FOCUSING ON APN THROUGH A GRADUATE PROGRAM

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FOCUSING ON APN THROUGH A GRADUATE PROGRAM

• Raisa GulRN, RM, BScN, MHAAssistant Professor
  and
• Director, Diploma ProgrammeAga Khan University,
  School of Nursing

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PRESENTATION FLOW

• Brief Overview of the Country
• ?
• Nursing Profession
• ?
• Challenges of MScN Program
• Integration of Advance Practice in Nursing (APN)
• ?
• Potential Impact Of APN

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PAKISTAN 56 Years of independence
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ABOUT THE COUNTRY

• Population of 140 Million 68 Rural and 32
  Urban
• Population growth 2.2
• Poor public health facilities
• Literacy 40
• Health care access, strong rural urban
  disparities
• IMR, 95 per 1000 live birth
• MMR, 200-700 per 100, 000
• Double disease burden infectious diseases ,
  Hepatitis (TB) and Hypertension, diabetes,
  cancers, mental Health problems
• Estimated of Doctors gt100000 Nurses 33000
  so, 1 nurse 3-4 doctors

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NURSING IN PAKISTAN

• Have Nurses, Lady Health Visitors and Midwives
• Entry to nursing education is grade 10-12
• Nurses are confined to hospitals, 20-30
  patients/nurse
• Predominant use of students for services
• Quality of nursing education is low
• Nursing Education, diploma and post basic diploma
  
• Demand for higher education by employer is low
  except at AKUH
• Opportunity for higher education is limited
• Limitation of nursing leadership and physicians
  dominance in Health Care System.

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AGA KHAN UNIVERSITY SCHOOL OF NURSING VISION Of
THE CHANCELLOR Promotion Of Nursing

• Begin with SON in 1980 as a break through
• Had an expatriate director and national faculty
  with post basic diploma
• 23 years later, have national Dean and Directors
• All faculties with at least undergraduate degree,
  but also Masters and PhDs
• Programmes development
• 1980 General Nursing Diploma
• 1988-Post RN BScN
• 1997 BScN
• 2001- MScN

First program in the country
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CHALLENGES OF ESTABLISHING MScN

• a) Conceptual Phase
• Creating awareness, ownership and approval
• Physicians, it takes nurses away from the real
  work
• Employer university Administration, how will
  they be differentdo we need to spent more money?
• Nurse Leaders, sense of insecurity

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Contd

• Strategies
• Communication, rationalization with current
  trends in nursing education
• Success of the developed Countries
• Assuring for strong consideration to enhance
  clinical knowledge, i.e. 22/59 credits (37 ) as
  core courses in the curriculum.

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b) Planning Phase

• Approval of the Board, concern for resources both
  human and financial
• Strategies
• Faculty development plan, sponsorship for
  graduate studies
• Expatriate faculty, visiting and short term
  contracts
• Collaboration with other universities abroad,
  Sheffield University and Minnesota

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• 2. Curriculum composition, specialist versus
  generalist Master
• Took generalist approach, with emphasis on
• Research and Clinical Practice due to
• Limited pool of nurses with BscN at the national
  level
• Diversity of potential candidates for MScN
• Envisaging greater impact through developing
  leaders
• 3. Developed transition programme in view of
  the national needs

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MScN CURRICULUM
5
Total Credit hours 59
10
7
37
41
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c) Implementation Phase

• Availability of expatriate faculty , 9/11/2001
• Undesirable effects of Faculty development plan
• Variation in employers demand
• Visa and licensure issues for students advance
  clinical practicum abroad
• Students perspectives, program credibility, cost
  benefits analysis
• Pool of potential students further decreased
  affecting enrollment in MScN.

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Strategies

• Pooling of resources within the university
• Inter departmental collaboration
• Physicians as preceptors for Advance clinical
  Practicum
• Visiting and Sessional faculty

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Our Experience of Advance Clinical Practicum

• Students comments
• Culturally it is appealing, will have more
  respect.
• Our role of counseling and teaching was very
  much appreciated.
• 50 of patients need counseling and teaching to
  cope with their diagnosis.
• patient were receptive to get examined or
  advised by a nurse.

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Contd

• Doctors were learning from us and we learned
  from them this Will definitely impact nurses
  image.
• If we identified what was missed out, they
  Physician were appreciative rather then
  defensive.
• Me and my preceptor have begun to work on
  research project.
• Physician remarked I am afraid if you have a
  clinic next to me. I will loose my patients to
  you.

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Students, Patients and Physicians perspectives

• Chance of independent decision making
• Application of knowledge, especially counseling
  and patient education
• Enhancement of assessment skills
• Projects nurses strengths and potential,
• Source of mutual and enrich learning experience
• Strengthening Nurse- Physician collegiality
• Enhance awareness among public about the scope of
  nurses work.

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Advance Practice in Nursing (APN)Concept to
implementation

• Need a vision
• Availability of human and financial resources
• Educational preparation of nurses at graduate
  level
• Creation of systems to recognize the APN role
• Requires credentialing and licensure by the
  regulatory body of nursing in the country.
• Note Importance of the decision maker should
  never be overlooked

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CONCLUSION

• Although the issue of role creation and
  Licensure by Pakistan Nursing Council for
  Advance Practice in nursing (APN) yet to be
  addressed, the potential Impact of APN in
  Pakistan appears promising with greater awareness
  and outcome in future.
• Chances for APN role are bright in the private
  sector, but it will take time for acceptance in
  the public sector.

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ACKNOWLEDGMENT

• Graduate Nursing Committee, Aga Khan
  University School of Nursing
• Madrean Schober
• THANK YOU