Innovative community nursing roles and practice the management of minor illness'

1
Innovative community nursing roles and practice-
the management of minor illness.

• Dorothy Ferguson Andrea Hiller
• Division of Community Health
• School of Nursing, Midwifery and Community Health
• Glasgow Caledonian University

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Overview

• Context Policy
• Context Professional
• Development education the challenge
• Education delivery student ownership
• Development Community of Practice..

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Context Policy

• Our national health a plan for action a plan
  for change (Scottish Executive 2000)
• GPs no longer to be gatekeepers
• aim to improve patients journey
• General medical services contract 2004a
• GPs no longer required to provide 24 hour care
• Review of the medical workforce 2004b
• need for team working and skill mix.

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Context Professional

• Advanced Practice - NMC
• Extended Roles Scope of Practice
• Role development for nurses essential for
  modernisation of NHS
• Prepared Nurses effective in role
• Clinical care, outcomes and health service costs
  similar.

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Context Education Development

• Development funding was award to Schools of
  Nursing
• Skills required those possessed traditionally
  medics
• Development board Academic, Service Managers,
  NHS Education Scotland

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Teaching Strategy

• Focus on developing knowledge clinical skills
  through peer assessment learning
• Learn through observation/assessment of peers
• Students develop a positive approach to critical
  feedback
• Reflecting on practice becomes standard

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Ownership

• Peer learning develops partnership approach and
  responsibility for learning as group ownership
• Maintains motivation of students throughout
  module
• Peer support learningspills into exam
  preparation
• Support for practice development

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Impact on Service

• 3 area health Boards Out of Hours service changed
  to GP light.
• Audit Scotland 2007 80 of patients satisfied
  with new service

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Student Feedback

• If I was to start thanking everyone who gave me
  so much support  encouragement it would read
  like a night at the BAFTA awards so I'll just say
  I couldn't have done it without you all - this
  has to be one of the best groups I have ever
  studied with and full credit to all their
  help  
• I was really worried about the role play I find
  it so embarrassing, however you lot made it easy
  I can for the first time in my life say I got so
  much from role play and I even miss it now, have
  learned so much, use knowledge and skills
  everyday in my practice, will miss u, how long
  can BB stay open, please???
• How about we march to Uni to demand BB is kept
  open?.

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Development of Community of Practice

• QNIS funding to development online Community of
  Practice
• Community of Practice defined as
• ..a group of professionals informally bound to
  one another through exposure to a common class of
  problems, common pursuit of solutions, and
  thereby themselves embodying a store of
  knowledge (Wenger et al 2002)
• ..informal networks that support professional
  practitioners to develop a shared meaning
  engage in knowledge building among members (Hara
  Kling 2000)

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Focus of the Community of Practice

• Explore develop a description of advanced
  practice in unscheduled care.
• Main themes
• Education
• Autonomy
• Experience
• Clinical Competence

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Description of Advanced Practice in Unscheduled
Primary Care

• Members of the community of practice unscheduled
  care are registered health care professionals who
  have acquired the expert knowledge base, clinical
  competencies and complex decision-making skills
  to assess and manage patients presenting for
  unscheduled care. They are highly experienced in
  clinical practice and are educated to a minimum
  of degree level. They work autonomously within
  their scope of practice and in collaboration with
  patients and other healthcare professionals
  within the context of unscheduled primary care.

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Conclusion

• Education continually evolving with role
• Peer support and critical approach positive
  artefact
• Development of Community of Practice to support
  already established peer support
• Community of Practice identity for
  practitioners in new roles in unscheduled primary
  care.

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References

• Hara, N., Kling, R. (2002). Communities of
  practice with and without information technology.
  American Society for Information Science and
  Technology, Conference. November 23,
  Philadelphia.
• Scottish Executive. (2000) Our National Health a
  plan for action a plan for change. Edinburgh
  Scottish Executive.
• Scottish Executive. (2004a) The National Health
  Service (Primary Medical Services Agreements)
  (Scotland) Regulations. Edinburgh Scottish
  Executive.
• Scottish Executive. (2004b) Securing future
  practice. Shaping the new medical workforce for
  Scotland. Edinburgh Scottish Executive.
• Wenger, E., McDermott, R., Snyder, W.M. (2002)
  Cultivating Communities of Practice. Boston
  Harvard Business School Press.