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Development of the role of the Advanced Nurse Practitioner in Diabetes. Helen Burke Advanced Nurse Practitioner (Diabetes) University College Hospital Galway. Historical Development ANP Roles Internationally.
Advanced Nurse Practitioner (Diabetes)
University College Hospital Galway.
of the U.S. and with the development of university based educational programmes delivered at masters degree level, this type of primary care role heralded the development of many similar roles in primary and more recently in acute care settings( Brown& Grimes1995, Walsh 2001,Guido 2004)
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.Criteria for Approval as ANP
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”
To train a suitably qualified, experienced nurse to independently assess, diagnose, treat, discharge / refer patients with diabetes attending diabetes services at University College Hospital Galway.
Response- ANP supports the empowerment of patients/families. Individualised care plans are developed for each patient incorporating holistic management.
Response- Optimise care for patients attending young adults/annual review clinics attending to the special needs of these group of patients.
Response- The ANP is actively involved in providing and optimising patient and family care .a) Involved in setting up transitional care for adolescents transferring to adult services .b) Service for schools. C) One home visit post discharge d) Implementation of NICE guidelines for the care of children/adolescents with diabetes e) Parent support workshops.
Response- The ANP is involved in the development process for a shared care scheme in the Galway area.
Involved in the Development of guidelines for best practice which will be used throughout the HSE West/North West/Mid-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/
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.
Young Adults 18-26 years.
Paediatric review clinic.
Annual Review clinic.
Group education programmes for Type 2 patients,
IN-PATIENT Service. Adult/Paediatric.
Social Work Department
Health Promotion.Advanced Nurse Practitioner
Jack-Age 68 yrs.
Diagnosis type 2 diabetes 1986.
Attending G.P. Services.
Treatment- Glucophage 850mgs/tds.
Complications- Coronary Artery disease. MI 2003. Coronary Artery by-pass 2003.
Referred to Diabetes Service 2005.
Attending annual review clinic.
Commenced on Lantus once daily. Remains on Glucophage 850mgs /tds.
Referred to dietitian.
Referral to opthalmology.
Referral to chiropody( Community chiropodist)
Telephone support twice weekly x 2 weeks, then weekly x 2 weeks for advice on insulin dose adjustment.
Continue telephone support weekly or Jack e-mails blood glucose readings.
HBA1c March 8.0%
Referred back to annual review clinic.
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%.
Peripheral vascular disease.------------------ 43%.
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”