students further decreased affecting enrollment in MScN.

13. Strategies Pooling of resources within the university: • Inter departmental collaboration • Physicians as preceptors for Advance clinical Practicum • Visiting and Sessional faculty

14. Our Experience of Advance Clinical Practicum Students’ comments : “Culturally it is appealing, will have more respect.” “Our role of counseling and teaching was very much appreciated.” “50% of patients need counseling and teaching to cope with their diagnosis.” “ patient were receptive to get examined or advised by a nurse.”

15. Contd… “Doctors were learning from us and we learned from them” this “Will definitely impact nurses’ image.” “If we identified what was missed out, they [Physician] were appreciative rather then defensive.” “Me and my preceptor have begun to work on research project.” Physician remarked “I am afraid if you have a clinic next to me. I will loose my patients to you.”

16. Students, Patients and Physicians perspectives • Chance of independent decision making • Application of knowledge, especially counseling and patient education • Enhancement of assessment skills • Projects nurses strengths and potential, • Source of mutual and enrich learning experience • Strengthening Nurse- Physician collegiality • Enhance awareness among public about the scope of nurses’ work.

17. Advance Practice in Nursing (APN)Concept to implementation • Need a vision • Availability of human and financial resources • Educational preparation of nurses at graduate level • Creation of systems to recognize the APN role • Requires credentialing and licensure by the regulatory body of nursing in the country. Note: Importance of the decision maker should never be overlooked

18. CONCLUSION Although the issue of role creation and Licensure by Pakistan Nursing Council for Advance Practice in nursing (APN) yet to be addressed, the potential Impact of APN in Pakistan appears promising with greater awareness and outcome in future. Chances for APN role are bright in the private sector, but it will take time for acceptance in the public sector.

19. ACKNOWLEDGMENT • Graduate Nursing Committee, Aga Khan University School of Nursing • Madrean Schober THANK YOU