An evaluation of the role of the Assistant Practitioner in critical care

Aims: To determine whether the Assistant Practitioner role has fulfilled the expectations of the original implementation plan which was to introduce this new role into the Critical Care Department of a large NHS Trust. This service evaluation will examine the introduction of Assistant Practitioners by establishing the perceptions of this new role and the impact of this change from key groups of staff, within the Critical Care Department. Background: The Department of Health (DoH) recognized the potential of assistant practitioners in a range of care settings. As a participant in this DoH initiative the Trust introduced the role into a number of areas. This service evaluation was undertaken following the training of small cohorts of Assistant Practitioners within the Critical Care Department. Methods: A literature review was conducted initially searching the key words assistant practitioner, role development and critical care. A service evaluation was undertaken using questionnaires and semi‐structured interviews for data collection. The data was analysed using a thematic approach. Results: The responses from the various staff groups revealed a number of key themes including patient care skills, role, preparation and training, drug administration and patient allocation. Conclusions: Overall, the data suggests that the Assistant Practitioner role has fulfilled the expectations of the original implementation plan as they deliver care to patients in the clinical environment as required. However, the data also reveals that there are still issues to be resolved. Relevance to clinical practice: The study has shown the Assistant Practitioners to be excellent in delivering patient care; however, there are limitations due to the complexity of the patient group in critical care areas.     

Contributions of the professional, public, and private sectors in promoting patient safety

Patient safety has become a national priority. This article discusses the contributions of the professional, public, and private sectors regarding patient safety. Definitions and detailed examination of the issues surrounding patient safety are presented. Ideas to create improved systems for the important issue of patient safety are explored. The opportunity for increased interaction among the various groups has great potential. Health care organizations that exemplify best practices in patient safety will be rewarded by the purchasers of health care and by accreditation agencies. The Leapfrog Group and the Joint Commission on Accreditation of Health Care Organizations are leading this effort. Nursing has a major role in leading efforts to find solutions to advance patient safety standards.     

Adolescent appropriate care in an adult hospital: the use of a youth care plan.

OBJECTIVE: This paper explores the development of a specific youth care plan which provides a framework for adolescent appropriate care in an adult acute care facility. SETTING: The Sydney South Western Area Health Service (SSWAHS) Youth Consultancy, Royal Prince Alfred Hospital (RPAH), Camperdown, Sydney, Australia. SUBJECTS: Young people aged 12- 24 years who were admitted to the acute hospital setting at RPAH. Approximately 2500 young people are admitted as in-patients to RPAH each year. PRIMARY ARGUMENT: Adolescents are a unique population with different developmental and health care needs. Adult acute care facilities are often ill-equipped to deal with the complex developmental needs of young people and need guidance and education to provide appropriate care for this population. Nurses play a pivotal role in caring for hospitalised young people. A developmentally relevant youth care plan may be an appropriate and effective tool to facilitate best-practice nursing. CONCLUSIONS: The Youth Care Plan was developed to provide a framework for developmentally appropriate assessment and care for young patients admitted to RPAH. This care plan also provides a mechanism for referrals to the Youth Consultancy team, which provides continuous education, consultation and liaison for staff related to both the Youth Care Plan and general adolescent health. The Youth Care Plan is regularly audited and has been trialled as a registered Continuous Quality Improvement project of RPAH.     

Nursing's agenda for health care reform: a critique.

This paper discusses the nature of the health care crisis with a focus on the issues of economics, the private insurance industry, race and ethics as they relate to Nursing's Agenda for Health Care Reform. Recommendations are made for assuring the entire population quality, equitable health care.     

Consumer-directed teaching of health care professionals involved in the care of people with spinal cord injury: the Consumer-Professional Partnership Program

The Consumer-Professional Partnership Program (CPPP) was developed to increase patient participation in the education of nurses and other health care professionals. Its goal is to inform nurses about disability and health issues from the perspective of people with spinal cord injury. This article discusses the development of this program and the first experiences with its implementation. Forty-three nursing professionals took part in CPPP training. Initial participant responses were positive, especially with regard to hearing from consumers about care preferences, barriers to care, and ways to improve patient-provider interaction.     

Health decisions: maintaining control of health care choices.

Advanced technology sometimes prolongs life without improving the quality of life. California's Durable Power of Attorney for Health Care (DPAHC) provides individuals with a tool to maintain control over their future health care should they become unable to make health care decisions. California Health Decisions (CHD) developed a comprehensive workshop designed to inform people about the DPAHC and its options and has played a leadership role in educating health care professionals, the general public, seniors, and employee groups. CHD has set a goal of helping 1 million Californians complete a DPAHC by 1995. This article describes the issues involved in implementing the educational goals to achieve this objective.     

Child care health consultants' roles and responsibilities: focus group findings

PURPOSE: To describe the roles and responsibilities of newly trained health professionals, primarily nurses called Child Care Health Consultants. METHOD: Health professionals hired by county agencies to become Child Care Health Consultants enrolled in the California Training Institute (CTI) for Child Care Health Consultants, a 9-day educational training program divided into three modules. They participated in one focus group during each module. Research staff led the focus groups and the participants were asked, "What are your roles and responsibilities?" Qualitative analyses were conducted and common themes were identified. FINDINGS: The nine focus groups included 44 participants, 95% were nurses with an average of 20 years of work experience. The roles and responsibilities of the Child Care Health Consultants were described by five themes: network, education, sustainability, on-site service, and administration. CONCLUSION: These findings contribute to the new field of child care health consultation by defining the common roles and responsibilities of Consultants.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

IMhPaCT: an education strategy for cross-training palliative care and mental health clinicians

The Australian Integrated Mental Health and Palliative Care Task (IMhPaCT) project aimed to improve the quality of palliative care for people with a severe and persistent mental illness and those who develop mental health issues as a response to their diagnosis of a life-limiting illness. These patients and families are generally cases of high complexity and require strong collaboration and cooperation across various service sectors. Education across both palliative care and mental health services was identified as a key objective in improving palliative care service delivery in this patient population. This article specifically addresses one aspect of the project-the education strategy. The processes of development, implementation, and evaluation of outcomes are discussed.     

Collaborating with the consortium: the development of a foundation in critical care skills programme

This paper outlines the role and function of NHS education and training consortia and how one consortium is addressing the issues of supporting practitioner-led, practice-based training initiatives in critical care. In late 1997 the consortium sought to identify current problems with recruitment and retention of competent critical care nurses, access to training and development and to examine the quality and appropriateness of current pre- and postregistration training related to the critical care areas. A number of issues were identified, with the need for a Foundation in Critical Care Skills Programme' for junior nurses as the principle short term priority. A programme supported by the local consortium, in collaboration with seven NHS trusts' critical care areas (totalling 27 different departments/units), has been developed, incorporating skills workshops, completion of open learning materials, assessments of core competencies and the submission of a portfolio of evidence in support of a professional award (ENB Certificate). The importance and value of collaboration in the development of this practitioner-led consortium-supported venture is highlighted.     

Approaching the 21st century. Congressional agenda for health care and occupational health.

1. Major health related legislative issues for occupational health nurses in the 1990s are OSH Act reform and restructure of the health care system. 2. OSHA reform issues have been consolidated into the Comprehensive Occupational Safety and Health Reform Act (S1622 and HR3160). 3. Health care reform is being addressed by many legislative initiatives and by organized nursing in Nursing's Agenda for Health Care Reform. 4. As the professional association for occupational health nurses, AAOHN serves as an advocate for the profession with the federal government.     

Improving healthcare delivery with the transformational whole person care model

A Whole Person Care model was developed by The New England School of Whole Health Education following a 2-year pilot study that demonstrated the transformational effects of whole health education. This holistic model of health education and behavioral interaction provides a tool for nurses, physicians, and staff to redirect the momentum of care toward in-the-moment, relationship-centered whole person care, improving healthcare worker and patient satisfaction and outcomes.     

Nursing drives interdisciplinary health care workforce planning in Wisconsin: one state's experience.

The Consortium for Primary Care in Wisconsin convened a forum to develop an interdisciplinary primary care workforce plan to address issues related to the supply of and demand for primary health care providers in Wisconsin. Nursing leaders played a pivotal role in making this effort successful and in ensuring that the focus would be on all primary health care professionals, not just physicians. This process used a primary care workforce planning tool (IRM) developed by the Bureau of Health Professions, U.S. Public Health Service which allowed Wisconsin to (1) examine its own workforce needs with data produced in Wisconsin, (2) compare the state's situation with national trends, and (3) include these data and projections in a cooperative process for state-level planning for interdisciplinary workforce development. The Bureau has encouraged other states and organizations to adopt a similar strategy through a series of IRM workshops in which the Wisconsin process serves as a model for training materials developed for these workshops. The Wisconsin planning process is an innovative model for other states to follow in facilitating workforce development and serves to encourage other states to share their experiences in the academic literature.     

Perceptions of training for care attendants employed in the care of older people

BACKGROUND: Care attendants, have long assisted nurses in the provision of care for older people in a variety of care settings in Ireland. While there has been recent interest in the provision of formal training for this grade of health care worker the majority remain untrained and unregulated. AIM: This paper describes a study undertaken to explore the perceptions of nurses and care attendants regarding the provision of formal training for care attendants employed in the care of the older people in southern Ireland. The aim was to identify through empirical research, the perceived implications of this training on the role of both nurses and care attendants. RESEARCH METHODOLOGY: A qualitative research design was used to afford each set of respondents the opportunity to express their thoughts and concerns. The research sites were two settings providing long-term care for older people. The research sample nurses (n = 40) and care attendants (n = 40). Data was derived through the use of two research instruments, focus group discussion and a questionnaire containing open-ended questions. Themes were extracted from the data using content analysis. RESULTS: The study identifies positive attitudes towards training for care attendants by both nurses and care attendants but also a perceived link between the provision of training and a blurring of role boundaries. In addition, findings disclose that although nurses are positively disposed to the training of care attendants, this is not accompanied by a desire to become actively involved. CONCLUSIONS: The study indicates a positive view of training for care attendants, also highlighting the importance of role clarification. Results are particularly relevant in the present climate of demographic change, changes in nurse education and staff shortages in Ireland.     

Development of integrated mental health care: Critical workforce competencies

In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.     

Integrating outcomes measurement into clinical practice improvement across the continuum of care: a disease-specific episode of care model

This article describes a model for incorporating outcomes measurement into a comprehensive, continuum-wide clinical practice improvement program developed at Lovelace Health Systems (Albuquerque, N.M.). Created in 1993, the Lovelace Episode of Care Program currently includes nine disease-specific multidisciplinary teams that are working to improve care by addressing such issues as severity, appropriateness, efficiency, continuous quality improvement indicators, practice guidelines, care maps, and outcomes. Key features and advantages of the model are discussed, as well as implementation issues, successes, lessons learned, program restructuring and improvement, and applicability of the framework across diseases and health organizations.     

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled “Health Care System and Health Promotion” was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students’ views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.     

Health care crisis in the black community: an epidemiological view.

Health care professionals must recognize Black populations' health care needs and target efforts to meet those needs whenever possible. In the future we hope mandated by federal regulations--congressman Louis Stokes of Ohio forwarded me a copy of the Disadvantaged Minority Health Improvement Act of 1990 (H.R. 5702) which was passed by the House of Representatives in October (1990). This amends the Public Health Service Act and provides for a Deputy Assistant Secretary for Minority Health who is charged with, among a myriad of functions, promoting minority health through the support of "research, demonstrations and evaluations to test new and innovative models, to increase knowledge and understanding of health risk factors, and to develop mechanisms that support better information dissemination, education, prevention and service delivery to individuals from disadvantaged backgrounds, including racial and ethnic minorities" (Dingell, 1990, p.3). Scholarships will be available to increase the number of minority health care workers. Hopefully, all health care workers will recognize the needs of Blacks and attempt to meet those needs. Nurse educators can facilitate this through their practices, research and teaching to increase access to health care for the Black community. Epidemiology in the curriculum will help accomplish this goal.