advanced role of nurse practitioner Define preoperative nursing and operating room nurse. Describe phases of the preoperative period. Describe the physical environment of the OR. Show specific areas within the operating room (OR). Locate and describe the use of furniture and equipment in the operating room. Identify the role of each member of the operating room team. Discuss how environmental layout contributes to aseptic technique. Perioperative nursing care is crucial in ensuring the well-being and safety of patients throughout the entire surgical process. It requires a high level of skill, knowledge, and attention to detail. play a vital role in promoting positive surgical outcomes and providing patients with the support and care they need during this vulnerable time.

1. Dr. Rajalakshmi Murugan
Associate Professor
AAU
1

2. Advanced Management of
Common Acute Pediatric Problems
Objectives
1. Understand epidemiology of illness
2. Demonstrate advanced skill in triaging and presenting
findings to other health care providers
findings to other health care providers
3. Integrate pathophysiology, epidemiology, developmental
stage, and age in the development of a differential
diagnosis based on a presenting symptom
 Hierarchal ranking of a differential diagnosis
 Rule in/Rule out of a diagnosis
4. Management of an emergency
2

3. Objectives (continued)
6. Apply strategies used to enhance, maintain and restore
health
7. Demonstrate increasing ability to communicate to other
health care providers and patients and families.
Understand the critical importance of interpersonal
transactions as they relate to therapeutic patient
outcomes
outcomes
8. Identify when consultation and referral to other health
care providers is necessary because the patient’s health
concern and intervention required exceeds the scope of
practice of the novice PNP in clinical practice
9. Review electronic/Internet-based sources of information
about evidence-based health care for children and
adolescents
3

4. Topics
 Role of the Nurse Practitioner in Acute Care
 Emergency management
 Mechanism of Injury
Differential diagnosis
 Differential diagnosis
 Urgent Issues in neonatal problems ,Psychiatry,
Respiratory, Cardiac, GI, Nephrology, Integument,
Neurology
4

5. The Nurse Practitioner
 Provides direct care focusing on health promotion and
the treatment and management of health conditions
 Is a “registered nurse” with additional educational
 Is a “registered nurse” with additional educational
preparation and experience who possesses and
demonstrates competencies to autonomously
diagnose, order and interpret diagnostic tests,
prescribe pharmaceuticals and perform specific
5

6. Acute Care Nurse Practitioner
(ACNP) Competencies
 Core clinical competencies
• Professional Role, Responsibility and
Accountability
Accountability
 Assessment of health status
 Diagnosis of health status
 Plan of care and implementation of treatment
 Health Promotion and Prevention of Illness and Injury.
 Specialty competencies
The specific knowledge, skills and personal attributes required for a nurse practitioner to
practice safely and ethically in a designated role and setting in specialty area
6

7. Health Assessment and Diagnosis
 Performs a focused health assessment and/or an
advanced comprehensive health assessment,
using and adapting assessment tools and techniques
based on client needs and relevance to client.
 Performs a complete or focused health history
appropriate to the client’s situation, including
physical, psychosocial, emotional, ethnic, cultural and
spiritual dimensions of health.
7

8. Health Assessment and Diagnosis
 Performs a complete or focused physical examination,
and identifies and interprets normal and abnormal
findings as appropriate to client presentation.
 Synthesizes health assessment information using
 Synthesizes health assessment information using
critical inquiry and clinical reasoning to diagnose
health risks and states of health/illness.
 Formulates differential diagnoses through the
integration of client information and evidence
informed practice.
8

9. Health Assessment and Diagnosis
 Anticipates and diagnoses emergent, urgent and life-
threatening situations.
 Orders and/or performs screening and diagnostic
investigations, interprets results using evidence-
informed clinical reasoning and critical inquiry, and
informed clinical reasoning and critical inquiry, and
assumes responsibility for follow-up.
 Diagnoses diseases, disorders, injuries and conditions,
and identifies health needs, while considering the
client’s response to the health/illness experience.
 Communicates with clients about health assessment
findings and/or diagnosis, including outcomes and
prognosis.
9

10. core competencies
 four categories of advanced nursing practice:
 Professional Role, Responsibility and Accountability
 clinical practice;
collaboration, consultation and referral;
 collaboration, consultation and referral;
 research; and leadership.
10

11. Clinical Practice
 Practices in accordance with federal and
provincial/territorial legislation, professional and
ethical standards, and policy relevant to nurse
practitioner practice.
practitioner practice.
• Incorporates knowledge of diversity, cultural safety
and determinants of health in the assessment,
diagnosis and therapeutic management of clients and
in the evaluation of outcomes.
11

12. Clinical Practice
 Incorporates knowledge of developmental and life
stages, pathophysiology, psychopathology,
epidemiology, environmental exposure, infectious
diseases, behavioural sciences, demographics
diseases, behavioural sciences, demographics
and family processes when performing health
assessments, making diagnoses and providing
overall therapeutic management
12

13. Clinical practice
 Provides client diagnostic information and education
that are relevant, theory-based and evidence
informed, using appropriate teaching/learning
strategies.
 Documents clinical data, assessment findings,
diagnoses, plans of care, therapeutic interventions,
diagnoses, plans of care, therapeutic interventions,
client responses and clinical rationale in a timely and
accurate manner.
 Engages in ongoing professional development and
accepts personal responsibility for maintaining nurse
practitioner competence.
13

14. Profiles of ACNP Roles - VIDEO
 Emergency
 Critical Care
 Specialty Practice
Inpatient
 Inpatient
 Outpatient
14

15. PNP Role in Emergency
 Direct nursing care, Assessment, planning, nursing
diagnosis , differential diagnosis , Treatment and
nursing care .
 Triage all sick children when they arrive at a health
 Triage all sick children when they arrive at a health
facility, into threec ategories:
 - those with emergency signs
 - those with priority signs
 - those who are non-urgent cases.

15

16. PNP role in emergency
 Assess a child’s airway and breathing and give
emergency treatments.
 Assess the child’s status of circulation and level of
consciousness.
consciousness.
 Manage shock, coma, and convulsions in a child.
 Assess and manage severe dehydration in a child with
diarrhoea.
 Plan and implement ETAT in their working area and
respective health
 facility.
16

17. Collaboration – Key Elements
 Responsibility
 Accountability
 Coordination
 Communication
 Communication
 Cooperation
 Assertiveness
 Autonomy
 Mutual trust
 Respect
17

18. Collaboration
 Multi-faceted concept
 Requires both independent and shared accountability
 Factors affecting collaboration:
Government support
 Government support
 Collaborative Practice agreements
 Leadership
18

19. Collaboration - Challenges
 The culture of professions and organizations
 Language, communication, socialization
 Values, beliefs, attitudes
 What does this mean?
19

20. Research
 Engages in evidence-informed practice by critically
appraising and applying relevant research,
best practice guidelines and theory when providing
health-care services.
health-care services.
 Develops, utilizes and evaluates processes within the
practice setting to ensure that clients receive
coordinated health services that identify client
outcomes and contribute to knowledge development.
20

21. Research
 Identifies and implements research-based innovations
for improving client care at the individual,
organizational and systems levels.
 Identifies, collects data on, and evaluates the
outcomes of, nurse practitioner practice for clients and
the health-care system.
21

22. Research
 Collaborates with other members of the health-care
team in the clinical area to identify research
opportunities and to conduct and/or support research.
 Acts as a change agent through knowledge translation
 Acts as a change agent through knowledge translation
and dissemination of new knowledge that
may include formal presentations, publication,
informal discussions and the development of best
practice guidelines and policies.
22

23. NP Leadership
 “Nurse Practitioner leaders are noticeably absent from
nursing literature”
“In order for NPs to increase exposure to their role and
 “In order for NPs to increase exposure to their role and
unique knowledge base, they must emerge as leaders
and experts in their field, demonstrating their
advanced skill set through publishing and presenting
at rounds and conferences. By contributing to
scientific knowledge, potential collaborators will gain
familiarity with and recognize the value of this role”
23

24. Leadership
 Provides leadership in the management of clinical care
and is a resource person, educator and role model.
 Acts as a preceptor, mentor and coach to nursing
colleagues, other members of the health-care
team and students.
24

25. Leadership
 Articulates and promotes the role of the nurse
practitioner to clients, other health-care providers,
social and public service sectors, the public, legislators
and policy-makers.
and policy-makers.
 Provides leadership in the development and
integration of the nurse practitioner role within the
health-care system.
25

26. Challenges of ACNPs in the Acute
Care Setting
 Evolving and gaining recognition
 Often report to individuals (physicians/administrators)
who are unfamiliar with the role
 Role articulation
 Role articulation
 Other professionals feel threatened by the role
 Full utilization of role components (education,
leadership, research)
 Scope of practice
 Funding
 Measuring outcomes
26

27. Implementation of the ACNP role
1. Employ a change model
2. Assign a champion
3. Articulate a vision
4. Establish a forum to facilitate communication
4. Establish a forum to facilitate communication
5. Attend to cultural and personality transitions
27

28. Activity
 In groups of 3-4
 Conceptualize an advanced practice nursing role in an
acute care setting in Ethiopia
 Create a role description
 Create a role description
 Complete a SWOT Analysis
 Create a strategy for implementing this role
28

29. Analysis of Acute Care Nurse
Practitioner Role in Ethiopia
Helpful to introduction
of the role
Harmful to
introduction of the role
Internal
(attributes of
organization)
Strengths Weaknesses
External
(attributes of
environment)
Opportunities Threats
29

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