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Advanced or Expanded Nursing Practice? Discussion of an “in-between-solution” for the need of new nursing roles in community nursing in rural areas in Germany
4th International ANP & APN Congress, Freiburg, 07.09.2017
Dr. Doris Arnold, UAS Ludwigshafen on the Rhine
Introduction
ANP/APN-Competencies
Scientific Certificates EB
Conclusion & Perspective
2 Doris Arnold
Introduction
ANP/APN-Competencies
Scientific Certificates EB
Conclusion & Perspective
3 Doris Arnold
Joint Project EB
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Scientific Further Education
Development of Structures
Data- and Information Management
Assessment of Needs and Research
Program Development System Supervision
Region
www.e-hoch-b.de
Doris Arnold 5
Germany
Western Palatinate
EB
Education as exponent of individual and regional
development
Evidence based needs assessment and linked development of
competencies
www.e-hoch-b.de Graphic: colourbox.de
Westpfalz/ Western Palatinate Fotograph: Doris Arnold 6
Project EB – Nursing & Health
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• Answer to Healthcare Needs • Increase in Desirability of Careers in Nursing
• Shortage of Nursing Personnel • Shortage of General Practitioners • Increase in Nursing and Healthcare Needs
Threat of Bottleneck in Supply for Nursing and Healthcare Services
Expanded Nursing Practice
Experienced and Scientifically Qualified Nurses
Feiks 2017
Few nurses with degrees in direct patient care in Germany!
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“The ratio of nurses with an academic degree amounted to 1.7 % overall, and to 1.0 % in
direct patient care. (…) There were significant variations among
hospitals nationwide concerning pay rates with a current lack of reliable pay structures.“
Tannen et al. 2017: State of development of the role of academic nursing staff at
German university hospitals in 2015
Hypothesis and Questions
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Nurses with profound clinical experience in community care can contribute to answering challenges in the provision of healthcare!
o What kind of qualification is feasible to enable nurses without academic degrees for expanded roles?
o Which competencies
are desirable?
can be obtained?
Introduction
ANP/APN-Competencies
Scientific Certificates EB
Conclusion & Perspective
10 Doris Arnold
Preliminary Definition EB Advanced Practice Nurse*
• Expert for complex situations in nursing and healthcare in the community setting
Role
• Clinical competencies for extended nursing tasks, incl. medical tasks, evidence-based practice, research skills
Competencies
• Community nursing and healthcare for chronically ill adult persons
Field of activity
• Autonomous, independent, innovative … Other
attributes
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*Project EB, Nursing & Health, Version: 31.05.2017
Geithner et al. 2016, Hamric et al. 2014
ANP/APN-Education in Germany
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Professional Nurses (RN)* via
BA/ BSc. Nursing 3-4 Y.
Professional Nurses (RN)*
via Vocational Training
3 Y.
BA/ BSc. Nursing 2 -3 Y.
*Pflegefachfrau/ Pflegefachmann
BA/ BSc. APN (other)
2-4 Y.
Master APN
Master APN
Postgrad. Education
Postgrad. Education
Clinical Experience
Clinical Experience
Ullmann et al. 2015 Doris Arnold
How do experienced nurses get an APN-Master?
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*“Akademische Schnellbesohlung“
„Academic Speed Soling?“*
Doris Arnold
„Shortcuts“
Master without Bachelor
long, long way …
Training + Experience + Bachelor + Master
Graphic: colourbox.de
Introduction
ANP/APN-Competencies
Scientific Certificates EB
Conclusion & Perspective
14 Doris Arnold
Assessment of Educational Needs
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Quantitative Research
Community nurses Western Palatinate (n=167)
Head nurses in community nursing services, Western Palatinate (n=28)
General Practitioners Western Palatinate (n=97)
Students in nursing programs in universities in Rhineland Palatinate (n=208)
Qualitative Interviews
Community nurses (11), head nurses (10), directors of community nursing services (3)
Relatives (6); General Practitioners (4)
Lecturers in Nursing (4), representatives of nursing organizations (4)
other experts (7)
Helbig et al. 2017; Scheipers & Arnold 2017
Results: Areas of Activities
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inter professional communication
intensive care
psychiatric care
palliative care
referrals (e.g. chiropodist)
prescriptions (e.g. dressings, nursing supply)
medical tasks (diabetes, dementia,
wounds, hypertension)
case- and care management
prevention + health promotion
wounds dementia care
counseling, informing, teaching
ethical + legal deliberation
extended community nursing
+ healthcare for chronically ill adult
persons
legal reasons
competition
Qualification Scenarios
• not possible without bachelor degree Consecutive
Master
• too expensive
• opposition from faculty
„Shortcut“ to Master
• lack of resources Bachelor APN
• financially feasible
• first step to APN
Scientific Certificates
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Scientific Certificates EB – Nursing & Health
Scientific Certificates
EB
strategies for treatment and
psychosocial support for living at home
with
dementia
counseling, informing, teaching
BIS
inter professional communication
in community healthcare
ethical + legal issues
in community health care
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• needs for Expanded Nursing Practice in community healthcare
Basis
• working nurses
Target group
• 15 ECTS/ Certificate (consideration for consecutive master possible)
Workload
• supervision by mentor + IT-facilitator
• practice project (app. 4 ECTS; E-Portfolio)
• min. one course in blended learning format
Basic points
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Certificates EB Framework
Graphic: colourbox.de
Head nurse working in a community nursing service, Western Palatinate
Nur Demenzerkrankte, warum die psychisch oder demenzerkrankten Menschen [sich so] verhalten? Was glaube ich, die Menschen am wenigstens akzeptieren können, [ist das] Verhalten. [Die] Erkrankung schon, weil wir wissen schon, der Mensch ist erkrankt. Der kann nichts dafür. Aber FEHLhandlungen, der uriniert irgendwo in die Ecken. Warum? Weshalb? Und so und so. Warum macht er DAS? Oder warum macht er/ diese Fehlhandlungen? (PDL09w_26.07.16)
Needs and challenges: Dementia
20 Doris Arnold *Translation: Doris Arnold
“But persons suffering from dementia, why do psychologically ill persons or persons suffering from dementia act like that? What persons can least accept is behavior. Illness is easier,
because we know this person is ill. He is not responsible. But SPURIOUS actions. He urinates somewhere into the corners. Why? How come? And so on. Why does he do THAT? Or why
does he do those spurious actions?”* (PDL09w_26.07.16)
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Needs/ Challenges
o Complex care situations with persons with dementia o Coping with challenging behavior o Counseling for Persons with dementia in their social surroundings
Features Content
o Advanced knowledge about dementia (nursing, sociology, medicine, gerontology)
o Advanced assessment and understanding clinical diagnostics o Family oriented nursing concepts for dementia care o Technological support for persons with dementia at home o Reflection about personal nursing experience in dementia care
Blended Learning
o E-Portfolio o E-Learning: Advanced knowledge about dementia; online test
with self evaluation
Practice Project
o E.g. reflection on clinical situation (in progress…)
Strategies for treatment and psychosocial support for living at home with
dementia
Graphic: colourbox.de
Introduction
ANP/APN-Competencies
Scientific Certificates EB
Conclusion & Perspective
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Conclusion
o Evidence suggests great demand for scientifically educated nurses with expanded skills in community nursing
o “Proper” APN-Education for nurses with vocational training takes a long way to go …
23 Doris Arnold Graphic: colourbox.de
Answer: Certificates EB
Competencies for expanded skills
Feasible and need-based
First step in direction to ANP/ APN
Challenges to face:
Until now, community nurses, who went to university, left direct patient care
Need for decently paid jobs for community nurses providing expanded nursing tasks
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Conclusion
Graphic: colourbox.de
Provision for needs of working nurses as students
Distance learning / blended learning formats
Counseling and supervision (tutors)
Creating possibilities for provision of expanded nursing tasks in community care
Participatory Action Research Project**
Joint working groups
Consisting of head nurses, community nurses, GPs, relatives, patients, etc.
Facilitated by member of team EB
Panel of experts to accompany working group
To Do – List 2nd Phase*: 2/18 to 7/20
25 Doris Arnold * Proposal waiting for decision ** Cf. Bryant-Lukosius & DiCensio 2004
Graphic: colourbox.de
References Bryant-Lukosius, Denise; DiCenso, Alba (2004): A framework for the introduction and evaluation of advanced practice nursing roles. In: Journal of advanced nursing 48 (5), S. 530–540.
Feiks, Alexandra (2017): Ist-Standerhebung zum Aus- und Weiterbildungsangebot und zum Fachkräftebedarf im Bereich Pflege und Gesundheit. Unter Mitarbeit von Clara Römer. Hochschule Ludwigshafen. Arbeits- und Forschungsberichte aus dem Projekt E-hoch-B – Bildung als Exponent individueller und regionaler Entwicklung (11). Online verfügbar unter https://www.e-hoch-b.de/publikationen/
Geithner, Luise; Arnold, Doris; Feiks, Alexandra; Helbig, Anna Katharina; Scheipers, Maike; Steuerwald, Tatjana (2016): Advanced Nursing Practice. Rahmenbedingungen in Deutschland und Literaturübersicht zu nationalen und internationalen Modellen erweiterter Pflegepraxis. Hochschule Ludwigshafen. Arbeits- und Forschungsberichte aus dem Projekt E-hoch-B – Bildung als Exponent individueller und regionaler Entwicklung (4). Online verfügbar unter https://www.e-hoch-b.de/publikationen/
Hamric, Ann B.; Spross, Judith A.; Hanson, Charlene M. (2014): Advanced practice nursing: An integrative approach. 4. Aufl. St. Louis, Mo: Saunders/Elsevier.
Helbig, Anna Katharina; Steuerwald, Tatjana; Arnold, Doris (2017): Bedarfsorientierte Gestaltung hochschulischer Bildungsangebote für eine erweiterte gemeindenahe Pflegepraxis – Erste Ergebnisse der quantitativen Studien des Teilprojekts "Pflege und Gesundheit". Hochschule Ludwigshafen. Arbeits- und Forschungsberichte aus dem Projekt E-hoch-B – Bildung als Exponent individueller und regionaler Entwicklung (10). Online verfügbar unter https://www.e-hoch-b.de/publikationen/
Scheipers, Maike; Arnold, Doris (im Erscheinen): Rekonstruktion hochschulischer Bildungsinhalte zur Erweiterung gemeindenaher Pflegepraxis basierend auf Experteninterviews mit Geschäftsführungen, Pflegedienstleitungen und Pflegefachkräften der Westpfalz (Arbeitstitel). Unter Mitarbeit von Dorit Dürrschmidt, Clara Römer und Alexandra Feiks. Hochschule Ludwigshafen. Arbeits- und Forschungsberichte aus dem Projekt E-hoch-B – Bildung als Exponent individueller und regionaler Entwicklung. Online verfügbar unter https://www.e-hoch-b.de/publikationen/
Tannen, Antje; Feuchtinger, Johanna; Strohbücker, Barbara; Kocks, Andreas (2017): Survey zur Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken - Stand 2015. In: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 120, S. 39–46.
Ullmann, Peter; Schwendimann, René; Keinath, Elke; Eder, Karin; Henry, Morag; Thissen, Katrin et al. (2015): Visionen und Realitäten in der Entwicklung von APN & ANP. In: Advanced Practice Nurses MAGAZIN, S. 8–23.
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Contact
Dr. Doris Arnold Fachbereich Sozial- und Gesundheitswesen Hochschule Ludwigshafen am Rhein Ernst-Boehe-Straße 4 Standort Maxstraße 29 67059 Ludwigshafen Tel.: +49 (0)621/5203-570 Fax: +49 (0)621/5203-569 Email: [email protected] http://www.e-hoch-b.de http://www.hs-lu.de/ehochb.html
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