Journey to Advanced Nursing Practice

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Journey to Advanced Nursing Practice
Sandra Delamere, ANP (Sexual
Health) GUIDE Clinic, St James
Hospital
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(No Transcript)
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A Reflection
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Nurse - led clinics
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March 8th 1987

• 87-4873 (nurse)
• P OD
• 87-53 (nurse)
• 87-6754 (nurse)
• J M
• 87-876 (nurse)
• 87-8765 (nurse)
• 87-4563 (nurse)
• P McM
• 87-908 (nurse)

11. Joe Bloggs (Soldier)
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Sexual Health
The physical, emotional, psychological,
social and cultural wellbeing of a persons
identity, and the capacity and freedom to enjoy
and express sexuality without exploitation,
oppression, physical or emotional harm. Sexual
health may be a primary or secondary focus of
nursing care, depending on the patient care
needs. This is more apparent for some people who
may need specific nursing care to develop and
promote sexual health. (Family Planning
Association. UK, 1999)
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Sexual Health

• Ethnicity and cultural issues
• Gender
• Age
• Economic status
• Physical and mental abilities
• Childhood experiences
• Mental and emotional health

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Sexual Health is an integral part of overall
health not just restricted to the avoidance of
STIs and HIV/AIDS. Sexual Health requires the
enjoyment of free choice, expression and
responsibility, with particular regard to the
prevention of transmission of STIs
HIV/AIDS
(Hendricks,1992)
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The Monks Report, 1988
This report highlighted the great diversity of
skills, role, responsibilities, knowledge and
training of nurses working in GUM. GUM nursing
offers many opportunities to develop a level of
nursing skills, knowledge and expertise that is
vital for an often stigmatised and neglected
patient group
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Role of Staff Nurse

• Nurse Triage
• Skilled chaperoning
• Nurse-led clinics for cryotherapy. Cervical
  screening, test of cures
• Patient information / education
• Venepuncture
• Safer sex education
• Link nurse

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Health Advisors Role (CNS)

• Contact tracing/ Partner notification
• Education/ information on STIs and treatments
• Safer sex education
• Pre and post test discussion
• Giving results, recalls and follow-up
• Lectures to nursing/non nursing staff

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ANP (Sexual Health) Role

• Deliver expert holistic clinical care
• Research
• Education / training
• Roles within practice and service development
• Consultant nurse in nurse-led clinics

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ANP (Sexual Health) role
Autonomy in Clinical practice
Expert practitioner
Pioneering Professional leadership
Researcher
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ANP (Sexual Health)

• Assessing, diagnosing, treating and discharging
  patients within an agreed caseload
• - Asymtomatic patients
• - HPV / Molluscum Contagiousum
• - Chlamydia Trachomatis
• - Vaginal Candidiasis / Balanitis
• - Bacterial Vaginosis
• - Trichomonus Vaginalis

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When nursing knowedge and theory continuously
inform a practitioners decision making, even
though some parts of the role might overlap with
medical or other healthcare professional role
then that may said to be advanced nursing
practice
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Conversely when a nurse is expected to perform
routine tasks with no opportunity to exercise
nursing knowledge or take autonomous decisions
then that is when a nurse becomes a doctors
assistant.
Read and Graves 1994
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Nurses Contibution to Sexual Health
Nurses are at the forefront of client interaction
and health education/health promotion
Preventative services
Preventative Health protection
Positive education
Preventative health
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P-LI-SS-IT Model (Anon 1976)
Level 1 The challenge for nurses at level 1 is
to create a comfortable environment that gives
patients permission to discuss concerns and
problems related to their sexuality and sexual
health.
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Level 2
Where nurses provide non-expert or limited
information relating to sexuality and sexual
health
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Level 3
Where nurses provide specific suggestions to
help patients with sexuality and sexual health
needs. Nurses need to complete training at
specialist level.
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Level 4
The most advanced level of nursing in
sexuality and sexual health care involves complex
interpersonal and psychological issues. Nurses
providing this level of care will be specialists
with family planning qualifications and further
specialist training
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Sexuality and sexual healthA legitimate area of
nursing

• Difficulties may occur because
• Poor training /education in specific area
• Lack of relevant nursing experience
• Religious beliefs or personal views on sexuality
• Embarrassment or lack of confidence that prevents
  nurses raising the issue
• Nursing culture may not regard it as important or
  appropriate

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As a health professional it is sometimes hard
to differentiate between what is personal and
what is professional. The boundaries are often
blurred and our beliefs do influence the way we
interact with our patients. In extreme cases this
can put health care professionals in a very
vulnerable position.
(Wilson , 2000)
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He questioned so calmly and easily every aspect
of my sexual development and my life that I
gradually found myself talking with almost equal
ease Carl Rogers, 1990,
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Clinical training

• 6 weeks observing sexual history taking,
  performing male and female genital examination,
  diagnoses and treatments (180hrs)
• 6 weeks being observed undertaking same (180hrs)
• 6 months independent practice (640hrs)

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Clinical Training

• Clinical supervision is provided by Dr Grainne
  Courtney
• Professional supervision is provided by Ms Anne
  Cuffe, Nurse manager

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Research and Audit

• A patient survey to compare the satisfaction of
  patients attending the ANP and the SHO, for
  sexual health screening in the GUIDE Clinic

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Succession Planning for ANPs (Sexual Health)

• A competency based framework which will replace
  the ad hoc training of the past.
• Benefits will include increased quality and more
  rapid progress through the speciality

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Transition period
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A day in the life of the ANP (Sexual Health)
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Nurse Prescribing
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(No Transcript)
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Debates

• Generalist Vs Specialist
• Mini-Doctor, Maxi-nurse

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Are Nurses trying to replace Doctors???

• Its not about turf disputes, its about good
  outcomes.
• 
  M. Smith (2004).

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Nurse Practitioners
Every clinic should have one!