Experience of nursing practice roles of apn


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Experience of nursing practice roles of apn

  1. 1. Experience of Nursing Practice roles of Advanced Practice Nurse (APN) “ The Future of Nursing and Caring for Geriatric Patients” Conference in Bumrungrad Hospital 31 October 2013 Sunee Suwanpasu RN, APNs Aging, Ph.D. Nursing Department, King Chulalongkorn Memorial HospitalThai Red Cross Society
  2. 2. • – • – Caregiver)
  3. 3. Advanced Practice Nursing
  4. 4. APNs in geriatric APN • • • 1. specialization) 2. expansion of practice) Long term care manager) • • • - 3. advanced practice) – –
  5. 5. – • • • • Older patients ?????? • • – –
  6. 6. The sixth vital sign • Functional status: The sixth vital sign • Optimizing functional status is a central tenet of geriatric practice (editorials in JGIM)
  7. 7. • • Preserve functional capacity of older patients • Increase safety: falls; pressure ulcer, acute confusion state • Help increase comfort • • • 40.4% of patients developed functional decline following hospitalization ( Wu et al. 2006) Before admission’ advanced age, Lower MMSE, IADL disabilities Presence of pressure ulcer, ADL disabilities, low social activities (HARP study) Hospitalization, Hypoalbuminaemia, pressure ulcer, LOS, tendency to fall (WU etal., 2006) Bed rest, or acute inactivity associated with hospitalization or disease state, posed a potent threat to muscle tissue and function capacity (Covinsky et al., 2003:Brown et al.2004; Janssen, 2006)
  8. 8. Care Management) Direct Care) educating) mentoring) coaching) Agent) Collaboration) empowering) Consultation) Change Ethical reasoning and ethical decision making) Based Practice) outcome management and evaluation) Evidence-
  9. 9. Nurses Improving Care for Health system Elders (NICHE) • Focus on the care needs of the older patients • The NICHE nursing care models – Geriatric Resources Nurse (GRN model) • • • • • • • • Provide excellent bedside nursing to hospitalized older adults Develop a corps of nurses armed with the clinical competencies to meet the needs of older adult, and serve as a resources to other staff Develop incentives and improve moral for nurses caring for the older adult Provide a mechanism for professional growth of nurses Enhance the nurse/patient relationship and patient satisfaction Promote the effectiveness of the interdisciplinary team Increase implementation of evidencebased clinical practice Facilitate safe and effective discharges Promote continuity of care between the hospital and other setting
  10. 10. Chula GRN model: improving the care of older patients in medicine unit Lecture - Small talk From the beginning •Advanced Practice geriatric Nurse •GRNs unit-based RN’s volunteer with a knowledge requirement •Nursing clinical round •Internal medicine physician provide consultation Evaluation Having the staff nurses routinely monitor and address common geriatric syndromes and share their knowledge with other staff Regularly scheduled -2 times for wks Clinical teaching rounds with a geriatric expert to address specific patient issues and integrate new geriatric knowledge
  11. 11. During round Chula SPICCES Patient Name: Date: GRN present a brief synopsis of • The patient’s history • Course of hospitalization • Treatment and expected outcome • Unresolved issues • Comprehensive assessment of hospitalized older patients SPICCES EVIDENCE YES No Sleep disorder Problems with Eating or Feeding Incontinence Caregivers preparedness Evidence of falls Skin breakdown REMARK............................................................. ........................................................................... ........................................................................... Adapted from a frameworks of six 'maker conditions of Fulmer, T. (1991) The Geriatric Nurse Specialist Role: A new Model. Nursing Management, 22(3), 91-93
  12. 12. Best practices in Nursing Care to older adults (The Hartford Institute for Geriatric Nursing) • • • • • • • • Fall prevention program Cognitive stimulation Exercise Delirium prevention Nutrition Caregiver preparedness Pressure ulcers prevention Incontinence management
  13. 13. • Behavioral Methods for Urinary Incontinence Bladder training, habit training, biofeedback, pelvic muscle exercises, timed voiding and prompted voiding. • Guidelines and position stands outlining nutritional standards of care for hospital patients; a high quality protein with each meal and essential amino acid (EAA) •Delirium prevention •Caregiver preparation • Resistance exercise and Walking program with coordination with PT& OT •Minimizing the use of sedative-hypnotic •Medication drug reconcile •Use environmental enhancement for eldercare •Multidisciplinary team small talk •Fall prevention protocol •Ensure assistive devices •Skin care •Cognitive stimulation Chula SPICCES Sleep disorder assessment Problems with Eating or Feeding assessment Incontinence assessment Caregivers preparedness assessment Evidence of falls assessment Skin breakdown assessment
  14. 14. 2nd round 1st round
  15. 15. 2nd round 1st round
  16. 16. 2rd round 1st round
  17. 17. 3th round 1st round
  18. 18. 2th round 1st round
  19. 19. Thank you and Question