Advanced practice nurse role within palliative care Essay

The intent of this assignment is to compare and contrast the current literature related to advanced nursing pattern. And to associate this literature to my pattern and the function of the alleviative attention nurse across clinical scenes.

In my current function as a hurting nurse specializer. I am involved in the attention and direction of patients with intrathecal ( IT ) catheters chiefly for patients with intractable malignant neoplastic disease hurting. Patients who have been tried and failed on intensifying doses of assorted opiates. and continue to hold unsatisfactory hurting direction with unbearable side effects are frequently referred to our service for consideration for an intrathecal catheter. Intrathecal catheters have been used for many old ages now in attempt to aim the specific hurting tracts within the spinal cord. as the medicine is delivered straight into the Central nervous system. merely little doses are required. and therefore patients experience less side effects. with improved hurting control ( Myers. J. Chan. V. . Jarvis. V. . Walker-Dilks. C. . 2010 ) .

The bulk of these patients are nearing the terminal phases of their disease procedure. therefore we work rather closely with the infirmary Palliative attention service when the patient in an inmate. However post discharge we visit the patients weekly in their ain places. this frequently involves working at an advanced nursing degree. working autonomously. measuring the patient and titrating medicine via their IT pump. with some way from the physician at Auckland infirmary. However this function besides involves supplying the patient and their household with an component of alleviative attention besides. they frequently require extra emotional support at this phase.

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In 2002 the World wellness organisation ( WHO ) defined alleviative attention as

” An attack that improves the quality of life of patients and their households confronting he jobs associated with life endangering unwellness. through the bar and alleviation of agony by agencies of early designation and faultless appraisal and intervention of hurting and other jobs. physical. psychosocial and religious. ”

Advanced nursing pattern refers to nurses working at an expanded degree of pattern within a specialised country. Advanced pattern is by and large defined as the integrating of practical cognition. clinical experience. theoretical cognition and research base. instruction. and may affect organisation leading ( ANA. 1995 ) . The term advanced pattern has been given to assorted functions within nursing. such as Clinical nurse specializers ( CNS ) . nurse practicians ( NP’s ) and other specialised functions within nursing. such as the anesthetic nurse ( Davies. Hughes. 1995 ) .

The literature related to advanced nursing pattern and alleviative attention was reviewed utilizing on-line databases. such as Medline. Ovid. Pubmed and the Cumulative index for nursing and allied wellness literature ( CINAHL ) . Cardinal words used in the hunt. were ‘advanced pattern nursing’ . ‘Clinical nurse specialist’ . ‘nurse practitioner’ . ‘palliative care’ and ‘nurse prescribing” .

After reexamining the literature. three articles were selected. and will be summarized below.

Article one

In 2004 Aigner et al did a comparative survey of nursing resident results between attention provided by NP/Physicians. compared to Physicians merely. The survey was based in Texas. USA. The chief aim of the survey was to find how the criterion of attention for nursing places occupants compares when provided by either NP/Physician. or physician merely.

Eight nursing places were evaluated. and two hundred and three occupants were indiscriminately blinded. Chi-squared trials were used for comparing for the information analysis.

Four results were selected to measure the quality of the attention provided by the two groups. they were. patients charts were retrospectively reviewed and the undermentioned result assessed-

Number of presentations to the exigency section ( ED ) . the cost of the visit. and the diagnosing.

Number of hospital admittances in general. and the cost of being admitted to infirmary.

The figure of acute visits and diagnosings for that visit.

The completion of advancement notes. patient histories and appraisals.

Besides the mean figure of medicines used by each topic and the figure of telephone calls and / or bleeps relayed to the nurse practician. was collated. Comparisons were besides made between the two groups sing. diagnosing made during acute visits compared to during hospital admittances. and the comparing between the cost of perennial admittances versus hospitalization ( Aigner. M. . Drew. S. . Phipps. J. . 2004 ) .

The consequences overall did non demo a important difference of attention provided by either the NP/physician group compared to the doctor merely group. No lessening was found in the sum of ED presentations and the costs were about the same. There was nevertheless a important difference in the sum of ague visits made by the NP/Physician group. which was probably related to an addition presence of the NP in the nursing places ( P

If a similar survey was to be conducted once more. it would interesting to research patient satisfaction between the two groups. and the satisfaction of the other staff working within each clinical country. And besides to look more into cost effectivity.

Article 2

Macmillian nursing was foremost introduced to the UK in 1975. and today there are over 2000 Macmillan nurses. The function of the Macmillan nurse is a specializer alleviative attention nursing function that involves adept clinical accomplishments. audience. instruction. instruction and leading ( Corner et al. 2002 ) .

In 2007 Ryan -Woolley. McHugh. G. and Lucker. K. conducted a survey in Manchester. looking at Macmillan nurses position on nurse prescribing in malignant neoplastic disease and alleviative attention medical specialty. It looked at the sensed incentives of why specialist nurses felt nurse prescribing would profit them and their patient groups. and besides explored the possible barriers to developing for the execution of this drawn-out function.

A national postal study was sent out to 2225 Macmillan nurses throughout the UK. 70 % response rate was achieved ( 1575 ) . 11 % of Macmillan nurses who responded were already trained as drawn-out formulary independent nurse prescribers. One-half of the nurses ( 88 of 168 ) were able to order from the drawn-out drug pharmacopeia. The average age was 43. 9 old ages ( SD 7. 3 ) . with a scope 26-63 old ages. The bulk of the nurses that responded were either working as alleviative attention clinical nurse specializers ( CNS ) ( 772. 49. 0 % ) or tumour site specific CNS ( 413. 26. 2 % ) . Others were either working as different types of CNS in the community ( 83. 5. 3 % ) . oncology ( 61. 3. 9 % ) and chemotherapy ( 19. 1. 2 % ) or as a lead malignant neoplastic disease nurse ( 45. 2. 9 % ) ( Ryan-Woolley et al. 2007 ) .

Extended formulary independent nurse prescribing ( EFINP ) was initiated in the UK in 2002. to let patients to acquire improved entree to medical specialties and besides do the best usage of nurses clinical accomplishments and experience. This differs from independent nurse prescribing. as independent nurse prescribers may necessitate to measure and name and handle patients ( Ryan-Wooley et al. 2007 ) . 21 % or nurses who completed his study had completed the EFINP class. . some had completed other relevant classs that enabled them to be independent prescribers. and 2 % were in the procedure of finishing the EFINP class ( Ryan-Wooley et al. 2007 ) .

In the studies the overall understanding was that nurse ordering improved patients attention by enabling them to have their medicine in a timely manner. One one-fourth of the prescribers felt there were issues around preparation. and that the medical mentoring was non equal. Some felt that the preparation provided was non specific plenty for malignant neoplastic disease and alleviative attention nursing. Out of 88 of the nurses who were already ordering. 44 were community based. 28 were infirmary based. and the other 15 were based in both the infirmary and community. The bulk of the nurses had been ordering on a regular basis throughout the past month. The makings of Macmillan nurses were assorted with around half holding a first grade ( 57 % ) but merely a minority ( 244 of 1504. 16. 2 % ) holding a Masters grade.

Some of the barriers for nurse prescribing that were identified in the study were ;

Having a supportive organisation and squad

Having medical support

Clinical supervision/mentorship

Multi-disciplinary squad ( MDT ) support

Appropriate guidelines

Fiscal inducement

Supported pattern and preparation one time practising

Entree to GP computing machine systems ( Ryan-Wooley et al. 2007 ) .

Article 3

In 2012 Steiner. K. . Carey. N. Courtney. M. . did a survey on the profile and pattern of nurses who prescribe hurting medicine throughout the United Kingdom ( UK ) . They looked at the nurse backgrounds. experience. work scene and prescribing pattern. 214 nurses throughout the UK that were on the Association for nurse prescribing ( ANP ) website were sent a questionnaire. All participants were qualified as nurse independent /supplementary prescribers ( NIP/NSP ) . The questionnaire included fixed pick and open-ended inquiries. The questionnaire had four subdivisions ;

Section 1 covered demographic information ( age. occupation rubric. country of pattern. geographical country. type of services provided. how many nurse prescribers the service had. and what future commissariats they had in topographic point for nurse prescribers within that clinical country.

Section 2 looked at ordering makings. degrees of experience and the country they practiced in.

Section 3 focused on nurse prescribing within hurting direction. including the type of medicines prescribed and the figure of hurting medicines that would be prescribed during a typical hebdomad.

Section 4 asked the nurses about the degree of developing they had received to go a nurse prescriber. and if they were satisfied with the preparation plan that they had undergone. and if they had any unrealized preparation demands. It besides asked them what there preferable preparation method was.

Out of the 214 nurses that responded. 35 % were in primary wellness attention and nurse practicians. 11. 7 % were hurting or alleviative attention nurses and 10 % in exigency attention. The nurses worked across a assortment of scenes. both primary. secondary and third attention.

43. 1 % prescribed hurting medicines up to 5 times per hebdomad. and 42. 6 % prescribed between 6-20 times per hebdomad. and remainder prescribed upto 50 times per hebdomad. The chief class nurses prescribed medicine for was patients in acute hurting station surgery ( 40. 6 % ) . 12 % prescribed for patients with malignant neoplastic disease or advanced unwellness ( alleviative attention ) . 12. 1 % prescribed for chronic hurting. A farther 33. 6 % prescribed for patients with a convergence of different strivings. The chief types of medicine prescribed were as follows-

Paracetamol and Non steroidal anti inflammatories ( 95. 3 % )

Opioids ( 34. 6 % )

Other medicines to handle side effects. such as antiemetic’s. were besides prescribed by the nurses. The nurses who worked within a hurting service or alleviative attention service were significantly more likely to order opiates than the other participates ( p The deficiency of preparation at an appropriate degree ( n=9 )

The deficiency of support for function development ( n=1 ) .

The preferable learning methods of the nurses surveyed were:

Elearning ( 74. 3 % )

Diaries ( 69. 6 % )

Formal survey yearss ( 62. 6 % )

Ordering forum ( 57. 5 % )

Work-based larning 45. 3 % ) ( Stenner et al. 2012 ) .

Despite the comparatively low sample size. this survey clearly identifies that nurses working in a broad assortment of scenes throughout the UK are ordering hurting medicines. It besides identifies that nurses in hurting specializer or alleviative attention functions are more likely to hold station alumnus instruction in hurting direction. and besides more likely to order strong opioids. Training and development issues were highlighted.

Discussion

By 2051. it has been predicted that there will be over 1. 14 million people aged 65 old ages and over in New Zealand ( NZ statistics. 2000 ) . by 2051 there is likely to be approximately half as many older people than kids ( NZ Stats. 2000 ) . In the last decennary. the figure of people being diagnosed with malignant neoplastic disease has increased by 24 % ( Ministry of wellness 2001 ) . Therefore there will necessitate to be sufficient alleviative attention services to run into the demands of an increasing figure of people with malignant neoplastic disease. Introducing more NP’s into specializer alleviant attention services would possible be a good manner of pull offing the increased work load predicted. More NP’s in the community and residential attention installations may besides take the strain off third centre’s. by forestalling hospital admittances.

To help with the predicted addition holding NP or CNS that can order will assist ease the load. The Acute hurting service nurse specializers at Auckland metropolis infirmary are presently in the procedure of using for expanded pattern functions. to let nurses with the right station graduated preparation ( harmonizing to NZ nursing council model ) to order a limited figure of medicines. working alongside a designated prescriber. In 2013 the NZ nursing council put together a audience papers for expanded/extended nurse prescribing. it stated “that the ground for this audience is to better patient attention by enabling registered nurses to do prescribing determinations so patients receive more accessible. seasonably and convenient health care. The function of the Nursing Council is to guarantee public safety in making that end.

The grounds for widening nurse prescribing are to:

• better patient attention without compromising patient safety ;

• make it easier for patients to obtain the medical specialties they need ;

• addition patient pick in accessing medical specialties ; and

• make better usage of the accomplishments of wellness professionals” ( NZ Nursing council. 2013 ) .

In order for nurses to obtain expanded pattern functions. professional development and acknowledgment plans ( PDRPs ) are being introduced. so nurses have a model to work to ( Kai Tiaki. 2009 ) .

As discussed in both articles 2 and 3 there are likely to be some deductions to the debut of this new function. such as financial/time restraints. deficiency of medical support. standardisation of preparation and on traveling instruction needed to stay up to day of the month on current pattern ( Ryan-Wooley at EL. 2007. Stenner at EL. 2012 ) .

However with the continued deficit of physicians and the continued addition for health care. particularly within the older population. spread outing the function of the nurse is a necessary enterprise. which is likely to better patient results ( World wellness organisation. 2006 ) .

Introducing expanded nurse functions and designated prescribing into alleviative attention services within New Zealand. particularly in primary and residential place scenes. may be a good manner of pull offing the predicted increased demand for more alleviative attention services in the hereafter. secondary to the rise in the older population and the figure of people being diagnosed with malignant neoplastic disease. As mentioned in the above articles it will supply patients with a more effectual service that they can entree easy. diminish the load on physicians. supply a more cost effectual service. and probably a more holistic attack to patients ( Aigner. M et Al. 2004 ) . Besides more nurses may be inclined to develop for the function as the outlook and instruction required is less than what is required to be an NP.

In relation to my function as a hurting nurse specializer and lovingness for alleviative patients with intrathecal catheters. I believe the execution of expanded pattern nursing with designated prescribing and or a Nurse Practitioner function would without a uncertainty better patient results. Pain is the most concerning facet for patients ( and their household ) confronting the terminal phases of their life. and presently malignant neoplastic disease hurting is under-treated in about 50 % of patients ( Joshi. M. . Chambers. W. . 2010 ) . At diagnosis 20-50 % of malignant neoplastic disease patients present with hurting and 70 % of patients with advanced disease will necessitate big doses of strong opiates for hurting direction ( Joshi. M. . Chambers. W. . 2010 ) .

These patients will frequently stop up being admitted into infirmary for hurting direction. and direction of associated side effects. and the quality of there life is frequently really impaired due to the side effects of opiates ( sleepiness. sickness. pruritis etc ) . Harmonizing to recent figures from Auckland infirmary. the cost of an inmate bed is over $ 4000 a twenty-four hours. When patients have intrathecal catheters inserted for their hurting direction. they require significantly less opiate. and hence side effects are less. With good hurting control and minimum side effects these patients can frequently return to there places and have a better quality of life. and non necessitate perennial infirmary admittances for hapless hurting control. which therefore saves 1000s of dollars to the wellness service.

However due to the possible unsafe complications related to Intrathecal analgesia ( infection. catheter migration. overdose ) ( Sjoberg. L. . et Al. 1991 ) . specialized nursing direction is required in the community ( Myers et Al. 2009 ) . If there were more specialised Nurse practicians or CNS with delegated prescribing rights. in the primary attention puting. patients could be discharged from infirmary Oklahoman and medicines titrated and symptoms treated within the patients place. without necessitating a Doctor to do alterations to prescriptions and hence supplying the patient with more effectual and timely intervention.

Aside from hurting and symptom direction. holding the advanced cognition and accomplishments to supply the necessary psychosocial. emotional and religious support to both patients and their household is besides really of import in this patient group ( O’Connor. M. . Lee. S. . Aranda. S. . 2012 ) . Often clip listening and reding these patients can be more of import than the medicines ( Meier. D. . Beresford. L. . 2006 )

Decision

Harmonizing to WHO. 56 million people die throughout the universe each twelvemonth. 60 % of these people would profit from alleviative attention. With the sum of older people in New Zealand predicted to increase so quickly in the following 50 old ages. the demand for more advanced pattern nurses within this forte is obvious. A comprehensive model is required to let nurses to hold a sound professional development program and supplying good clinical support and continued chances for acquisition is necessary. Primary wellness attention scenes have been highlighted as an country were NP and CNS are in deficit and likely investing in developing nurses with the necessary advanced accomplishments to pull off alleviative patients in the community will be a cost effectual investing in future old ages by maintaining patients out of third attention. and likely better patient and household satisfaction by supplying a more holistic attack to the terminal phases of life.

Mentions

Aigner. M. . Drew. S. . Phipps. J. . . ( 2004 ) . A comparative survey of nursing place occupant results between attention provided by nurse practitioners/physicians versus physicians merely. _JAMDA_ . 16-23.

ANA. ( 1995 ) . _Advanced nursing practice_ .

Davies. B. H. . A. . . ( 1995 ) . Clarification of advanced nursing pattern: features and competency. _Clinical nurse specializer. 9_ ( 3 ) . 156-160.

Joshi. M. . Chambers. W. . ( 2010 ) Pain alleviation in alleviative attention: a focal point on interventional hurting direction. _Expert reappraisal of neurotherapeutics. 10. 5. _ 747.

Meier. D. . Beresford. L. . ( 2006 ) Advanced pattern functions in Palliative attention: a Pivotal function and position. _Journal of alleviative attention medical specialty. 9 ( 3 ) . _ 624-627

Ministry of Health. ( 2001 ) . The NZ _Palliative attention strategy_ .

Myers. J. . Chan. V. . Jarvis. V. . Walker-Dilks. C. . . ( 2010 ) . Intraspinal techniques for hurting direction in malignant neoplastic disease patients: a systematic reappraisal. _Support malignant neoplastic disease attention. 18_ . 137-149.

Nursing council of New Zealand. ( 2013 ) . Nurse ordering audience papers.

O’Connor. M. . Lee. S. . Aranda. S. ( 2012 ) _Palliative attention nursing-A usher to pattern. . _ Ausmed publications. North Melbourne. Austrailia.

World wellness administration. ( 2002 ) . _Palliative attention plan_ .

Ryan-Wooley. M. . G. . Lucker. K. ( 2007 ) . Ordering by specializer nurses in malignant neoplastic disease and alleviative attention: consequences of a national study. _Palliative medical specialty. 21_ . 273-277.

Sjoberg. M. . Appelgren. L. . Einarsson. S. . Hultman. E. . Linder. L. . Nitescu. P. . Curelaru. I. . ( 1991 ) _Long -term intrathcal morpine and bupivicaine in “refractory” malignant neoplastic disease hurting. I. Consequences from the first series of 52 patients. Acta Anaesthesiology Scand. 35_ . 30-43

Statisticss. N. Z. ( 2000 ) . _Population ageing in NZ_ .

Stenner. K. . . Carey. N. . Courternay. M. . . ( 2012b ) . Ordering for pain-how do nurses lend? A national questionnaire study. _Journal of clinical nursing. 21_ . 3334-3345.

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