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The Evolving Roles of Critical Care Nurses in HK ICU

Annual Scientific Meeting 2012 Hong Kong Society of Critical Care Medicine

2 December 2012 @ Eaton Smart Hotel

Dr. Esther WONG RN; RM; MSc.; Phd.; FHKAN (Critical Care); FHKAN (Management)

President, Hong Kong College of Critical Care Nursing (HKCCCN)

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Nurses in ICU

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Contents• History of Nursing & An overview of Critical Care

Nursing in HK

• Nursing Manpower & Career Progression Model

• ANP & APNs

• The Operational Definition of APN

• Challenges of APN(Critical Care) & Contribution of Critical Care Nurses.

• The way ahead

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History of Nursing & An Overview of Critical care Nursing

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History of Critical Care Nursing (1)

4000B.C. The priests were the healers. The healing treatment included prayers

and sacrifices. • The actual care of the patients, such as dressing wounds was done by

helpers.

2000 -1000 BC• People thought that diseases were the result of sin. Illness was seen

as “magic”, “sin” or “punishment’.

460 B.C.• Hippocrates, the “Father of Modern Medicine” was born. He

founded the most famous center of medicine. He discovered that diseases are due to disordered function of the body and that the evil spirits were not the cause of diseases. His treatment was based on close clinical observations of signs and symptoms. His medical notes are still regarded as models. He required that all physicians should take an oath to preserve the ethics of medical practice. The “Hippocratic Oath” is still taken by every qualified physician today.

• However, even during Hippocrates’ time there was no mention of trained personnel giving skilled nursing care.

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History of Critical Care Nursing (2)During the Christian Era - the monks and nuns cared for the sick,

the poor and the aged.

17 CenturyIn France - The most important order was that of “Augustinian Sisters” . The

Sisters did nursing care as well as domestic work. They lived a religious life and their work was directed by priests.

• Later Vincent de Paul, a French priest, took interest in nursing. He organized a group of country girls who had good character and trained them in giving nursing care to the sick in hospitals and in homes. From this group of girls he selected some and founded community of religious sisters. This community was called “Sisters of charity” (or “Sisters of Vincent de Paul”). Their prime function was to care for the sick. Vincent de Paul wanted the sisters to learn reading, writing and some arithmetic. Later on, sisters were instructed to obey the physicians and to serve patients whole-heartedly.

Middle of 18th century and the beginning of 19th centuryIn the US - nursing services started to be delivered by civil nurses in the US.

1019C. “Mother of Modern Nursing”/ “Founder of modern nursing”

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History of Critical Care Nursing (3)

19 Century – Dawn of Modern Nursing

An English lady, Florence Nightingale (1820-1910) studied nursing in the first REAL nursing school- Kaiserwerth Deaconess Institute.

• Military Nursing - she was sent to serve in the Crimean War with 38 women in 1854. British Casualties were high; she started to separate patient groups to be nurses, established cleanliness & sanitation rules and improved water supply. Patients received special diets and proper nursing care.Within 6 months, the mortality rate in the Barrack Hospital in Turkey was reduced from 42 to 2 percent.

• Nightingale was a nurse philosopher statistician, and historian.

• She established a reputation which allowed her to establish Nursing School and improve nursing standards at home.

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History of Critical Care Nursing (4)

20 Century in HONG KONG• 1960 – Government started to send nurses to be trained in the United Kingdom

(Critical Care Nursing ENB 100).

• 1983 - With input from senior nurses with overseas experience, the local basic ICU training started as in-house program at QMH, HK .

• 1985 – Medical & Health Department Era– short specialty program with no certificate issued.

• 1991 - Post Basic Nursing Studies Era- Started Intensive Care Nursing Training as certificate program.

.. • 1995 – Institute of Advanced Nursing Studies (IANS) of Hospital Authority

- Started the first ICU Post Registration Certificate Course (PRCC) program.

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Same as countries overseas, the scope of the clinical roles & functions of RN(CC) in HK can be summarized as follows:

1) Perform continuous patient assessments. 2) Provide patient physical care. 3) Administer and manage patient medication. 4) Manage technical equipment. 5) Assist in performing special procedures. 6) Advocate client (patient and/or family included) needs7) Collaborate with multidisciplinary healthcare team members.8) Maintain safe environment for patient and staff. 9) Document medical and nursing management10) Promote professional development.

10 Functions/Duties and tasks performed by critical care RNs

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Supporters for Critical Care NursesSupport from two nursing organizations

• HKACCN - very well established (since 1996) professional body to nurture the professional development of critical care nurses.

• HKCCCN - established in 2011 and is an academy college of The Provisional Hong Kong Academy of Nursing (PHKAN) which aims at regulating the standards of specialist nursing practice.

Support from HASpecialty Advisory Group – Leadership of SAG (Critical Care)

- Support improvement initiatives- Set a platform to share good practice among 14/15 ICUs

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Nursing Manpower & Career Progression Model

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ICU Statistics

No. of Beds under HA 27,800

Staff and organization 53,000 staff in 7 Clusters & all part of a single organization

No. of ICU Beds under HA 200 in 15 ICUs (Including both PMH & YCH)No. of ICU/HDU nurses under HA & in private hospitals in early 2011

950 (800+ in HA)

Annual ICU admissions 12000-13000

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New Career Progression Model (2008)New Career Progression Model (2008) TThe 3-tiers career pathway for a critical care nurse

Nurse Consultant Department Operations Manager

Advanced Practice Nurse

Ward/Unit Manager

Registered Nurse(Specialty Nurse)

Registered Nurse (Pre-Specialty)

Registered Nurse (Beginner)

Clinical Management Career

Tier 3

ANP Level

Tier 2ANP Level

Tier 1

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CGM(N)CGM(N) RewardReward

GM(N)GM(N)

Additional Additional Increment/ Increment/ PromotionPromotion

Specialty Specialty NurseNurse

7 7 –– 10 Years10 Years

1) Specialty Qualification1) Specialty Qualification2) Experience2) Experience3) Performance3) Performance

3rd3rd

4 4 –– 6 Years6 Years Practice NursePractice Nurse(Pre(Pre--SpecialtySpecialty))

Additional Additional IncrementIncrement

1) Generic Competency1) Generic Competency2) Specific Competency2) Specific Competency3) Experience3) Experience4) Performance4) Performance

2nd2nd

3 Years3 Years Practice Practice NurseNurse(Beginner(Beginner))

Annual Annual IncrementIncrement1st1st

1) 1) PreceptorshipPreceptorship2) Performance2) Performance

Nurse Nurse ConsultantConsultant**

PromotionPromotion1) Clinical Mgt Leadership 1) Clinical Mgt Leadership

ExpertiseExpertise2) Experience2) Experience3) Performance3) Performance

5th5th

18 Years +18 Years +

Advanced Advanced Practice Practice NurseNurse**

PromotionPromotion1) Sub1) Sub--Specialty/Mgt QualificationSpecialty/Mgt Qualification2) Higher Academic Qualification2) Higher Academic Qualification3) Experience3) Experience4) Performance4) Performance

4th4th

12 Years +12 Years +

* * Management allowance for designated positionsManagement allowance for designated positions

MilestonesMilestones

Career Progression

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ANP & APNAdvanced Nursing Practice &

Advanced Practice Nurses

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What is an Advanced Practice Nurse?

International Council of Nurses (ICN) defines an Advanced Practice Nurse / Nurse practitioner (APN/NP) as “a registered nurse who has acquired the expert knowledge base, complex decision- making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice” and requires education at a master’s level. (http://www.icn-apnetwork.org/)

http://www.icn-apnetwork.org/

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Critical Care - Advanced Nursing Practice CC - ANP

• An advanced level of nursing practice that maximizes the use of in-depth nursing knowledge and skill in meeting the complex health care needs of clients with the specialized clinical area of critical care nursing.

Canadian Association of Critical Care Nurses (2008)

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Critical Care - Advanced Nursing Practice

• The CC-ANP role has expertise in a specialized practice grounded in knowledge from nursing theory and other theoretical foundations, experience and research associated with the filed of critical care

• CC-ANP includes five interrelated components:

advanced practice (Clinical)

education

research

consultation

leadership

• Contributes to the advancement of nursing science and to support nurse- sensitive indicators

• A crucial role in assuring positive patient outcomes.

American Association of Critical Care Nurses (2008)Canadian Association of Critical Care Nurses (2008

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Types of APNs in HKTo be in line with the global specialization trend

• NS - HA had Nurse Specialist piloted in ICU in 1992The Chinese University of Hong Kong organized the first tertiary level Diploma Course in acute care nursing in 1995.

• APN - HA had Advanced Practice Nurse piloted from 2003 to January 2006.

HKACCN pioneered a commissioned Program (The program was conducted by Australian critical care nursing experts) on Advanced Critical Care Nursing in 2001 through 2007 with the last 4 years being a program conducted in collaboration with HA.

• NC – Nurse Consultant positions were first appointed in 2009

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Intensive Care Nursing : 3 tiers Service Care Model

We focus on provision of timely care to critically ill patients and their relatives with expert preventive and resuscitative interventions. The ultimate goal is to sustain life and aid recovery

although transition to facilitation of peaceful death will be included if condition indicates.

Differentiation of ranksLevels of Service delivery Complexity of interventionsComplexity of interventionsIdentification of improvement opportunities with influences to cluster level

• Be sensitive to professional service development globally and to benchmark to local practice.

• Initiate and evaluate changes based on evidence to enhance quality of service

• Initiate clinical protocol and monitor their effects

Expert care to enhance clinical outcomes• Manage complex ICU cases and difficult situations e.g.

patients with multi-organs failure & appropriate use of technology to achieve optimal care.

• Initiate and accept nursing referrals e.g. patients with high MEWS score, wound care, & endo-tracheal tube care etc.

• Proactive out-reach support to specific and complex cases.• Lead cluster specialty trainings and hospital critical care

knowledge and skills training to optimize patient cares.• Empower APNs to assure quality critical care standards.

Implementation of continuous improvement

• Participate in changes actively

• Adopt team cohesion measures

• Conduct quality improvement process

Coordination of complex critical care • Act as a resource person and mentor to staff• Assure holistic care with appropriate staff

allocation matching skill level and patient complexity

• Organize and participate in cross-disciplinary care• Participate in organization of staff training• Monitor provision of care standards in the unit.

Implementation of safe practices

• Be compliant with practice guidelines and protocols

• Be assertive to clarify doubtful practices.

Individual holistic patient care

• Provide holistic cares to critically illpatients to enhance recovery.

•Act as trainer to novice and student.

NC(DOM-

Managementsupport &

shared governance)

NS/NO/APN(WM-Management support)

Specialty RN

A Three Tiers Service Care Model for Nurse Consultant Service Model in Intensive Care

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*Lead changes in traditional care process

*Empower staff competency in delivering  complex patient

care.

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What is an Advanced Practice Nurse?

The seven thematic units that formed the generic features of the advanced nursing practice developed by Mintzoukas & Watkinson S. in 2007 (p.32) after extensive systematic review of literature were:1 - the use of knowledge in practice;2 - critical thinking; 3 - clinical judgment and decision-making skills;4 - professional leadership and clinical inquiry;5 - coaching and mentoring skills;6 - research skills; and7 - changing practice. Advanced Practice Nurses are expected to be able to master all the skills.

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6) Enhancing professional

and personal attributes of general and

advanced practice

5) Managing and negotiating innovative and effective

approaches to care delivery

4)Enhancing quality

assurance and improvement

3) Demonstrating effective

leadership and teamwork

2)Enhancing therapeutic

nurse-client relationships

1)Managing clients

with complex conditions

Six Domains

Six Domains of Competency Framework APN(CC)

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Hong Kong College of Critical Care NursingThe Competency framework of APN(CC) consists of six domains:1) Managing clients with complex conditions;

2) Enhancing therapeutic nurse-client relationships;

3) Demonstrating effective leadership and teamwork;

4) Enhancing quality assurance and improvement;

5) Managing and negotiating innovative and effective approaches to care delivery; and

6) Enhancing professional and personal attributes of general and advanced practice.

SIX domains (A total of 72 statements)

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Nurse Consultant PilotBackgroundBackground

NC emerged in HK in early 2009 NC emerged in HK in early 2009

Pilot Study Pilot Study -- 7 7 NCsNCs have been appointed in 5 have been appointed in 5 clinical specialties : clinical specialties :

Community Psychiatric, Community Psychiatric,

Continence, Continence,

Diabetics, Diabetics,

Renal, and Renal, and

Wound and Stoma Care. Wound and Stoma Care.

An evaluation study of the pilot implementation of the new NC An evaluation study of the pilot implementation of the new NC post in HA was conducted by CU from post in HA was conducted by CU from July and July and September 2009.September 2009.

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Findings from the Evaluation Study

The Review and Evaluation of the Pilot Implementation of the new NC post in the HA conducted by the Chinese University of Hong Kong (2009) has delineated:

• the clinical work involvement of the NCs with expert practice (47.7%), and

• service development (35.0%) ranked the top in terms of time involvement, followed by

• education (8.7%), • continuous quality improvement (5.0%)

and • research (3.6%).

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Continuous Quality Improvement (5.0%) quality control of service standard, protocol development and implementation

Research (3.6%) promote & implement evidence-based practice

Education (8.7%) staff supervision, in-service education, community education

Service Development (35.0%) Development of care delivery model, facilitating intra- and inter- disciplinary and cluster service collaboration, initiating new service projects, strengthening hospital-community interface

% = observed time spent in each role

Expert Practice

Education

Research

Service Development

Continuous Quality Improvement

Expert Practice (47.7%) expert clinician / consultant, complex patient care patient risk identification /stratification, care coordination

NCs’ Roles and Scope of Practice

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As at October 2012 in HA

• There are altogether 171 APN/NO/NS working in ICU and only 3 NC (Critical Care) appointed.

• 4000 APNs & 60 NCs in all specialties of all hospitals.

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The Operational definitionof APN

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The Nursing and Midwifery Council (NMC) (2005) in U.K. published the operational definition of APN

APNs are highly skilled nurses who can perform the following:• take a comprehensive patient history;• carry out physical examinations;• use their expert knowledge and clinical judgment to identify potential diagnosis;• refer patients for investigations where appropriate;• make a final diagnosis;• decide on and carry out treatment, including the prescribing of medicines, or refer

patients to an appropriate specialist;• use their extensive practice experience to plan and provide skilled and competent

care to meet patient’s health and social care needs, involving other members of the healthcare team as appropriate;

• ensure the provision of continuity of care including follow-up visits;• assess and evaluate, with patients, the effectiveness of the treatment and care

provided and make changes as needed;• work independently, although often as part of a healthcare team;• provide leadership; and• make sure that each patient’s treatment and care is based on best practice.

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Operational Definition of APNs in HKHKAN will work on the operational definition for APNs in

Hong Kong basing on the competencies stipulated, it will not be identical to other very well developed countries in which their Nurse practitioners diagnose, prescribe and refer.

NURSING as a body of knowledge changes according to the development in science and technology.

Nursing is striving to change from medical model of giving care to nursing model, where the emphasis is on the patient as a person and not only on the disease.

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Challenges of APN (Critical Care) &

Contributions of Critical Care Nurses

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• The perceived challenges collected in an interview 30 APNs working in HA hospitals in 2010:

1) Shortage of nurses2) Growing service demand - The advanced & highly sophisticated

technical systems, the changing pattern of diseases coupling with medical and pharmaceutical advances new models of care

3) The rapid rate of knowledge explosion and high customer expectation in nursing care.

4) The demand driven by demographics due to ageing population is fast growing and problem of readmission – discharge planning.

5) With technology eliminating many of the natural endpoints of life – nurses need to guide decision making on Pain Management& EOL care.

6) Nursing Leadership (Poor staff morale)7) Collaborating with interdisciplinary teams8) Potential risk of contracting infectious diseases9) Skill Dilution due to novice nursing workforce.

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Explore Areas for Improvement Services Workforce competency1. End of life care

Expected outcomes with involvement in EOL care

• Decrease patient suffering• Increase family satisfaction• Transform ICU mortality to one of

the quality service indicators

2. ICU Readmission Trial run of post ICU discharge Follow-up

3. Family satisfaction Survey performed

4. Training models – structured training to all level of nurses in ICU.

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ICU Family Satisfaction Program

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Provide family with

* ICU related information* update of patient’s condition

* interview for discharge planning*Involvement in planning EOL care

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Pre‐ICU admission Critical Care Outreach Team 

*responds to the ill patients in 

ward such as the track and 

trigger systems (MEWS) &   *provides pre‐ICU admission 

assessment and support Optimize quality care in ICU

Traditionally,  ICU nursing care starts in ICU. 

Now 

Boundary‐

free of care

Added value Care Process

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Training foci in different level of nursesNovice

(New comers)

Independent 

nurses(Junior RN)

Specialty Nurses 

(Intensive Care) (Senior RN)

Advanced 

Practice Nurses(APN)

Training 

foci• Clinical reasoning• Critical thinking 

through clinical  scenario

• Integration into  workforce

• Communication

• Critical thinking  through clinical 

scenario• Communication

• Career ladder  progression

• Professional  development

• Sustaining  clinical service

• Role model &  leader

• Role expansion• Service 

development• Audit / 

Research

Strategies 

/ Program  highlights

• Orientation  program

•Preceptorship program

• Simulation training

• Simulation  training

• Post‐ registration 

Specialty  Training

• Risk  management

•Mentorship  program

• Critical care  specific 

postgraduate  program

•Simulation  training on 

advanced  technology

• Ward  management

• Project  management

• Service‐specific  training program  

• Build staff competency in • profession knowledge, • technical skills and • non‐technical skills 

• Meet different levels of staff development  needs  

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Patient satisfaction score of 140 patients under the care of NC

Satisfaction scores Mean + SD Reference range

Trust subscale 46.6 + 4.4 11 - 55

Professional subscale 22.3 + 2.2 5 - 25

Educational subscale 28.3 + 2.9 7 - 35

Overall satisfaction score 101.6 + 8.5 24 - 120

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NC

APN

Nurse Consultant (NC)

1. Be an expert consultant on complex care2. Initiate and participate in Service

planning and development3. Establish mechanism for evaluating

service quality4. Lead specialist education development5. Cultivate a spirit of inquiry to support

knowledge development and transfer.6. Direct research utilization & EBNP

implementation.

Service Outcomes

Patient Outcomes

Advanced Practice Nurse (APN)

1. Offer individual and direct specialty care

2. execute service initiatives3. provide specialist education4. maintain service quality5. Implement and transfer specialty

knowledge

Roles, scope of practice and level of expertise between NC and APN

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RN: ‘Doing things well’Specialist: ‘Doing things better’NC: ‘Doing better things’

Maylor (2005)

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Expanded Role of NursesNurse-led Protocols

血糖控制 Glycaemic control

鎮靜劑量調控 Sedation protocol

供氧 Oxygen therapy

呼吸机戒除 Weaning protocol

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對護理敏感的成效指標 Nursing Sensitive Outcome Indicators

呼吸喉管移位

Unintentional extubation or Displacement of endotracheal/tracheostomy tubes

壓瘡 Pressure ulcer

感染 Infections

病人滿意度 Patient’s satisfaction

家屬滿意度 Family’s satisfaction

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Maximizing Nursing Contributions

We would like to enlist your support in the development of the nursing roles, please help to further build their advanced practice capacity in terms of :

I –Training support- provide continuing professional development to critical care nurses.

II - Role support1 - Create protocol-driven orders or protocols for special situations.

* Glucose monitoring* weaning ventilator* medication titration* diagnostic investigations* nursing referrals* nurse-facilitated discharge

2 - Generate new knowledge through research3 – Joint position statements on certain issues.

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The way ahead

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Hong Kong Academy of Nursing

• The establishment of the HK Academy of Nursing (HKAN) is to regulate the nursing practice and to promote professional development of APNs in the specialty areas.

• As the new roles in advanced nursing practice emerge, we require additional legislation and regulation because we want the “APN” title and the “APN” scope of practice to be protected

• This regulation is intended to safeguard the public by ensuring that nurses meet the advanced standard levels of knowledge and education.

• Doctors’ support to our move is imperative!

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The Provisional Hong Kong Academy of Nursing

臨時香港護理專科學院

Established in 2011

http://www.hkan.hkAddress: 1/F, School of Nursing,

Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong

http://www.hkan.hk/

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PHKAN Council Members pictured with advisors and guests prior to the

1st council meeting on 9th Nov. 2011

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Academy Colleges under The Provisional Hong Kong Academy of Nursing (PHKAN)

1. Hong Kong College of Medical Nursing2. Hong Kong College of Surgical Nursing3. Hong Kong College of Community & Public Health Nursing4. Hong Kong College of Cardiac Nursing 5. Hong Kong College of Critical Care Nursing6. Hong Kong College of Emergency Nursing7. Hong Kong College of Perioperative Nursing8. Hong Kong College of Mental Health Nursing9. Hong Kong College of Paediatric Nursing10. Hong Kong College of Gerontological Nursing11. Hong Kong College of Midwives12. Hong Kong College of Education & Research in Nursing13. Hong Kong College of Nursing & Health Care Management14. Hong Kong College of Orthopaedic Nursing

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Hong Kong College of Critical Care Nursing Limited

Incorporated under Companies Ordinance

on 3 January 2011

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PresidentDr WONG Yee Hing, Esther

Vice-PresidentMr. CHAN Wing Keung, DavidMr. HA Chi Fung, Stephen Ms KWOK Lai Ping, NoraMs YEUNG Chin Pang, Andrew

SecretaryMs LEUNG Oi Kwan, Vilna (1st Sec.)Ms HO Ka Man (2nd Sec.)

TreasurerMr. MAK Chiu Ming (1st Treasurer) Mr. LUK Hing Wah (2nd Treasurer)

Council MemberMr. CHAN Wing YauMs CHAN Yuk SimMs CHAU Lai SheungMs KWOK Lai YinMs KWOK Wai LingMs KUNG Chui Fan, DorisMs MAK Wai LingMs PANG Mei Hing, AnitaMs SO Hang MuiMr YU Kin Yip, KennethMs YAN Siu Lan

2011 – 2014 Council Members of the Hong Kong College of Critical Care Nursing

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2011 – 2014 Council Members of the Hong Kong College of Critical Care Nursing

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2011-2014

Honorary Advisors• Dr. FUNG Yuk Kuen Sylvia • Professor CHAN Siu Chee Sophia• Professor Agnes TIWARI• Professor LEE Tze Fan Diana• Professor PANG Mei Che Samantha• Dr. Hon. LEE Kok Long Joseph• Dr. YAN Wing Wa• Professor Ruth KLEINPELL (Overseas)

Honorary Legal Advisor: Mr. Sam YEUNG & Mr Brumen LI

Honorary Auditor: Mr. PANG Wai Lim,

Hong Kong College of Critical care Nursing

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Hong Kong College of Critical care Nursing

ChairpersonMs CHAN Yuk SimCo-chairpersonHO Ka Man

SecretaryMr Peter LAI

Council MembersDr. Esther WONGMs CHAU Lai SheungMr. YEUNG AndrewMr. CHAN David

Clinical Consultative Work GroupMembersMr. CHIANG VicoMs. CHOW LouisaMs. CHUNG Wai YeeMs. KWOK Lai YinMs. LAM Chung LaiMs. LI Siu ChunMs. LEE Hoi WanMr. TANG Hing Wan StephenMs. PANG AnitaMs. WONG Hoi Mei RubyMs. YAN Siu LanMr. YU Kin YipMs. KUNG DorisMs. KWAN Yuen Fan EvaMs. WONG Lai ChingMs. LUI Carmen

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Hong Kong College of Critical Care Nursing

ChairpersonMs CHAU Lai SheungCo-chairpersonMr. CHAN Wing Keung, David

MembersMs. KUNG Chui Fan, Doris Ms. LEUNG Pui Wah, RowlinaMs. LAU Po Yin, Bonnie Mr. LAU Yiu Kuen, HanMr. CHEUNG Ki Leung Ms. LO Wan Po, Joanna Ms. Tracy FUNG Mr. LO Wai Shun, WilsonMs. LEE Sui Fong, Christina

Professional Development Committee

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Hong Kong College of Critical Care Nursing

ChairpersonCHAN Wing YauCo-chairpersonDr Esther WONG

MembersMs Vilna LEUNG Ms LEUNG Fung Yee Ms Nora KWOK Mr Kenneth YU Kin YipMs HO Ka man Ms KWOK Lai Yin

Examination & Accreditation Committee

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Hong Kong College of Critical Care Nursing

ChairpersonMs SO Hang MuiCo-chairpersonMr. Stephen HA

MembersMs Anita PANG Ms Laurinda MAKMs CHIU Mei ChunMr. Kenneth YU

Administration & Registration Committee

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Hong Kong College of Critical care Nursing

Quality & Standard Committee

ChairpersonMr. Kenneth YUCo-chairpersonMs Nora KWOK

MembersMr. Peter LaiMs Lam Chung LingMs Laurinda MakMs Phyllis KwokMs Chan Suk Sim

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Hong Kong College of Critical Care Nursing

Promotion & Public Relations Committee

Chairperson: Ms MAK Wai LingCo-Chairperson: Mr Andrew YEUNG

Member: YAN Siu LanWong Sai WingKuo YingLam Tse Yin

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The Provisional Hong Kong Academy of Nursing&

Hong Kong College of Critical Care Nursing

Processing its Bill to become Statutory HK Academy of Nursing

Academy College of the Provisional Hong Kong Academy of Nursing

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The PHKAN Founding Council in 2012

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Fellows of The Provisional Hong Kong Academy of Nursing – Critical Care

12 May 2012

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Only Grandfather Fellow Members in 2012 & 2013

ThereafterCategories of Memberships:(1) Associate Member(2) Full Member(3) Fellow Member(4) Honorary Fellow Member

Hong Kong College of Critical Care Nursing

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On or before 12 May 2014

A Registered Nurse with over 15 years in ICU/ HDU practice within 2 years of the establishment of the PHKAN (on or before 12 May 2014). Among the 15 years of ICU-related experience of which 7 years must be in ICU/HDU; and has demonstrated significant contribution to intensive care service development, and in the opinion of the Council, the conduct of his / her practice is consistently good throughout such years and at present.

For those who have retired, the last experience practicing in the specialty must not exceed 5 years at the time of application

Academy Fellows under Grandfathering Scheme of The Provisional Hong Kong Academy of Nursing

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Granting of Grandfather / Grandmother

• 15 years in specialty area– the15 years that are relevant to the specialty of the

Academy College, accumulated since nursing registration.

• Significant contribution in the specialty area with documentation proof: e.g.– In leadership position of specialty-related activities (such

as work groups, committees)– Invited member in local and / or international initiatives– Demonstrated contribution in practice and service

development

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Young Critical Care Nurses - Those with less than 15 years critical care experien

by 2014.

Earned membership & Fellowship• Successful completion of

membership examination prior to becoming a Full Member.

• Further assessment on specialty contribution prior to becoming a fellow

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Associate Member (Trainees)

Registered Nurses who are interested in Critical Care Nursing may apply to be trainees

(1) Basic Critical Care Nursing Training - within 2 years

(2) Higher Critical Care Nursing Training- within 4-6years

Hong Kong College of Critical Care Nursing

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Basic Critical Care Nursing Training• 100 Hours Theoretical Input

Topics includs:- Elementary Critical Care Nursing (ECG, Resp., CVS, RNT) - ACLS - Patient documentation- Workplace violence - Nursing standard & audit- Pain management - Health information system- Wound management - Basic infection control- Incident / accident reporting - Crisis management- Pharmacology for nurses - Legal aspects- Team management - communication skill- Occupational Safety and Health

• Logbook with at least 90% of the items listed signed by HKCCCN ‘s Nursing Fellow / Advanced Practice Nurse or above in the clinical care area

Hong Kong College of Critical care Nursing

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Proposed Curriculum Requirement for Accreditation

• Generic competence framework with 7 domains and 54 statements

• Theoretical hours 500 + Clinical hours 500 = 1000 hours

Theoretical Hours1/3 in generic postgraduate content (e.g. evidence-based practice,

health economics, legal and ethical aspects)1/3 in core APN content (e.g. health assessment, pathophysiology)1/3 in specialty APN content (e.g. diabetic-related assessment,

planning, implementation & evaluation of care)

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Higher Critical Care Nursing Training

• Specialty Training – structured critical care program. • Logbook with items listed signed by an Academy Fellow,

Member (APN) or above in the clinical specialty area• Successfully passed the Full Membership Examination set

by HKCCCN.• May apply to be registered as Advanced Practice Nurse

(APN).

Hong Kong College of Critical Care Nursing

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Through innovation, collaboration and regulation

…….. our dreams come true.

Excellence in Nursing

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Both the medical and nursing discipline need to grow. Critical care doctors and nurses are team mates in the ICU. With the changing roles of nurses, it’s hoped that: WE can work collaboratively, complementarily and harmoniously for the care of our critically ill patients.

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� The Evolving Roles of � Critical Care Nurses in HK ICU��Annual Scientific Meeting 2012�Hong Kong Society of Critical Care Medicine�2 December 2012 @ Eaton Smart Hotel��� Dr. Esther WONG� RN; RM; MSc.; Phd.; FHKAN (Critical Care); FHKAN (Management) � President, Hong Kong College of Critical Care Nursing (HKCCCN)�Slide Number 2Slide Number 3Slide Number 4Slide Number 5ContentsSlide Number 7History of Critical Care Nursing (1)History of Critical Care Nursing (2)Slide Number 10History of Critical Care Nursing (3)History of Critical Care Nursing (4)�Supporters for Critical Care NursesSlide Number 15ICU StatisticsSlide Number 17New Career Progression Model (2008)� The 3-tiers career pathway for a critical care nurseSlide Number 19Slide Number 20What is an Advanced Practice Nurse? Slide Number 22Critical Care - Advanced Nursing Practice �Types of APNs in HKSlide Number 25What is an Advanced Practice Nurse? Slide Number 27Slide Number 28Nurse Consultant PilotFindings from the Evaluation StudySlide Number 31Slide Number 32Slide Number 33The Nursing and Midwifery Council (NMC) (2005) in U.K. published the operational definition of APN�Operational Definition of APNs in HKSlide Number 36Slide Number 37Explore Areas for Improvement ICU Family Satisfaction ProgramSlide Number 40Training foci in different level of nursesSlide Number 42Roles, scope of practice and level of expertise between NC and APNSlide Number 44Slide Number 45Slide Number 46 Maximizing Nursing ContributionsSlide Number 48Hong Kong Academy of Nursing ��The Provisional Hong Kong Academy of Nursing ��臨時香港護理專科學院��Established in 2011PHKAN Council Members pictured with �advisors and guests prior to the� 1st council meeting on 9th Nov. 2011Academy Colleges under�The Provisional Hong Kong Academy of Nursing (PHKAN)�Slide Number 532011 – 2014 Council Members of the �Hong Kong College of Critical Care NursingSlide Number 55�Hong Kong College of Critical care Nursing�Slide Number 57Slide Number 58Slide Number 59Slide Number 60Slide Number 61Slide Number 62Slide Number 63Slide Number 64Slide Number 65Slide Number 66Slide Number 67Slide Number 68Slide Number 69Slide Number 70Slide Number 71Granting of Grandfather / GrandmotherYoung Critical Care Nurses �- Those with less than 15 years critical care experience � by 2014.�Slide Number 74Slide Number 75Proposed Curriculum Requirement �for AccreditationSlide Number 77Slide Number 78Both the medical and nursing discipline need to grow. Critical care doctors and nurses are team mates in the ICU. With the changing roles of nurses, it’s hoped that:�WE can work�collaboratively, complementarily and harmoniously�for the care of our critically ill patients. �Slide Number 80