Advanced Practice

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Advanced Practice Clinical Assessment

• Where are we today?

Linda McKee Cardiothoracic Nurse
Practitioner Western Infirmary, Glasgow
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History

• Development of advanced nursing practice in UK
  fragmented and poorly documented.
• Early experimental appointments were made due to
  a shortage of junior doctors.
• Advanced practice roles however have continued to
  evolve.

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History

• Many differing titles, roles and remits
• Often leading to confusion within the profession,
  allied professions and the public.

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History

• UKCC(1994) defined Advanced Practice as
• adjusting the boundaries for the development
  of future practice, pioneering and developing new
  roles responsive to the changing needs and with
  advancing clinical practice, research and
  education enrich professional practice as a whole

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Advanced Practice of the Past

• Little formal education
• On the job training
• Often by medical colleagues
• Based on others perceptions of what was required.

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Developments

• Formal training programmes introduced for
  advanced practice university linked
  qualifications.
• NMC have acknowledged the need for advanced
  practice to be officially recognised as a
  qualification on the register

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NMC Registration

• Discussions ongoing between the NMC, Department
  of Health and educational institutions to clarify
  educational and legal requirements for Advanced
  Practice registration.
• Advanced Practice registration should be a
  reality by August 2006.

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• Clinical Assessment

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What is involved?

• Includes history taking, physical examination and
  patient management.
• Further training explores specialist skills such
  as advanced cardiac, abdominal, respiratory and
  neurological assessment.

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Ongoing Professional Development

• Work place practice is also essential to help
  reinforce newly acquired expertise.
• Support from medical peers in relation to
  practice.

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Course

• 15 week course
• One week intense top to toe clinical examination
  tutorial
• Weekly clinical examination practice sessions
• Case study with 2 OSCE stations

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Benefits to Patient

• Access to immediate examination, review and
  possible intervention.
• Builds relationship of trust with Advanced
  Practice Nurse.
• Increased patient satisfaction
• More holistic care to the patient.

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Benefits to Nurse

• Ability to systematically examine patient and
  identify potential problems.
• Ability to deliver or initiate immediate care.
• Increased autonomy.
• Actual practice instead of advised practice.

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Awareness

• Limitations of professional/personal experience
  and competence.
• When to make an appropriate referral.
• The need for ongoing clinical practice
  development.

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The Future

• Changes to cardiothoracic medical staffing and
  training.
• Increasing emphasis on advanced practice roles
  within cardiothoracic surgery departments.
• Further development of additional specialised
  practice i. e. surgeons assistants.

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Challenges for the Future

• Continuing development of clinical skills
• Ensuring standards for best practice
• Clear guidelines for advanced practice roles.
• Research and audit.

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A Familiar Situation ??
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Information

• www.pduk.net
• www.etu.sgul.ac.uk/cso/index.htm
• http//omeweb2.ucdavis.edu/doctoring/doctoring
• http//medicine.ucsd.edu/clinicalmed/links.html
• http//echt.chm.msu.edu/videolect/viewvideos.htm