Post on 31-Dec-2015
transcript
The Challenges of providing The Challenges of providing an acute CCN service in an acute CCN service in Northern IrelandNorthern Ireland
Peter Johnston Bsc, RGN, RSCN, CCNPeter Johnston Bsc, RGN, RSCN, CCN
Community Paediatric NurseCommunity Paediatric Nurse
Causeway Health & Social Services TrustCauseway Health & Social Services Trust
Northern IrelandNorthern Ireland
85 MILES
110 MILES
The Mourne Mountains The Fermanagh Lakes
The Giant’s Causeway
StatisticsStatistics
Population under 19 years of age=500,153Population under 19 years of age=500,153
Population Population 20012001
% total % total UK UK populatiopopulationn
EnglandEngland 49,000,0049,000,0000
83.6%83.6%
ScotlandScotland 5,000,0005,000,000 8.6%8.6%
WalesWales 3,000,0003,000,000 4.9%4.9%
Northern Northern IrelandIreland
1,700,0001,700,000 2.9%2.9%
Total Area :5,456 square miles
Current CCN provision in Current CCN provision in N.IrelandN.Ireland
CCN teams are now available in every CCN teams are now available in every Community and combined Trust in NICommunity and combined Trust in NI
Each team has a unique skill mix and Each team has a unique skill mix and ethos but underlying is the dedication ethos but underlying is the dedication of care for sick children in their own of care for sick children in their own homehome
Generic teams covering all referralsGeneric teams covering all referrals Specific complex needs and acute Specific complex needs and acute
teams within Trust areasteams within Trust areas Limited provision of respite care in Limited provision of respite care in
some but not all Trustssome but not all Trusts
What are the What are the challenges ?challenges ? Organisational Organisational Regional Regional LocalLocal ProfessionalProfessional GeographicalGeographical FinancialFinancial Changing population profile of Changing population profile of
N.Ireland N.Ireland
Organisational Organisational Review of Public Administration Review of Public Administration Challenges in integrating teams from Challenges in integrating teams from
previously separate trusts with previously separate trusts with differing priorities differing priorities
Further integration of health and Further integration of health and social services MDT working social services MDT working
Regional Regional Inequalities of health Inequalities of health Inequalities of accessInequalities of access Differences in priority across trustsDifferences in priority across trusts Lack of regional strategy and visionLack of regional strategy and vision
Local Local
Remaining small sizes of teamsRemaining small sizes of teams Dominance of Chronic and Complex Dominance of Chronic and Complex
needsneeds Poor knowledge amongst GP’s and Poor knowledge amongst GP’s and
other health care professionalsother health care professionals
Professional Professional Changing and evolving roles in Changing and evolving roles in
community paediatrics specialisms, community paediatrics specialisms, palliative , acutepalliative , acute
Lack of representation at higher Lack of representation at higher levels within trusts and board/ levels within trusts and board/ department leveldepartment level
Recruitment and trainingRecruitment and training
Geographical Geographical Largely rural population Largely rural population Inequality of access to regional Inequality of access to regional
servicesservices Closing of local hospitals / Closing of local hospitals /
Reconfiguration of services Reconfiguration of services Emphasis on increased community Emphasis on increased community
care and specialismscare and specialisms
FinancialFinancial Focus on estates and revenue Focus on estates and revenue
promotionpromotion Reduction in service developmentReduction in service development Trust prioritiesTrust priorities Competing service needsCompeting service needs Direct ruleDirect rule
Population profile Population profile
Ethnicity -new language and cultural Ethnicity -new language and cultural challengeschallenges
De-urbanisation De-urbanisation
How we are meeting the How we are meeting the challenges ?challenges ?RegionallyRegionally A Healthier Future –Twenty year vision A Healthier Future –Twenty year vision Developing Better ServicesDeveloping Better Services Children’s commissioner / Minister for ChildrenChildren’s commissioner / Minister for Children Children’s strategyChildren’s strategy Strategic framework for children, young people and Strategic framework for children, young people and
familiesfamilies
LocallyLocally Greater integration of services both within health and Greater integration of services both within health and
with social serviceswith social services Proposed establishment of children's directorates in Proposed establishment of children's directorates in
each Trust areaeach Trust area Service initiativesService initiatives
How we are meeting How we are meeting the challenges ?the challenges ? Quarterly CCN forum meetingsQuarterly CCN forum meetings Sharing of best practiceSharing of best practice Development of equipment registerDevelopment of equipment register Guest speaker from specialist nurse Guest speaker from specialist nurse
forum from the regional children's forum from the regional children's hospitalhospital
Biannual conference Biannual conference
The real challenge?The real challenge? Though there are many organisational and Though there are many organisational and
service challenges facing CCN’s in Northern service challenges facing CCN’s in Northern Ireland the only way that we can realistically Ireland the only way that we can realistically affect the future of our service is to actively affect the future of our service is to actively become involved in the higher levels within the become involved in the higher levels within the HPSSHPSS
We now have our first CCN in a senior nurse We now have our first CCN in a senior nurse management rolemanagement role
Representation at Department levelRepresentation at Department level Advancing roles of CCN’s across the region.Advancing roles of CCN’s across the region.
A Scottish Perspective of A Scottish Perspective of Community Children’s Community Children’s
Nursing ServicesNursing Services
Presented by Karen Sinclair on behalf ofPresented by Karen Sinclair on behalf of
the Scottish CCN network groupthe Scottish CCN network group
March 2006March 2006
Scottish DemographicsScottish Demographics
• Scotland has a population of just over 5 million
• 20% of Scotland’s population are children aged 0-19years old
CCN BackgroundCCN Background
• Before Diana funding in 1999 only four health boards had established CCN services
• Today thirteen out of fifteen have a CCN service available
CCN Team ConfigurationsCCN Team Configurations
0
2
4
6
8
10
12
14
16
WT
E
H
G
F
E
D
C
B
A
0
1
2
3
4
5
6
7
8
9
Trained CCN in teams
Qualified Community Children’s NursesQualified Community Children’s Nurses
Setting the SceneSetting the Scene
• Most operate a Mon-Fri 8am-5pm flexibly• Tertiary hospital based teams work limited
hours at weekends• No CCN services offer 24/7 provision• Most teams aim to provide a needs led
service • Acute community services account for
between 5-20% of most CCN teams caseload
Challenges of providing acute Challenges of providing acute community services in Scotlandcommunity services in Scotland
• Team size• Travel• Clinical responsibility• Communication• Funding for equipment and supplies• Accountability
Challenges of providing acute Challenges of providing acute community services in Scotlandcommunity services in Scotland
Challenges of providing acute Challenges of providing acute community services in Scotlandcommunity services in Scotland
• Travel
• Team size
• Clinical responsibility
• Communication
• Funding for equipment and supplies
• Accountability
The FutureThe Future
• Promote CCN services
• Needs assessment and analysis
• Development Plans
• Increase skill mix in teams
• Employ practice development nurses
• Training future CCN
ConclusionConclusion
• CCN teams in Scotland are small and none provide a 24/7 service
• Needs led service
• Between 5% and 20% of caseload is acute
• Challenges
• Future
AcknowledgementAcknowledgement
• I would like to thank my colleagues in the Scottish Community Children’s Nursing Network group for providing me with up to date information on their teams and the services they provide locally
Advanced Practice Skills -What are they and how do
we achieve them?
Dr Fiona SmartDirector of Studies:
Advanced Clinical Practice with responsibility for CPD
The question [s]?
• Not least the meaning of advanced?• And the debate about skills …
– what is a skill and – who should/ could/ might own it?
Advanced Practice Skills -What are they, how do we achieve them and importantly how will we know that they are in place and in use?
But first, the legacy
• With a clean slate …
• With the slate we have …
• Numerous, potentially competing agendas– Not least
• The European WTD• Changes to medical education/ development• Issues re. access – timely and appropriate• User/ carer focused/ centred provision
• The impetus for and reality of role design
Role Redesign???• Is what?• A venture/ an initiative/ a solution ?• To address … what?:
– Staff shortages– Job dissatisfaction via the development of new and emerging
roles– ?
• Argued to:– expand the depth and breadth of roles, creating new jobs or
moving tasks up or down a traditional uni-disciplinary ladder
– change traditional and long-standing barriers to change such as professional boundaries, team structures and hierarchies, existing care processes and established divides between organizations
– benefit the entire healthcare team
For nursing …
• Numerous possibilities• Multiple tensions … not least
• The decision to regulate the role of the nurse practitioner
• Subject to the approval of the Privy Council
• The protection of a new title in the family of nursing– Registered Advanced Nurse Practitioner
An unexpected gain?
• The validation of skills …– as opposed to knowledge in
isolation
• A challenge to the division which separates work-based roles and allows the perception that
• Doctors know; nurses do
Perhaps even …
•Approval for ‘dirty work’
•The closer the role of the worker to the body, the less well regarded they are likely to be
The Advanced Nurse Practitioner
“ Advanced nurse practitioners are highly experienced, knowledgeable and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed ”
NMC 2005
More specifically …• Advanced nurse practitioners are highly skilled nurses who can:• carry out physical examinations;• use their knowledge and clinical judgement to decide whether to
refer patients for investigations and make diagnoses;• decide on and carry out treatment, including the prescribing of
medicines, or refer patients to an appropriate specialist;• use their extensive practice experience to plan and provide skilled
and competent care to meet patients health and social care needs, involving other members of the health care team as appropriate;
• ensure the provision of continuity of care including follow-up visits;• assess and evaluate, with patients, the effectiveness of the
treatment and care provided and make changes as needed;• work independently, although often as part of a health care team
that they will lead; and • as a leader of the team, make sure that each patient’s treatment
and care is based on best practice.
So what was the question[s]?
•Advanced Practice Skills •[1] What are they and•[2] How do we achieve them?
The easy bit … controversy accepted
• The RCN’s 7 domains of practice– Reviewed and Reordered– Minor Amendments
• Mapped to the Knowledge and Skills Framework
• The Benchmark/ Standard has been established
How will the standard be achieved?
– Group A
• Potential registrants who have undertaken a programme based on the competencies that have been approved by the Council. Currently this group would include all those who had obtained an award as a Nurse Practitioner from a Higher Education Institution (HEI) where the programme had been jointly approved by the HEI and the RCN since 2002;
– Group B
• Includes individuals who undertook programmes that were based on programmes similar to those undertaken by nurses in Group A but prior to 2002. Programmes would have included most of the competencies that have now been approved but they may not all have been assessed;
– Group C
• Includes individuals who have completed other programmes approved by HEIs in 'advanced clinical practice’;
– Group D
• Includes individuals who have not completed a conventional programme of preparation, but who wish to have their prior learning and competencies (certificated or not) accredited
– Group D may include individuals who have spearheaded the development of this level of practice.
Catch up addressed [?]Future provision …
• M level thinking
• The next 5 years
• Thereafter• all taught modules/ provision at Level 4
Meanwhile …
• If we know the skills–How are they to be known/ valued?
• If the skills matter–How will they be supported/ enabled/ sanctioned in practice?
Nursing’s Past
• Status ….
• Potential …
• Internal tensions
• And its future ………………..
Today’s Challenge old times; new thinking?
• “Training is to teach a nurse to know her business, that is to observe exactly, to understand, to know exactly, to tell exactly … training has to make her not servile, but loyal to medical orders and authorities … training is to teach the nurse to handle the agencies within our control which restore health and life, in strict obedience to the physician’s or surgeon’s power and knowledge” [Nightingale 1882: 6 in Gamarnikow 1978]
And so the challenge …
Advanced Practice Skills -What are they, how do we achieve them and importantly how will we know that they are in place and in use?
Thank you
Questions?