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Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
Advanced practice   Majid  Al-Maqbali Riyadh Sept 2013
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Advanced practice Majid Al-Maqbali Riyadh Sept 2013

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This presentation highlighted the process that the MoH in Oman used to build consensus on the importance of establishing the role of NP in Oman. All of what has been presented could be used by other …

This presentation highlighted the process that the MoH in Oman used to build consensus on the importance of establishing the role of NP in Oman. All of what has been presented could be used by other health systems especially in GCC

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  • 1. 1 Establishing the Nurse Practitioner Role in Oman Dr. Majid Al Maqbali, RN, PhD Director of Nursing & Midwifery Affairs MOH(HQ) - Oman September 17, 2013 Leading Through Change Excellence Beyond Limits 17&18th September 2013 / 12-13th Dhu Al-Qada 1434
  • 2. 2 Objectives:  Develop awareness about the process of developing a new role in a health system  Appreciate the role of using evidence, stakeholder’s opinions, and international models in developing new roles in nursing  Recognize the model of scholarship, practice, and leadership in transforming nursing
  • 3. Advanced Nurse Practitioner “ A registered nurse who has acquired the expert knowledge base, complex decision making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and /country in which she or he is credentialed to practice. A master’s degree is recommended for entry level” (ICN, 2002) 3
  • 4. 4 Driving Forces In Oman  Service Driven – ‘Shortfall’ in Doctors both numbers and specific expertise .  Emerging Health problems due to lifestyle changes e.g. Diabetes, hypertension.  People are living longer and are more likely to develop long term conditions requiring specialist care.  The global trend of moving care closer and deeper in the community  Clinical career pathway for nurses to stay at the bedside.
  • 5. Methodology: Triangulated Approach 1. Gathered data on specific advanced practice skills practiced by nurses, service configuration, practice standards, education process and professional regulation. 2. Assessed the perceptions of Health Care Professionals. 3. Seek the advice and support of the experts in the field (WHO Consultants, Academics, Health Administrators, and Decision makers). 5
  • 6. Consultancies: Dr. Tesfamicael Ghebrehiwet, ICN  Brainstorming and focus groups:  Profession is ready.  The role has to be legitimized.  Epidemiologic and demographic Imperatives.  Public acceptance. 6
  • 7. Consultancies: Madrean Schober  Site visits and discussions in the health centers: suggested a more in-depth evaluation.  Workshop with key multidisciplinary stakeholders: SWOT analysis of the current situation - identification of common health problems, client characteristics, settings, scope of practice, educational preparation, facilitating factors and hindrances. 7
  • 8. 8 Our Process: Needs Analysis  Build on the work of Schober– Site visits, focus groups, workshop.  Data gathering and analysis from Primary Healthcare setting.  Nursing stakeholder focus groups discussions  A review of International literature on Nurse Practitioners / Advanced Practice.  Perceptions of health professionals on the ANP role in Oman
  • 9. Findings  The infrastructure in the country is well positioned to progress towards development and implementation of ANP.  Nurses are functioning in an extended role due to the demand and need for care.  Legitimizing the role with appropriate training and supervision will surely serve as an innovative way of ensuring quality of care, system efficiency, and cost effectiveness. 9
  • 10.  Statistical analysis: 60 % of the nurses working in primary health care centers  Nurses, 95% of whom were diploma trained, were carrying out these tasks without the necessary education and legal authority  56% of the PHC nurses who practice this role have less than 5 years of experience that is alarming  Nurses are prescribing drugs that are not permissible by them including broad spectrum antibiotics for which they are not legally authorized 10 Findings
  • 11.  The doctor patient ratio in primary health care is much lesser than the doctor patient ratio in the hospital, resulting in a population being underserved by doctors.  The emergent needs appear to be twofold:  Extended nursing role - Provision of local professional development to upgrade nursing education for those nurses already functioning in an extended capacity.  Developing a program for advanced nurse practice within the country based on the local needs (Schober & Affara, 2012).11 Findings
  • 12. Findings (Focus Group):  Internationally the role, responsibilities, titles, and educational preparation of Nurse Practitioners is not standardised.  International Council of Nurses have defined a role and recommend a ‘Masters’ preparation (I.C.N, 2002)  We need a clear definition of ‘Advanced Practice’ for Oman’s context. 12
  • 13.  Internationally minimum educational preparation is a Bachelor degree.  Curriculum development – Local – ‘v’ – Abroad.  Clinical Practice and Assessment to be done in Oman as Omani nurses are registered to practice.  The need to address preventative health strategies – health promotion – health education rather than just ‘curative’ strategies.  The role of Consultants / Senior specialists as mentors and assessors of 13 Findings (Focus Group):
  • 14. 14  Internationally most cited reason for implementing Advanced Practice is Physician shortage (USA, UK Netherlands, France, Switzerland).  Internationally Nurse Practitioners provide similar outcomes of care to Medical staff (Horrocks, et al. 2002).  Currently there is a global shortage of nurses - planning one profession to replace the work of another needs careful thought (Simoens et al. 2005). Findings (Focus Group):
  • 15. 15  Workforce planning to meet population needs – move from curative to preventive strategies & management of chronic illnesses.  Current service gaps include – Palliative care, community mental health, care of the elderly, and discharge planning (Focus groups Muscat). Findings (Focus Group):
  • 16.  The appropriate duration of clinical experience required as a pre- requisite for the ANP role is at least 4 years.  Specific skills required by the ANP as expressed were emergency life saving skills and implementing treatment regimen.  Critical thinking skills and skills to work autonomously were considered the most important decision making skills of an ANP. 16 Perceptions of health care professionals
  • 17.  The most important roles of the ANP include history taking, physical assessment, acting in emergency situation, critical thinking and engaging in knowledge generating activities.  The core competencies required for the ANP role included communication skills, knowledge generating skills and assessment skills.  There should be one ANP for each Wilayat/District. 17 Perceptions of health care professionals
  • 18. Perceptions of health care professionals  ANP’s could be trained locally with clinical placements to meet the country’s needs in a cost effective way .  The major issues that could be addressed by the ANP’s include health promotion, managing acute /severe illnesses and disability limitation and rehabilitation.  ANP’s should work within a multi-professional team communicating across professional boundaries. 18
  • 19. Perceptions of health care professionals  Introducing the ANP role will enable physicians to spend more time with acutely ill and sicker patients.  The public will accept the role of the ANP in the health care system as part of the multidisciplinary team.  Doctors should be involved in the clinical preceptorship and theoretical preparation of the ANP’s. 19
  • 20. Suggested Model of Practice 20
  • 21. Conclusion O: Ownership (Health care providers, decision makers, government, and public) M: Model A: Accept everybody’s point of view and use them (participatory leadership) N: Nursing is caring 21
  • 22. 22 References: Directorate of Nursing and Midwifery Affairs, (2011b) Advanced Nursing Practice – A data collection process to assess the situation nationally; DNMA, Ministry of Health, Sultanate of Oman Horrocks S, Anderson E, Salisbury C, (2002) Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ; 324(7341): p 819–23. International Council of Nurses, (2002) Definitions and characteristics for nurse practitioner / advanced practice nursing roles. www.icn.ch/networks_ap.htm [Accessed Feb 23rd 2011] Schober, M. (2007) Development of Advanced Community Nursing / Nurse Practitioner Roles & Educational Programs in Oman, World Health Organisation; short term consultancy. Simoens S, Villeneuve M, Hurst J. (2005) Tackling Nurse Shortages in OECD Countries. OECD Health Working Papers No. 19, English, 59 pages, doi: 10.1787/172102620474

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