International Conference for Nurse Practitioner / Advanced Practice Nursing

Parallel Sessions

Find the sessions of your interest in the schedule below

During the conference there are almost 450 sessions spread over 10 rounds of 1 hour each that you can choose from:

Oral presentations
3 grouped 15-minutes presentation with 5-minutes discussion each
Poster & Pitch
grouped poster pitches of 5 minutes each followed by group discussion
Specials
special focus sessions by thought leaders
Symposia
a maximum of three coherent presentations followed by discussion
Workshops and clinical workshops
interactive or teaching of (clinical) competencie

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Monday 27th Aug 2018

10:00 - 11:00 Parallel Sessions Round 1

The use of the SPIKES protocol to improve communication for nurse practitioners a global approach

Oral Presentation554Ramona Sowers, Dept.of Veterans Affairs/ Simmons College of Nursing, Neurology, DURHAM, United States of America

Eduard Flipse ZaalMon 10:00 - 11:00

Communication in our daily environment allows for people to interact in real time and instantaneously. Such interactions across cultures often times can be difficult even in the best of situations. In many cultures, what is considered acceptable interactions in one culture often times translates as inappropriate and rude interaction in another culture. Globally,

Nurse Practitioners are the providers of health care for various patient populations

When information involves changes to an individual’s health resulting sickness, chronic illness, terminal illness and death communication imperative. A review of the literature demonstrates there is no culturally acceptable standardized practice protocol for Advanced Practice Registered Nurse to disseminate such information to their patients. The presentation will discuss the application of the SPIKES protocol (Set-up, Perception, Invitation, Knowledge, Empathy/Emotion, Strategy and Summary) for the world’s Nurse Practitioners to use to disclose adverse health information across all cultures.

Changing healthcare and the role of the NP/APN
bad new, Best practice, culture, Primary care

Poster & Pitch

Exploration of advanced practice competencies necessary for achievement of universal health coverage

Poster & Pitch336Judy Honig, Columbia University School of Nurisng, NY, United States of America

Arcadis Zaal corner AMon 10:00 - 11:00

Introduction: An expanded role in nursing is emerging globally in response to the need to increase human resources to achieve Universal Health Coverage (UHC). The Global Health Workforce called for the transformation of nursing education to prepare a nursing workforce to effectively address the goal of UHC. Within this framework is the call for action to advance UHC in the Eastern Mediterranean Region. Though Jordan boasts good health indices. It has a well insured population that is draining resources and a health system that focuses on secondary and tertiary care at the expense of primary care however, is well positioned to move UHC agenda forward. Little attention has been focused on advanced practice nursing (APN) preparation. The purpose of this study is to delineate APN practice and competencies in relation to UHC in Jordan as an initial step towards educating APNs and establishing the foundation for future work on building APN capacity in Jordan.

Methods: A descriptive exploratory survey design will be utilized to identify APN competencies that are important in achieving UHC. The survey instrument developed by PAHO Collaborating Center will be utilized. It will be piloted to assess psychometric properties and revised, as needed. The final survey instrument will be sent to a minimum of 100 participants consisting of nursing key informants in academia, service, councils, associations, hospitals and practicing nurses who are master prepared. The survey will be distributed through an electronic link. The demographic data will be analyzed using descriptive statistics. Means frequencies and percentages will be used to analyze the survey data as well.

Conclusions: The pilot stage is underway and the full survey will be distributed immediately thereafter. The delineation of APN practice and competencies relevant for Jordan will be presented as well as strategies to disseminate the results within the various health sectors.

International developments and collaboration
Primary care, universal health coverage

Challenge of developing nursing practice models for the facilitation of critical patients’recovery

Poster & Pitch299Misuzu Nakamura, Jichi Medical University, SHIMOTSUKE-CITY, Japan

Arcadis Zaal corner AMon 10:00 - 11:00

Objective: The present study aimed to develop models for the facilitation of critical patients’ recovery by examining component factors of nursing practice.

Methods: Focus group interviews with CNS and PreCNS were conducted to collect data: case examples of nursing care provided to facilitate patients’ recovery. The interview results were documented verbatim, and component factors related to nursing care and its facilitation were extracted and interpreted. The descriptions were summarized and classified according to their similarities.

Results: Data were collected from five groups. The mean age was 40.8 ± 5.7 years old. The male-female ratio was 6:18. The mean total period of working as nurses was 18.3 ± 6.2 years. The mean period of working as CCNS was 3.4 ± 1.7years. The mean interview time was about 55 minutes. Descriptions of nursing care provided for recovery were classified into 19 categories, including: [exerting our best efforts while placing the highest priority on life support], [initiation of risk prevention intervention from the period in which patients’ conditions are unstable], [provision of combined care to shorten the care period], [placing an importance on the well-being of patients], [understanding of the situation and nursing practice with composure], [development of relationships with patients to help them express their needs], [coordination to encourage patients to participate in treatment and care], [setting of goals and the development of plans with patients], and [interaction with patients while helping them understand the recovery process].

Discussion: Advanced and sophisticated nursing care was provided in cooperation with critical patients to maximize their abilities to recover, while carefully avoiding the risk of exacerbation for patients with an unstable condition, based on clinical judgments supported by “thought and practice”.

Research
Critical patients’recovery, Critical/ acute care, Nursing practice models, Research

Nurse Practitioner practice, work environments, and outcomes in the U.S.

Poster & Pitch267Lusine Poghosyan, Columbia University, School of Nursing, United States of America

Arcadis Zaal corner AMon 10:00 - 11:00

Introduction & Purpose. The demand for primary care services in the United States (U.S.) is growing. The nurse practitioner (NP) workforce can help meet this demand. However, policy and organizational barriers constrain NP practice. We investigated NP work environment and outcomes in healthcare organizations in two states with different NP scope of practice laws.

Methods. A cross-sectional survey design was used to collect data from 314 NPs in Massachusetts (MA) and 278 NPs New York (NY) state in 2012. NPs completed measures of patient panel status (i.e., whether NPs have their own patient panel), work environment, job satisfaction, turnover, and demographics. NP work environments were measured with the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire: NP-physician relations (NP-PR), NP-administration relations (NP-AR), Independent NP Practice and Support (IPS), and Professional Visibility (PV). Multivariate Analysis of Variance investigated the effect of state and organization type on work environments. The chi-square tests examined the effect of organization type on job satisfaction, turnover, and patient panel status.

Results: NPs were employed in physician offices, hospital-based clinics, and community health centers. Organization type predicted work environment (p<0.05) with no interaction between state and organization (p>0.05). High scores on PV and IPS were recorded in community health centers and on NP-AR and NP-PR in physician offices. Overall, 26% of NPs were dissatisfied with their job, and 19% of NPs in MA and 11% in NY planned to leave their job. Organization type had no effect on job satisfaction (?^2=1.91, p>0.05) or turnover (?^2=2.30, p>0.05). A significant relationship existed between organization type and NP patient panel status (?^2=29.38, p<0.05) with community-health centers exhibiting a significantly higher proportion.

Conclusion. Addressing policy and organizational challenges is needed to fully exploit the capacity of the NP workforce and to maximize the NPs’ contribution to patient care.

Research
Organizational Climate, Primary care, Research

Overview of first paediatric APN-led clinic in an acute tertiary paediatric hospital in Singapore

Poster & Pitch146Cynthia Rong Xiu Lim, KK Women's and Children's Hospital, Division of Nursing, Singapore

Arcadis Zaal corner AMon 10:00 - 11:00

Introduction An Advanced Practice Nurse (APN) in Singapore is a hybrid role of Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS).

With increasing healthcare demand, APN (Paediatrics) track was started in 2012 and licensed to practice in 2015. Area of practice is in the general paediatric wards, working collaboratively with the physicians. The first paediatric APN-led clinic was set up in 2017 to provide continuity of care and optimizing care delivery

As there were no restrictions to specific case types referred to the clinic, the spectrum of cases reviewed remains unknown. Therefore, this paper will provide an overview of the clinic service.

Method

 

Plan: Review need for Paediatric APN-led clinic for follow up cases from inpatient wards. Paediatric Consultant provides supervision in the initial phase.

Do: Set-up of APN-led clinic once a week with the following elements:

Assuming accountability in history taking, evaluation and management.

Providing patient support and education.

Discuss patient’s management with clinical supervisor and develop joint agreement.

Study: Report and evaluate clinic waiting time, case types, patient’s attendance and default rate, and readmission for same diagnosis at admission.

Act: Review study objectives and recommend service improvement.

Conclusion

 

The overall clinic attendance was 64%, default rate of 23%.

Case types include pneumonia, urinary tract infection, bronchiolitis, febrile fit, obesity, constipation, and meningitis. Evaluation of diagnostics and laboratory investigations were also expected of the APN.

Waiting time to attend APN-led clinic is approximately one week while physician clinic is fifteen weeks.

There was no readmission of the same diagnosis reported.

In conclusion, this is the first APN-led Paediatric clinic in Singapore. Case types reviewed were considerably broad with shorter waiting time compared to physician clinic. As the service was still at its infancy stage, it requires further evaluation on patients’ satisfaction and expansion of service to review new case referral.

Changing healthcare and the role of the NP/APN
APN-led, Paediatric, Paediatrics, singapore

Patient identification: the basis of a culture of patient safety

Poster & Pitch131Cecília Rodrigues, Centro Hospitalar do Porto, PORTO, Portugal

Arcadis Zaal corner AMon 10:00 - 11:00

Background:

The correct identification of the person under health care in an institution is a basic principle of a patient safety culture and quality of care provided.

Failures associated with patient identification process are the cause of medication errors, transfusions, complementary diagnostic and therapeutic screenings, invasive procedures performed on wrong persons, and other incidents of high severity.

Objectives

Identify if all hospitalized patients have identification wristband and check if the name is correct and readable.

Methods

In a 580-bed adult teaching hospital, between January and October 2017, on random days of each month, patients were audited for identification by wristband by a team of nurses with experience in clinical audit.

Results

In the 10 months studied, 122 audits were performed, resulting in 2659 patients audited. From the total patients audited, 2561 (96.3%) were correctly identified with wristband. There were 98 failures: 81 patients had no identification wristband, 16 patients had an identification wristband but the name was unreadable and 1 patient had a wristband with the wrong name. The rate of correctly identified patients increased progressively over the months: in the first month (January 2017) 89.3% of patients were correctly identified with a wristband; in October 2017, the rate of correctly identified patients was 99.2%. The partial results of this audit were disclosed in general risk management meetings with clinical services in March, June and September 2017.

Conclusion

Given the potential negative implications of the absence of identification of the person undergoing health care, these results indicate that there is a clear opportunity for improvement in patient identification. Clinical audit has proved to be an instrument for improving quality and safety, particularly in improving the identification of patients.

Changing healthcare and the role of the NP/APN
Best practice, Clinical audit, Patient identification, Patient safety

Analysis of breastfeeding self-efficacy and maternal characteristics in Brazil

Poster & Pitch513Juliana Monteiro, University of São Paulo, Ribeirão Preto College of Nursing, Department of Maternal-Infant and Public Health Nursing, RIBEIRÃO PRETO, Brazil

Arcadis Zaal corner EMon 10:00 - 11:00

Introduction: Breastfeeding self-efficacy has been identified as an important variable that influences the beginning and maintenance of breastfeeding. Self-efficacy differs from non-modifiable variables since it can be changed using individualized interventions according to the needs of each woman. Therefore, self-efficacy can contribute to increase the rates of breastfeeding. The aims of this study were: to identify the breastfeeding self-efficacy among Brazilian mothers; to verify the association between breastfeeding self-efficacy and the maternal sociodemographic and obstetric characteristics. Methods: This was a cross-sectional study developed at a public maternity hospital in Ribeirão Preto, city located in the Southeast region of Brazil, which is the richest region of the country. The sample of this study was 244 adult mothers during the postpartum period. For data collection, we used a questionnaire on sociodemographic and obstetric information and the Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF). Data was analyzed using the statistical program SAS® 9.0. Results: Most participants (83.93%) had a high level of breastfeeding self-efficacy. There was a statistically significant association between breastfeeding self-efficacy and the variables: type of delivery and postpartum complications. Therefore, women who had vaginal delivery had a higher level of breastfeeding self-efficacy than those who underwent cesarean section (p = 0.0376). Also, women who did not have postpartum complications had a higher self-efficacy than those who had complications (p=0.0410). Conclusion: this study confirms that the BSES-SF is easy to use, is a low-cost tool and is validated to evaluate breastfeeding self-efficacy among women in postpartum period. Furthermore, we identified factors that are associated with the self-efficacy and could be considered in clinical practice in order to contribute with the breastfeeding encouragement and success.

Research
Breastfeeding, maternal health, Research, Self-efficacy, Women's health

Process evaluation of a multi-component self-management intervention for adults with epilepsy

Poster & Pitch494Loes Leenen, Academic Centre for Epileptology Kempenhaeghe, HEEZE, Netherlands

Arcadis Zaal corner EMon 10:00 - 11:00

Background: People with epilepsy need to self-manage. They, as well as their relatives, have to deal with the psychological burden, reflected in a reduced quality of life. Support in self-management can be of importance. We developed a multi-component self-management intervention (MCI) for patients and their relatives. This eight-week group intervention, conducted by nurse practitioners, consists of six two-hour sessions. The main components are: providing self-management education; stimulating proactive coping through goal-setting and facilitating peer and social support.

This process evaluation is to establish the feasibility, fidelity and acceptability of the intervention by assessing performance according to protocol, attendance and adherence, and the opinion of patients, relatives and facilitators about the intervention.

Method: Study population consists of 52 patients with epilepsy living, 37 relatives and six facilitators. In this prospective mixed methods study, data were gathered using questionnaires for patients and relatives, registration forms for facilitators and by carrying out semi-structured group interviews with patients, relatives and facilitators.

Results: Patients and relatives attended a mean of 5.2 sessions. Forty-seven (90%) patients and 32 (86.5%) relatives attended at least five sessions. The mean group size was 8.1 (SD= 1.3; range 6-10). All elements of the intervention were offered, except for one e-Health tool. The sessions were considered useful by patients, relatives and facilitators. The participation of a relative (social support) and sharing ideas and feelings about having epilepsy with peers (peer support) were rated as important aspects.

Conclusion: This process evaluation revealed that the MCI was largely performed according to protocol, attendance rate was high, and participants and facilitators had, on the whole, a favourable opinion about the MCI, and would recommend it to others with epilepsy and their relatives. Overall, the adherence of patients and relatives was high. The MCI is considered feasible according to patients, relatives and facilitators.

Research
Epilepsy, Process evaluation, Research

Encounters between nurse practitioners and multicultural families in ICU

Poster & Pitch475Sevald Høye, Hedmark Inland University of Applied Sciences, Department of Nursing, ELVERUM, Norway

Arcadis Zaal corner EMon 10:00 - 11:00

The increase in people on the move creates populations that are culturally diverse. People meet various challenges regarding the migration process, social life, jobs and health issues. When a person suffers from acute and critical illness, he/she may be in need of intensive care.

The aim of the study was to explore the comprehension of culture, caring and gender among first and second generation immigrant women as relatives on their encounters with intensive care nurses in Norwegian hospitals.

Design. Based upon discourse analysis an exploration of subject positions, interpretative repertoires and ideological dilemmas focused immigrant female relatives’ experiences with a cultural and gender perspective. Participants were recruited from three university hospitals and one regional hospital. The participants were family members of a patient who had been critically ill and admitted to the ICU for a minimum of three days. Immigrants who were relatives to critically ill people were interviewed.

Findings. The following themes were revealed; being the caring person as woman, being intertwined between the Western hospital culture and the original family culture and belonging to a minority in a Western majority culture.

Conclusion. The women in the families with a critically ill family member mainly act as the caring person. Dilemmas occur in how much every family transfer the responsibility for their loved one to the nurses. Anxious attitudes regarding caring activities are rarely linked to their cultural background.

The implications for practice might be that nurse pratitioners has to take into account that immigrant family members want to take part in caring activities. The nurse practitioners should ask families about cultural habits when a family member is critically ill. Further research should explore understanding of how to manage nursing leadership among patients and families with cultural backgrounds different from nurses.

Research
Critical/ acute care, Discourse analysis, Family member, Immigrant, Intensive care, Research, Women

Evaluation of quality of life and distress in patients using HPN and their caregiver

Poster & Pitch47Judith Beurskens, Radboudumc, Gastro enterology, NIJMEGEN, Netherlands

Arcadis Zaal corner EMon 10:00 - 11:00

Home total parenteral nutrition (HPN) is indicated in irreversible intestinal failure (IF) to guarantee patient survival and improve quality of life (Qol). The patient’s caregiver is often an essential partner who helps perform daily activities. The aim of this study was to compare Qol and experienced distress in IF patients and (if present) their caregivers.

Methods: All HPN patients and their caregivers of our HPN population were invited. Qol and distress were assessed using the validated HPN-Qol and the “Lastmeter” questionnaire or the Caregiver Strain Index.

Results: During the year 2016 a total of 193 patients and their caregivers were invited. Fifty-six patients (37%) did not have a caregiver. 147 patients (76%) and 91 caregivers (63%) completed the questionnaire. The most common underlying diseases leading to IF were short bowel syndrome (SBS, 48%) and dysmotility (42%). Both the SBS group as the dysmotility group had a reasonable Qol (SBS 6 vs Dysmotility 5.8) but the experienced distress was significantly higher in the group with dysmotility (SBS 5 vs Dysmotility 7). The Qol of patients with SBS was not significantly affected by all aspects associated with HPN. The caregiver of the patient with impaired motility experienced a higher burden than the caregiver of the patient with SBS.

Conclusion: This is the first evaluation of Qol and distress of patients using HPN and their caregivers in the Netherlands. The results suggest that the Qol of the group as a whole is reasonable, but that compared to SBS a higher burden is experienced in the group with dysmotility. Also the caregiver of the patient with dysmotility experienced a higher burden than the caregiver of the patient with SBS. Furthermore, it is noticeable that in particular the burden that patients with dysmotility experienced with eating, fatigue and abdominal pain significantly impacted their Qol.

Health-care Policy
Qol, Research

Advanced nurse practitioner led care in oncology

Poster & Pitch22Hilary Thomas, Velindre Cancer Centre, Rhosyn Day Unit, CARDIFF, United Kingdom

Arcadis Zaal corner EMon 10:00 - 11:00

Oncology Advanced Nurse Practitioners (ANP) are changing healthcare and the role of the ANP within cancer care. Since developing the ANP service in 2015 a recognised improvement in the management of malignant ascites, Venous Thromboembolism, (VTE) and in the complication management of central venous catheters (CVC) is demonstrated. Patients and colleagues refer directly to an ANP via a pager system Monday–Friday. The ANP service includes the education, training and assessment of nursing and medical staff in the complication management of these patients to ensure a 7day service is maintained.

The ANP role in the management of these patients is provided:

Malignant ascites management

Full clinical assessment

Arrange diagnostic ultrasound scan

Review blood results - pre-procedure

Consent, educate and insertion of short-term and permanent ascitic drains

Bedside ultrasound scan

Management of complications that may arise pre or post procedure e.g. abnormal blood results – acute kidney injury (AKI).

Educate hospital and community staff in the management of ascitic drains which includes problem solving of permanent ascitic drains.

Update and maintain ascites management pathways and protocols

Train and assess medical staff in inserting short-term ascitic catheters.

Complication management of CVCs

Clinically assess patients presenting with symptoms of PE / DVT

Authorise diagnostic ultrasound scans

Prescribe anticoagulation therapy

Regularly review symptoms and ongoing management following discussion with the coagulation team.

Educate colleagues in recognizing and problem solving CVC complications.

Consent, educate and placement of peripherally inserted catheters (PICC) for patients receiving systemic anti-cancer treatments, and acutely unwell patients requiring total parental nutrition.

This is now a well established nurse-led ANP service. Data collected demonstrates the positive impact this service has had on patients experience and waiting times through timely, expert review and management.

Hilary Thomas, Rachel Hill and Sarah Owen.

Changing healthcare and the role of the NP/APN
Best practice, Oncology

Problematic alcohol use in people with mild to borderline intellectual disability

Poster & Pitch401Irene van der Linden, Tactus Verslavingszorg, Almelo and Enschede, DEVENTER, Netherlands

Arcadis Zaal corner IMon 10:00 - 11:00

Problematic alcohol use in people with mild to borderline intellectual disability.

The effectiveness of a cognitive behavioural intervention: A quasi-experimental design.

I. van der Linden

SUMMARY

BACKGROUND: Cognitive behavioural therapy plus (CGT+) is a treatment of problematic drug use in people with mild to borderline intellectual disability, whose effects on alcohol consumption is not yet sufficiently known.

AIMS: To assess the effect of CGT+ on the severity score for problematic alcohol consumption, as well as the influence of participants' willingness to change on this effect.

METHODS: In a convenience sample (n = 18, 67% man, 39% intelligence quotient (IQ) 50-70, 61% IQ 70-85) were pre- and post intervention Alcohol Use Disorder Identification Test (AUDIT) and Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q) scores compared using a one-group t-test. In addition, the correlation between pre-intervention willingness to change and change of AUDIT score were calculated.

RESULTS: The average AUDIT decrease was 8.9 points (n = 13, Z = -2.805; p < 0.005), the use decreased by an average of 6.8 units (range 0 - 24) (Z = -2.524; p < 0.012). High scores on willingness to change before the intervention correlated moderately but significantly (r = 0.57, p = 0.05) with the decrease in AUDIT score.

CONCLUSIONS: Despite limitations in the method and sample size, CGT+ appears to be effective in reducing alcohol consumption in people with mild tot borderline intellectual disability, especially in people who are willing to change.

Evidence based clinical practice/scientific research
Alcohol use, Intellectual disability, Mental health, Research, treatment

Rate, timing and predictors of relapse in patients with anorexia nervosa

Poster & Pitch373Tamara Berends, Altrecht, Rintveld Eating Disorders, ZEIST, Netherlands

Arcadis Zaal corner IMon 10:00 - 11:00

Background: Relapse is common among recovered anorexia nervosa (AN) patients. Studies on relapse prevention with an average follow-up period of 18 months found relapse rates between 35% and 41%. In leading guidelines there is general consensus that relapse prevention in patients treated for AN is a matter of essence. However, lack of methodological support hinders the practical implementation of relapse prevention strategies in clinical practice. For this reason we developed the Guideline Relapse Prevention Anorexia Nervosa. In this study we examine the rate, timing and predictors of relapse when using this guideline.

Method: Cohort study with 83 AN patients who were enrolled in a relapse prevention program for anorexia nervosa with 18 months follow-up. Data were analyzed using Kaplan-Meijer survival analyses and Cox regression.

Results: Eleven percent of the participants experienced a full relapse, 19% a partial relapse, 70% did not relapse. Survival analyses indicated that in the first four months of the program no full relapses occurred. The highest risk of full relapse was between months 4 and 16. None of the variables remained a significant predictor of relapse in the multivariate Cox regression analysis.

Conclusion: The guideline offers structured procedures for relapse prevention. In this study the relapse rates were relatively low compared to relapse rates in previous studies. We recommend that all patients with AN set up a personalized relapse prevention plan at the end of their treatment and be monitored at least 18 months after discharge. It may significantly contribute to the reduction of relapse rates.

Evidence based clinical practice/scientific research
Anorexia Nervosa, Relapse, Research

The illness experience of clients with chronic schizophrenia in Taiwan

Poster & Pitch107Huifang Wu, Cardinal Tien Junior College of Healthcare and Management, NEW TAIPEI CITY, Taiwan

Arcadis Zaal corner IMon 10:00 - 11:00

Schizophrenia is an early-onset, chronic and disabling mental illness with great impact on patients, families and the whole society. The lifetime prevalence of schizophrenia is approximately 1% in the world, and 0.3% in Taiwan. Schizophrenia has been the most noticeable major mental illness since 20th century, and with very large amount of research involved. However, existing studies tend to focus upon the psychopathological changes of symptoms and the evaluation of effect of medication treatment. Little has been written on the subjective experiences of clients with schizophrenia. A qualitative phenomenological approach was used to explore the in-depth illness experiences of clients with chronic schizophrenia. The study was conducted in a psychiatric day care center in Northern Taiwan. Ten interviewees were invited to share their experiences through face-to-face semi-structured interviews. Credibility, auditability, fittingness, and confirmability (Lincoln & Guba, 1985) were achieved through adherence by Colaizzi’s (1978) seven-step data analysis. Three themes and 11 subthemes were identified: life chaos after suffering from mental illness (terrible experience/impact of the first onset, negative implications of symptoms, lifelong suffering, and stigma of mental illness), feelings regarding medication (affirmation of its positive effects, living with side effects, and ambivalence to reducing the medication dosage), and expectations for the rest of life (looking forward to becoming a better person, continuous participation in the rehabilitation program, leading a structured daily life, and support from family). The findings indicate the importance for mental health providers to understand the subjective experiences of clients with schizophrenia and offer insights into providing client-centered health care that may assist them to cope with their illness experience.

Patient participation
Illness Experiences, Mental health, Research, Schizophrenia

Patient aggression experienced by hospital staffs in a general hospital of Singapore

Poster & Pitch62Lina Jiang, Changi General Hospital, Psychological medicine, SINGAPORE, Singapore

Arcadis Zaal corner IMon 10:00 - 11:00

Aim: The aim of this study was to identify the prevalence/types of aggression experienced from patients by health care professionals in a general hospital of Singapore, examine the contributing factors to the aggression experienced, and explore psychological impact on staffs when handling aggressive patients.

Methods: The study is a mixed qualitative and quantitative non-experimental design. A non-random purposive sample (N=1912) of hospital frontline staffs from a variety of healthcare professionals were included. Data was collected through self-reported questionnaires on Perception of Patient Aggression Scale, Depression Anxiety and Stress Scale, and face-to-face interview.

Results: Majority of the staffs (84.5%) have experienced aggression from patients. The most frequent type of aggression experience by staffs was verbal aggression (81.7%), and nurses reported the highest prevalence of aggression in all types. Comparing with those from psychiatric units, staffs from Accident and Emergency room are 4.377 times more likely to experience verbal aggression (CI:1.147-16.699, p = .031); staffs from inpatient geriatric are 2.96 times more likely to experience physical aggression (CI: 1.261-6.946, p = .013); staffs from inpatient rehabilitation are 6.2 times (CI:1.648-20.014, p = .006), and from inpatient geriatric units are 5.7 more times more likely to experience sexual harassment/ intimidation (CI:1.699-22.782, p = .006). Gender, profession, years of working experience, and the symptoms of anxiety were the significant contributing factors for respective types of aggression experienced. Despite knowing aggression and violence can be attributed by illness or miscommunication, staffs still experienced a mixed feeling of anger, frustration, fear, traumatisation and guilt when handling such patients.

Conclusion: Findings of the study creates an awareness to the frequent occurrence of aggression in a general hospital. It provides a direction in designing a constructive training programme preparing health care professions to be more competent in managing aggression, thereby minimising the risk resulting from aggression.

Research
general hospital, Mental health, patient aggression, Research

Concurrent Sessions

Providing quality patient-centered care for refugee children

Workshop523Andrea Achenbach, Vanessa Kimm, University of Iowa College of Nursing, University of Iowa College of Nursing, IOWA CITY, United States of America

Van der Vorm ZaalMon 10:00 - 11:00

The United States of America resettled 85,000 refugees in 2016. For the past 3 years, a small community public health clinic in the middle of America has worked to meet the unique health care needs of its refugee community. A team of local public health nurses and the nurse practitioner provides health care to the refugee community. Nurse practitioners can improve short-term and long-term health outcomes for this population by addressing their specific needs in a culturally competent and empathetic manner.

The purpose of this presentation is to educate nurse practitioners on quality patient-centered care for refugee children.

Refugee children are an underserved population that experience unique health disparities. These children have unique health needs based on their diverse backgrounds and experiences. Refugee children are vulnerable to health inequalities due to language and communication barriers, under-insured parents, and the complexity of available support services for refugee families. Several elements of care have shown to improve the delivery of health care for refugee children. These elements are routine comprehensive health screening, coordination of health care, integration of physical, developmental, and psychological health care, providing culturally appropriate services, promoting accessibility and affordability of care, and advocacy. Nurse practitioners education and skill set make them well suited to care for this diverse population.

Topics covered in this presentation include:

1) The unique medical needs of refugee children.

2) Growth and development considerations

3) Psychosocial issues

4) Family adaptation

The nurse practitioner will come away from this presentation equipped with a toolbox to provide quality care for refugee children in their communities as well as support for their families.

Changing healthcare and the role of the NP/APN
Best practice, Prevention and public health, Refugee

Updates on the management of hypertension and cardio-vascular disease

Clinical WorkshopCW1Deborah Gray, Old Dominion University, NORFOLK, VIRGINIA, United States of America

Van Rijckevorsel ZaalMon 10:00 - 11:00

This presentation will review key points, incorporating new guidelines and treatment options for the diagnosis and management of hypertension and dyslipidemia in the prevention of cardiovascular disease.

Biography

Dr. Deborah C. Gray, DNP, FNP-C, ANP, BC, FAANP is Director of the Family Nurse Practitioner Program and full-time faculty in the Doctor of Nursing Practice Program at Old Dominion University. She has practiced as a Nurse Practitioner for over 26 years in a variety of primary care settings, and owns an NP business. She has taught, presented, and published her work on various clinical topics, NP Entrepreneurship, and Telehealth. Dr. Gray is Co-Chair of the ICN INP/APN Network Research Subgroup. She is a Fellow of the American Association of Nurse Practitioners and a Fulbright Core Scholar Award Recipient.

Evidence based clinical practice/scientific research
cardio-vascular disease, Prevention and public health

Applied complex clinical decision making for nurse specialists in mental health care

Workshop474Diana Polhuis, GGZ-VS master education nurse specialist in MH, UTRECHT, Netherlands

Schadee ZaalMon 10:00 - 11:00

The aim of the workshop is to experience how Nurse Specialists MH can improve their clinical decision making skills on an advanced nursing practice level in order to provide effective patient treatment.

Method: We developed a format for complex clinical decision making in advanced mental health nursing practice, based on existing classification models. Medical and nursing diagnostics are integrated and lead to a personalised descriptive diagnose that gives direction to measurable outcomes and effective treatment. The format integrates DSM-5, ICF, functional health patterns, NANDA-international, NOC and NIC. We'll present the use of the format, give examples of personalised descriptive diagnoses and let participants interactively involve.

Other information: There is evidence for a positive relationship between critical thinking and clinical decision-making in nursing. Good decision-making practice consists of a combination of intuitive and analytic aspects.

In the last decade's classification of nursing diagnostics, interventions and outcomes has been developed, researched and validated. On the one hand the use of these qualifications requires knowledge about and analytic skills of the clinical decision-making process. In educating and training Nurse Specialist trainees however we noticed the tendency to make clinical decisions intuitively and less analytically, probably due to the complexity of the required skills. On the other hand, simply following the decision-making process is not effective. It also needs critical thinking and a good way of teaching and training. Exposure to cases in several contexts and providing feedback and role modelling has proven to be effective teaching instruments.

Conclusion: Using a logical format that integrates validated classifications helps Nurse Specialists in mental health nursing to make clinical decisions in complex situations. The adaptation of the format requires training, modelling and feedback in different contexts in order to integrate these skills in daily practice.

Changing healthcare and the role of the NP/APN
Best practice, Complex clinical decision making, Mental health, personalized descriptive diagnosis

Chronotherapy, a new light on things?

Oral Presentation457Bianca van der Meulen, PsyQ, Depressie Ambulant, THE HAGUE, Netherlands

Eduard Flipse ZaalMon 10:00 - 11:00

Chronotherapy i.e. bright light therapy (BLT), is only mentioned in the Dutch multidisciplinary guideline as a treatment for Seasonal Affective Disorder. However current studies show that chronotherapy can be used as treatment for a variety of clinical diseases.

Temporal order is essential for good health. Physiological, psychological, behavioural and hormonal rhythms are functionally and specifically entrained or synchronized to sleep-wake and day-night cycle. Disturbances in temporal order have clinical consequences that are expressed as various (psycho)pathological symptoms (Haffmans et all, 2006). All rhythms are synchronized through a pacemaker, located in the suprachiasmatic nucleus: the biological clock. Research has shown that an irregular lifestyle such as changing working hours, night shifts, an irregular sleep or eating patterns can disrupt the rhythms of the biological clock. We see disrupted biological rhythms among patients with Major depressive disorder but also with ADHD, schizophrenia or bipolar disorder (Germain & Kupfer, 2008; McClung, 2007). Changing hormonal rhythms are seen in women during pregnancy, during the menstrual cycle, just after giving birth, or during menopause (Wirz-Justice, 2006). This can lead to disruption of other rhythms such as mood, concentration, eating and sleeping pattern. The benefits of chronotherapy may also be found outside/beyond mental health care. In the Netherlands contemporary clinical research focuses on giving BLT as treatment of Parkinson’s disease, but also in patients who survived cancer but have residual complaints of chronic fatigue.

People’s sensitivity of their biological clock differs. Some will desynchronize sooner than others. Chronotherapy helps the biological clock 'reset' rhythms and reduce complaints. Other forms of chronotherapy are darkness therapy, melatonin, sleep/wake deprivation, Social Rhythm therapy (SRT), where timing and psycho-education play an important role.

This workshop focuses on educating people about chronobiology, how to diagnose desynchronized rhythms, and what kind of interventions to use.

Evidence based clinical practice/scientific research
chron apy, Mental health

Narrative Exposure Therapy for PTSD in patients with Severe Mental Illness: a mixed methods design

Oral Presentation619Maria Mauritz, GGNet Mental Health Care Center/Radboudumc, WARNSVELD, Netherlands

Eduard Flipse ZaalMon 10:00 - 11:00

Background: In the Netherlands, Severely Mentally Ill (SMI) patients receive Flexible Assertive Community Treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid Posttraumatic Stress disorder (PTSD) are sometimes offered trauma focused treatment like Eye Movement Desensitization Reprocessing or Prolonged Exposure. There is also sufficient evidence for the effectiveness of Narrative Exposure Therapy (NET) within various vulnerable patient groups with interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients.

Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma whether: a) PTSD and dissociative symptoms changes and b) changes occur in SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight in patients’ experiences with NET and to identify influencing factors on treatment results.

Methods: This ongoing study has a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population includes adult SMI outpatients (n=24) with comorbid PTSD and receiving NET.

The quantitative study parameters are: existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, mixed models will be used to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters are: experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will focus on interpreting how qualitative results enhance the understanding of quantitative outcomes.

Preliminary results: descriptive statistics and qualitative results will be available for 15 participants.

Discussion: The results of this study will provide more insight into influencing factors for clinical changes in this population.

Evidence based clinical practice/scientific research
Mental health, physical abuse, posttraumatic stress disorder, Research, sexual abuse

CANCELLED: Researching the skills of advanced practitioners in relation to mental health practice

Oral Presentation562Angelina Chadwick, University of Salford, Health and Society, SALFORD, United Kingdom

Eduard Flipse ZaalMon 10:00 - 11:00

The overarching aim of this study was to evaluate the use of mental health skills that graduates from the generic advanced practitioner programme at the University of Salford utilised in their role as an advanced practitioner. The climate that the practitioners work in sees the mentally ill often presenting at healthcare services with physical health problems, and the mortality rate for this group of clients being higher than those without mental health problems (Thornicroft, 2011).

The study adopted a descriptive ‘case study’ (Yin 1994) approach using interviews to elicit participant experiences and to allow them to voice personal beliefs in regard to the mental health component of the programme and its impact on their practice. The study received ethical approval (University of Salford 2017). 10 interviews were conducted with participants that had recently completed the programme, each lasting no more than one hour. The interviews were verbatim transcribed and coded for analysis. The analysis presented a narrative of varying levels of application of mental health skills that had become inherent in the practitioners clinical work. Key findings illuminated arguments that suggested the utility of mental health skills for the use in advanced practice roles and the need for broadening psychological type skills within such roles.

Mental health skills that are taught in the mental health component of the advanced practice programme had broadly two objectives; to address key tangible skills that can be applied in developing a therapeutic relationship with someone presenting with both physical and mental health problems, and to focus on the personal development of the practitioner’s skills in self-awareness and self-reflection on practice. Hence the mental health component focuses the development of skills needed to work with the mentally ill and to develop a higher level of individual emotional intelligence that may aid personal resilience.

Changing healthcare and the role of the NP/APN
emotional intelligence, Mental health, Research

Forensic psychiatry: facts and fiction

Oral Presentation375Marlinde Van Veenendaal, GGZ Drenthe, Forensic Psychiatry, ASSEN; Annemiek Schäfer, GGZ Noord Holland Noord, HAARLEM, Netherlands

Hudig ZaalMon 10:00 - 11:00

During this oral you will be given information about the forensic services in the Netherlands and what does this mean exactly for the nurse practioner in practice. You will receive information about the state of the art treatments aspects in forensic services. After this oral you will the facts and figures in forensic care. On the basis of practical examples, the hot topics in forensic services will be shared.

Topics among other things will be: facts and fiction about forensic care, high and intensive care from a forensic perspective, treatment stages, safety in care and medicinal treatment of patients with sexual disorders.

Authors have written an article about this topics and this article will be published in the magazine “Psyfar VS” in 2018. PsyfarVS is an magazine that focuses on pharmacology for nursing specialists.

Education
Best practice, Mental health, pharmacology of patients with sexual disorders, state of the art treatments

The advanced nurse practitioner mental health in forensic psychiatry

Oral Presentation180Monique Jansen Duighuizen, FPC De Oostvaarderskliniek, ALMERE, Netherlands

Hudig ZaalMon 10:00 - 11:00

The aim of this abstract is to give international recognition to the role of the Advanced Nurse Practitioner (ANP) in forensic psychiatry in the Netherlands.

In the Dutch legal system there is a special judicial measure for people who have committed a crime. The court will impose this measure if there is:

- A serious offense (4 years in prison or longer);

- A psychiatric disorder possibly in combination with a mild intellectual disability;

- High risk of recidivism.

If the above points are mentioned and the person is declared irresponsible, there will be no imprisonment, but compulsory treatment in a forensic psychiatric clinic. Purpose of the treatment is a safe return to society (Infographic Ministry of Security and Justice, June 2017).

Number of forensic patients in the Netherlands: 1374 (2016). F.P.C. Oostvaarderskliniek had 164 patients in treatment in 2016. The average treatment duration is 7.5 years (DJI in number 2012-2016 / July 2017).

F.P.C. Oostvaarderskliniek is a governmental institution with a high level of security and high care. The treatment is aimed at reducing the risk of recidivism. We work with the Risk Management Model as a treatment framework (Treatment Vision Oostvaarderskliniek, 2015).

At this moment there is one ANP and one ANP in training. The ANP is not yet an official profession within the Ministry of Justice. The ANP works under the supervision of the psychiatrist.

The ANP has both patient and personnel-related tasks. To patients, she is responsible for prescribing medication, focusing on comorbidity somatic and psychiatric problems and medication monitoring. In medication monitoring, one of the methods we use is the Forensic Early Warning Signs (Frans Fluttert 2008).

Personnel-related tasks include, among other things, developing and giving training and stimulating and motivating disciplines to contribute to and optimize patient care and consultation.

Changing healthcare and the role of the NP/APN
Advanced Nurse Practitioner, Forensic Psychiatry, Mental health

Continuity of care for people with severe mental illness

Oral Presentation65Thijs Beckers, MET ggz, Netherlands

Hudig ZaalMon 10:00 - 11:00

People with severe mental illness can receive treatment from specialised mental healthcare teams or from their general practitioners. In some countries, like Great Britain or the Netherlands, there are ‘in between’ options, providing care that is less intensive than specialised mental healthcare, but more intensive than care from the general practitioner. There is little knowledge on which person needs which intensity of care.

The aim of this presentation is to give insight into how the care for people with severe mental illness is organised and how the decision on which intensity of care your patient needs can be improved. To accomplish this aim, studies conducted both by the authors and others will be discussed.

First, the different intensities of care for people with severe mental illness will be discussed, along with the number of people with severe mental illness that use these types of care, or no care at all. Additionally we summarise the existing knowledge on the topic of allocating care.

Second, we discuss the relationship between the different types of recovery (symptomatic, functional and personal) and the needed intensity of care.

Third, we will discuss when nurse practitioners and other healthcare professionals think people with severe mental illness can be referred to less intensive types of care and how these professionals reach this decision.

Finally, we combine the earlier discussed information into practical considerations for use in daily practice. We also explain how our research will continue in order to develop a useful tool for nurse practitioners and other healthcare professionals to aid in the decision whether to refer people with severe mental illness to less intensive care.

Research
intensity of care, Mental health, recovery, Research, severe mental illness

Introducing advanced nursing practice to an ED in Saudi Arabia - A quality improvement initiative

Oral Presentation570Siobhan Rothwell, Johns Hopkins Aramco Healthcare, Emergency, DHAHRAN, Saudi Arabia

Jurriaanse ZaalMon 10:00 - 11:00

Emergency Departments struggle to manage safe, effective care in the face of increasing patient volume. The role of the Nurse Practitioner has been shown to improve key factors such as waiting times and the patients' experience in the Emergency Department.

The purpose of this presentation is to highlight the benefits of the Nurse Practitioner Role in an Emergency Department in Saudi Arabia. This quality improvement project evaluated the effectiveness of a Nurse Practitioner based in the Emergency Department managing patients presenting with minor trauma over a three month period. A pre- post intervention approach was implemented and evaluated.

Over a three month period, waiting times and the number of patients who left without being seen was reduced. Most importantly was the successful integration of the Nurse Practitioner role into the multidisciplinary team. Currently there is no recognition of the role of the Nurse Practitioner in Saudi Arabia. howvever, robust credentialling and privileging was undertaken (the Nurse Practitioner was licence in her country of origin) and the project was part of a pilot project in collaboration with the Saudi Arabian Ministry of Health.

This is a significant step forward in contributing to the discussion around advanced nursing practice in Saudi Arabia and presentation of the findings on an international stage will support the advanced practice movement, with the necessary focus on local training opportunities and not to rely on the expatriate workforce.

Changing healthcare and the role of the NP/APN
Best practice, Emergency care, Minor trauma, Nurse Practitioner

An innovative education model to improve resuscitation skills and neonatal outcomes in Rural India

Oral Presentation520Lori Spies, Baylor University, Louise Herrington School of Nursing, DALLAS, United States of America

Jurriaanse ZaalMon 10:00 - 11:00

Introduction: Stillbirths account for 3 million infant deaths each year and approximately 900,000 infants die due to birth asphyxia. In India the neonatal mortality rate is 25/1000 live births but infants born in rural settings are twice as likely to die. The effectiveness of implementing neonatal resuscitation education in low resource settings has been challenged by a myriad of infrastructure disparities. This presentation will provide the results of a multidisciplinary, multinational advance practice nurse-led study to test an innovative resuscitation skills education program based on Helping Babies Breathe.

Research Method: The feasibility cluster randomized control trial was implemented in the Nagakurnool district of rural India. 60 villages were randomly assigned to the intervention or control group. Nurses and midwives received initial training at an all-day hands-on workshop. Knowledge, skill, and outcome measures from the control group were monitored without further interventions. The intervention group additionally received: periodic re-training, multimedia teaching, and monthly train the trainer sessions. Information retention was assessed with pretests and skills check-off and posttest at 1 month and 1 year. Birth outcomes were evaluated as secondary outcomes.

Summary of Findings: Improved knowledge and skills were noted after initial training in both groups (n =48). Pre vs. Post-tests results at 1 month were without statistical differences between groups. The one year evaluation is pending. There were significantly (p< 0.0001) more newborns requiring resuscitation in the control group 37/147 (25%) than in the intervention group 17/233 (7%). Newborn deaths within 7 days of birth were not significantly different. Conclusion: While the one month results were non-significant within months the intervention group had significantly less need for newborn resuscitation. This may be related to better application of skills in newborn stabilization. The NNP and FNP researchers noted increased engagement and vestment in importance of resuscitation and acquisition of skills.

Research
Multidisciplinary, Neonatal resucitation, Prevention and public health, Research

How nurse practitioners globally have addressed the UN’s sustainable development goal 3

Oral Presentation337Judy Honig, Columbia Univerisity, School of Nursing, NEW YORK, United States of America

Jurriaanse ZaalMon 10:00 - 11:00

Aims

The United Nations (UN) 17 Sustainable Development Goals (SDG) were created to end all forms of poverty, fight inequalities and tackle climate change were adopted by world leaders at a historic UN Summit in September 2015. SDG 3 (Good Health and Wellbeing) is directly linked to the work NPs engage in globally. Within SDG 3 there are a number of key target indicators that are to be met. However, the extent to which these target indicators have been addressed in the last two years by NPs has not been fully explored.

Methods:

An integrative review of how NPs globally have addressed SDG 3 within the published literature was conducted. The main keyword of Nurse Practitioner was used in combination with keywords related to each SDGs 3 target indicators which were deemed pertinent by the research group were utilized in searches of four online databases. Limits of the search were those published in English between the dates of January 2016 (when the UN 17 SDGs came into effect) to January 2018. Further identification of publication's country of origin as well as level of evidence using the Joanna Briggs Institute Levels of Evidence scale will be performed.

Results:

Preliminary results to date indicate that not all SDG 3 target indicators have been met by NPs in the published literature. However, this will be substantiated once integrative review process and time frame is completed at the end of January 2018.

Conclusion:

The findings are limited to published literature. More emphasis should be placed on publication of NP practice which could contribute to meeting SDGs. This will to inform our nursing colleagues, other healthcare professionals and healthcare policymakers the role that NPs play now and into future to achieve the goal of Good Health and Wellbeing within any global health care setting

Changing healthcare and the role of the NP/APN
Healthcare, Nurse Practitioners, Prevention and public health, Research, Sustainable Development Goals

Overcoming barriers. Linking theory to practice in advanced nursing students

Oral Presentation190Ursula Serdarevich, Universidad Isalud, Nursing, BUENOS AIRES, Argentina

Mees ZaalMon 10:00 - 11:00

In Argentina during the last 20 years the field of Nursing has experienced significant changes. The introduction of new technologies, the advances on postgraduate studies and the opportunities for participating in health policies has demanded to modify the academic offer.

Nursing educators has an important role for teaching advanced students nursing taxonomies, epistemological perspectives regarding the concept of care and including Nursing Process in the everyday work.

Some barriers are still a threat for accessing these tools. They include:

- Fragmented use of resources and procedures.

- Misunderstanding of theoretical models.

- Limited awareness on the scope of taxonomies.

- Scarce of hypothetic thinking during the diagnostic process.

- Restrictions on the use of terminology.

The Nursing Process incorporates narratives, case study and life histories in the phases of planning, intervention and evaluation. This versatile and flexible instrument favors the link between theory and practice.

The experience shows that the presentation of the Nursing Process needs to be clear to avoid frustration, abandonment and mechanical use in practitioners and students.

The purpose of the presentation is to share the author 's experience with two cohorts of students (2015 - 2016) applicants for the Nursing Degree (ISalud University – Argentina) learning and using the Nursing Process. A methodology based on scaffolding (tutorial) and collaborative learning was implemented. It focused on student’s opinions and practice using the tool and in ways of overcoming difficulties that may appear during clinical practice.

Generating tools that assist Nursing educators becomes a challenging goal including scientific knowledge, didactic/pedagogic skills and mastery of epistemological foundations.

Education
Nursing Process, Scaffolding

Global exchanges for nurse practitioner students

Oral Presentation61Melanie Rogers, University of Huddersfield, United Kingdom, Mary Steinke, University of Indiana, Kokomo

Mees ZaalMon 10:00 - 11:00

 

This presentation explores the method, results and benefits of a global exchange between Nurse Practitioner (NP) students in the UK and USA. Collaborative exchanges for NP students are expanding beyond the confines of individual institutions to encourage international collegial relationships to develop which will enhance NP education in addition to personal and professional development. This type of exchange enables NP students to look at individual, national and international issues that impact their practice.

The exchange developed in response to one the ICN NP/APN Network’s aim of increasing collaborative experiences for NP students. Students from the University of Huddersfield and Indiana University met via an interactive discussion board (https://www.thecn.com/) on 2 occasions to explore a number of aspects of the NP role including clinical practice, education, leadership and research. The students gave their own experiences of these aspects of their role in addition to debating key international NP literature.

The discussions are to be evaluated via a questionnaire on survey monkey in spring 2018. The findings will be presented at this conference. This presentation will discuss the benefits and challenges of global exchanges for NP students and how this can benefit the international arena.

Developing collaborative global exchanges require commitment, flexibility, enthusiasm and creativity on the part of the faculty. Clear aims and outcomes of the collaboration need to be explored and established in addition to consent via individual institutions. Students then need to be excited and willing to engage fully via interactive means taking into account time differences, cultural differences as well as national variations in NP education. Having had pre-existing collaboration as researchers enabled this exchange to develop.

Education
Education, Nurse Practitioners, Primary care, Research

Advanced clinical practitioner apprenticeships in England: a new model to consider

Oral Presentation59Katrina Maclaine, London South Bank University, LONDON, United Kingdom

Mees ZaalMon 10:00 - 11:00

The English Government has ambitious plans for the number of apprenticeships needed to boost productivity across all sectors. An apprenticeship is defined as training to perform effectively in a particular occupation. From April 2017 large employers, including healthcare organisations, have been required to contribute 2% of their paybills to fund apprenticeships leading to many analysing how they can use this opportunity to develop their workforce.

The “Advanced Clinical Practitioner” (ACP) is being developed as a higher apprenticeship by a Trailblazer group comprising ten employers and two Higher Education Institutions (HEI). Rules for apprenticeship approval require the standard should describe a new role. Making this case has been interesting and challenging given that a multitude of advanced practitioners already exist across all healthcare settings. However without this being argued successfully, this new funding stream would not be available to support the development of more practitioners to an advanced level of clinical practice to meet the current escalating patient and service demands. There have also been significant implications for HEIs under the apprenticeship training rules. While a full masters award has been stipulated in the proposals, the employer plays a much greater role in apprenticeship training than in traditional HEI based programmes. In addition part of the final year requires an End Point Assessment (EPA), set nationally by the Trailblazer group, is conducted independently of the ACP programme provider. This has required critical reflection whether a traditional 60 credit masters level Dissertation is needed compared to other ways of utilising the third year credit. The first course is due to start in September 2018 with numbers predicted to be higher than traditionally accommodate on a masters award.

This presentation will review the journey to date and share lessons learned from the perspective of one of the lead HEIs within the Trailblazer.

Innovation
Apprenticeship, Innovation

A pilot of family-centered rounds in a general hospital in Tilburg, the Netherlands

Oral Presentation620Ilse van Haren, Elisabeth-Tweesteden Hospital, Netherlands

Plate ZaalMon 10:00 - 11:00

Supported by standards, goals and mission Elisabeth-Tweesteden Hospital (ETZ) in Tilburg started a pilot of family-centered rounds on the neonatal department questioning: is the pilot improving satisfaction and will it bring added value to the family centered care in the ETZ in Tilburg.

Methods

Parents of newborns with an expected stay of at least three  days were included. Nineteen  patients received standard care of the traditional rounds. Twenty-eight patients received a family-centered round to evaluate the condition of the child and to create the multidisciplinary policy. All parents, nursing en medical staff filled out forms to evaluate information, communication and satisfaction. Literature was used to formulate the questions. To implement the pilot we used a PDCA method.

Results

Parents feel better informed by the nurse practitioner/pediatrician (86% pilot vs 63% traditional). They confirm that nursing and medical staff give relevant information about their child (79% versus 44%).  Parents are more satisfied about the general information (82% vs 63%) and the medical policy (79% vs 58%).  Parents feel slightly more involved in the clinical decision making within the pilot group. The overall satisfaction about the way information was offered, discharge criteria and the possibility to share their concerns was the same in both groups.

Nursing en medical staff experienced the pilot as a more efficient method supporting the feeling of working as a team and the vision of family centered care.  ‘Talking with parents’ instead of ‘talking to parents’.

Conclusions

In summary family centered rounds are improving satisfaction of parents, medical and nursing staff. This small pilot showed no negative effects of family centered rounds on a neonatal department for both parents and health providers. Parents feel slightly better informed in the pilot group. Family centered rounds brings an added value to the team vision of family centered care.

Patient participation
Best practice, family-centered rounds, Paediatrics

Developing and implementing a primary care advanced nurse practitioner masters programmes

Oral Presentation214Evelyn McElhinney, Glasgow Caledonian University, Nursing and Community Health, GLASGOW, United Kingdom

Plate ZaalMon 10:00 - 11:00

- Introduction statement indicating purpose of presentation

Changing ways of working within Scotland’s models of health and social care requires a shift in the balance of care from hospital to community settings; ensuring people are cared for at home and

Changing healthcare and the role of the NP/APN
Best practice, new ways of working, Primary care

Developing of APRN education and role in Hungary

Oral Presentation207Orsolya Máté, University of Pécs, Faculty of Health Sciences, PÉCS, Hungary

Plate ZaalMon 10:00 - 11:00

Before 2017 the Nursing education on the higher education level was structured in Hungary by the followings: Bachelor of Nursing (4 years education, 240 credits), Master of Nursing (3 semester education, 90 credits). The year 2017 is truly a historical moment for Hungary and Hungarian nurses for the legislative decree clearly regulates the Hungarian competencies of Advanced Practice Nurses, bringing the APN as definition and role in life in Hungary and in Central Eastern Europe. Among Eastern European countries Hungary was the first, who regulated the APN roles with a legislative decree. The introduction of this legislation gave the opportunity to take real steps, so changes were made in the Faculty of Health Sciences of the University of Pécs. According to the international criteria of the program, the Institute of Nursing Science was the initiator for replacing the former Master of Nursing program with the establishing of the new master of Nursing program, called APRN with 6 specialities. Beginning in September of the 2017/18 academic year Hungary will launch several of the following specifications of the APN, within the training program of Nurse Practitioner: Nurse Anaesthetist, Primary Care Nurse Practitioner, Emergency Care Nurse Practitioner, Acute Care Nurse Practitioner, Geriatric Nurse Practitioner, Perioperative Nurse Practitioner. The entry requirements are in the case of Nurses the Bachelor of Nursing degree for all specialisations, in the case of Emergency Care Nurse Practitioner the Bachelor of Prehospital Care can be accepted. Hungary has recognized the need for change, and in the coming years it will strive to achieve the highest professional standards in both education and practice. While the statutory regulations allow these tasks/competencies, the current legal background to practice needs to be defined and adopted by law. This must be fixed by January 2019, when the first graduates complete their studies.

International developments and collaboration
APN, Hungary

Preparing nurse practitioner students to deliver adolescent SBIRT for substance use

Oral Presentation411Stephen Strobbe, University of Michigan School of Nursing, Health Behavior and Biological Sciences, ANN ARBOR, United States of America

Ruys ZaalMon 10:00 - 11:00

Introduction: Adolescent substance use has been identified as the number one public health problem in the United States. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based clinical approach, designed to assist individuals in preventing or changing substance use behaviors before more serious problems develop. Universal SBIRT is recommended as part of routine health care, yet few health care professionals are prepared to deliver this service. The purpose of this project was to 1) assess the feasibility of integrating Adolescent SBIRT into an advanced practice health assessment course in nursing, and 2) to determine whether a combination of education and clinical simulation would result in improved competence and confidence in the delivery of Adolescent SBIRT by nurse practitioner students in an advanced health assessment course.

Methods: Sixty-seven nurse practitioner students were offered 1) a highly advanced computer simulation, 2) a didactic lecture on prevention and SBIRT for substance use in primary care, and 3) a face-to-face clinical simulation, including interactive role-plays in group settings. SBIRT skills were scored automatically in conjunction with a computer simulation Assessment Challenge. Self-perceived competence and confidence were measure via pre- and post-survey items that focused on specific Adolescent SBIRT skills. Two-tailed tests were applied at significance level of ?=0.05.

Summary: Of 67 nurse practitioner students taking an advanced health assessment course, 61 (91%) engaged in educational and clinical activities related to Adolescent SBIRT, and provided both pre- and post-survey data. Upon completion, 52 of 61 (85%) students achieved a recommended passing score of > 75. Significant improvements in self-reported competence and confidence were noted across all measured domains (p<0.001). Conclusion: Adolescent SBIRT was successfully integrated into an advanced health assessment course. Nurse practitioner students demonstrated learning and reported significant increases in competence and confidence in the delivery of Adolescent SBIRT.

Education
Addiction, Adolescent, Research, SBIRT

Failures: qualitative study on patient perspective, living with ADHD, sleeping and eating disorders

Oral Presentation213Cinderella Zwennes, Parnassia, Netherlands

Ruys ZaalMon 10:00 - 11:00

The purpose is to introduce new information about a three-dimensional, inextricable healthcare problem. How do patients suffering from ADHD, a delayed sleepphase, and eating disorders such as binge eating and/or obesity cope? Literature showed earlier that almost 80% of ADHD patients suffer from circadian sleeping problems due to late onset of their melatonin production. Disrupted sleep patterns and being overweight also effects the hormonal balance; due to high levels of leptine, ghreline and cortisone patients experience less satiation, which leads to a continuous hunger feeling. ADHD leads to an increased risk of developing a disturbed diet, due to reduced inhibition and self-control. Quantitative research showed a relationship between the three dimensions. Little is known however about patient’s perspective on these matters. In daily nursing practice, we see patients with obesity and ADHD struggling with increasing fatigue and little personal power to change this during treatment. We chose a qualitative phenomenological design based on the theory of Parse. Patient experience and knowledge is an important data source in this model. We interviewed six patients in two institutes.

Respondents appoint a personal relationship between ADHD, sleep and eating patterns. They all suffer from binge eating and moments of failure when on a diet, most of the time caused by a rebound effect when their medication wears off. Personalised story's gave an inside in this negative proces. They spoke about low self-esteem, a distorted body image, continuous failure moments, and the increasing struggle in making choices and losing control. Most days end in feelings of failure; eating unhealthy food.

By means of personalised life story's, the effectiveness of ADHD treatment can increase. If sleep, eating patterns and ADHD are assessed and treated by nurses, with a transdiagnostic view on risk factors for quality of life and incorporated in a personalized treatment/care plan.

Research
Addiction, ADHD, Mental health, Patient perspective, Research

Transcending responsibility: dealing with the harmful use of alcohol

Oral Presentation91Susanne van den Hooff, University of Applied Sciences Inholland/Erasmus University Rotterdam, GSW, AMSTERDAM, Netherlands

Ruys ZaalMon 10:00 - 11:00

All people are vulnerable to risk factors contributing to noncommunicable diseases (NCD’s), whether from unhealthy diets, physical inactivity, exposure to tobacco smoke, or the harmful use of alcohol (World Health Organization, 2017). During this presentation the focus will be on the harmful use of alcohol.

Family members of patients suffering from chronic alcoholism often experience difficulties to convince healthcare professionals that there is a need for professional care. Even in the situation when the family member suffering from chronic alcoholism, is admitted into a general hospital for treatment of, for instance, a broken leg. In this situation the alcohol problem is not the reason for admission and therefore is not dealt with. The principle of respect for patient’s autonomy is highly valued; it is the choice of the patient to use or not use alcoholic beverages.

This problem raises ethical dilemmas. A debate between the different actors is necessary when the responsibilities of family members, healthcare professionals such as nurse practitioners and advanced practice nurses, and legal professionals seems to conflict. Not only in general hospital care but also in homecare situations.

This presentation will discuss some of these dilemmas and the different responsibilities based on some practical examples from qualitative research. It will address the concept of Transcending Responsibility. Each actor has his own formal responsibility, however, care might improve and NCD’s might diminish if the actors not only reason from their own perspective but try to transcend their responsibility to relate to the other actors’ perspective. This will ask for a reexamination of assumptions and values, critical thinking and new creativity (Hooff van den, 2015).

Collaboration and Inter-Disciplinary Practice
alcoholism, ethics, Non-communicable diseases, Research, responsibilities

Symptomatic and functional recovery in late-life depression

Oral Presentation199Rose Collard, Radboud university medical center, Psychiatry, NIJMEGEN, Netherlands

Van Beuningen ZaalMon 10:00 - 11:00

ABSTRACT: Aim- Functional decline provides insight in the total impact of diseases, such as depression, on individuals. This study examines the change in several domains of functioning over two years in older persons depressed at baseline (non-remitted group and remitted group after two years) and in a non-depressed comparison group.

Methods- Longitudinal data of depressed older persons aged (N=378) and a non-depressed group (N=132) were collected from the Netherlands Study of Depression in Older persons (NESDO). Depression was classified according to the DSM-IV criteria at baseline and at two-year follow-up. Severity of depression and functional limitations were assessed at six-month intervals.

Results- Linear mixed models showed that the level of functional limitations differed between the three groups during two years follow-up. The non-remitted group had the highest level of functional limitations during two years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remain.

Higher severity of depression appeared a risk factor for a declining course of functioning, especially the social aspects of functioning.

Conclusion- This study showed that late-life depression has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that late-life depression treatment should aim broader that just symptomatic recovery, but also include functional recovery.

Evidence based clinical practice/scientific research
Elderly, functional limitations, late-life depression, Mental health, Research

New models of care meet the needs of older adults: the development of a gerontology nursing service

Oral Presentation216Janet Parker, Helen Bowen, Waitemata District Health Board, Older Adults and Home Health, AUCKLAND, New Zealand

Van Beuningen ZaalMon 10:00 - 11:00

In Waitemata District Health Board similarly to the rest of New Zealand, the 65+ population will increase from 13% in 2014 to 20% in 2034. Currently 7% of people 65+ live in aged residential care (ARC).

Acute admissions from ARC are potentially avoidable with early identification and intervention. Staff in ARC manage the care of older adults with complex health problems, often with little training and support.

Community dwelling older adults with complex health problems are at increased risk for poor outcomes and acute admissions.

The increasing numbers of older adults with complex health problems places increased pressure on health delivery services and requires different models of care to meet their needs.

2004: First gerontology nurse practitioner (GNP) and two Gerontology Nurse Specialists form the Gerontology Nursing Service (GNS) review patients in the community to provide comprehensive geriatric assessment (CGA) in an outreach model to ARC and the community, resulting in fewer admissions and shorter stays in acute care.

2007: the Residential Aged Care Integration Programme (RACIP) developed to provide clinical advice, resources, support and education for ARC with significantly decreased hospitalisations for the intervention group than the comparison group. GNP Intern (eventually endorsed as a GNP) joined the medical team in a rehabilitation ward to increase team stability, minimise the impact of junior medical staff rotation and improve continuity of care.

2010: GNPs reviewing older adults with complex geriatric issues in clinic releasing geriatricians to see the more medically complex.

2014: Interim Care in ARC with GNS oversight for older adults who are non-weight bearing after orthopaedic surgery and unable to be managed at home until fit for rehabilitation.

Meeting the needs of older adults with complex health issues through a gerontology nursing team has reduced pressure on acute health services and improved quality of care for older adults.

Changing healthcare and the role of the NP/APN
admissions, aged care, Best practice, Elderly care, prevention

Complications and risk factors in elderly with hip fracture following orthogeriatric treatment

Oral Presentation67Ellis Folbert, Ziekenhuisgroep Twente Almelo-Hengelo, Traumasurgery, ALMELO, Netherlands

Van Beuningen ZaalMon 10:00 - 11:00

Introduction

This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome, we examined the association between baseline patient characteristics and a complicated course.

Methods

Patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at the Ziekenhuisgroep Twente, Almelo (ZGT) between April 2011 and October 2013 were included. Data registration was carried out using the clinical pathways. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high risk (HR, ASA 3 =, n=341) and low risk (LR, ASA 1-2, n=111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.

Results

49.6% (n=224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n=17). In 57.5% (n=196) of the HR patients, a complicated course was seen compared to 25.2% (n=28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p=<0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%), p=0.301) and pneumonia (HR 10.9% vs. 5.4%, p=0.089). Independent risk factors were age (OR 1.04, 95% CI 1.01-1.07, p=0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p=0.031) and ASA score =3 (OR 3.62, 95% CI 2.22-5.91, p=<0.001). Conclusions

After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients. The in-hospital mortality rate was 3.8%. Risk factors were increasing age, poor medical condition and delirium risk VMS Frailty score. Possible areas for improvement were targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs).

Collaboration and Inter-Disciplinary Practice
Critical/ acute care, Elderly patients, Hip fracture, Integrated treatment, Research

Development of the nurse practitioner role in Tanzania

Oral Presentation88Jane Blood-Siegfried, Duke University, United States of America

Van Weelde ZaalMon 10:00 - 11:00

Introduction:

We would like to discuss advancing the role of the nurse practitioner as a solution to meeting SDG’s and steps taken to introduce this role in Tanzania.

Description:

More than 70% of Tanzanians live in rural areas. Nurses (64%) are more likely to practice in rural underserved communities than physicians (30%). The majority of global healthcare education programs are oriented to single diseases/conditions, not comprehensive primary preventative care. Nurses in rural areas of Tanzania are already providing care without the requisite training: therefore it is logical that educating nurses as nurse practitioners will improve health outcomes.

Summary:

In an exploratory study we sampled district hospitals, health centers and dispensaries, in each of the four high-risk regions of Tanzania. Interviews with local nurses, health facility managers, non-nurse health professionals, and health service consumers demonstrated that nurses were prescribing for patients and performing minor surgical procedures, well beyond their educational preparation. The consensus by all participants was that nurses should receive training in skills to provide comprehensive primary care as a solution to the lack of providers. We convened a national consensus meeting that included politicians and policy makers to define the NP role and outline a path forward. The government of Tanzania and the Nurses and Midwifery Council are supportive of this project,

The nurse practitioner role is not “task shifting”: it is an advanced practice specialization that goes beyond single disease training programs. Health care provided by nurse practitioners has proven to be cost-effective, high quality, and equivalent or even superior to care provided by other cadres, especially in the area of prevention, maternal child health, vaccinations, and non-communicable diseases.

Conclusion:

Initiating a Nurse Practitioner education program requires more than proving a need. The concerns from multiple stakeholders, governmental officials, and educational commissions all need to be addressed.

International developments and collaboration
Nurse Practitioner, Primary care, Research

Context and implementation of advanced nursing practice in Canada and Spain

Oral Presentation16Sonia Sevilla Guerra, Hospital Clinic de Barcelona, Nursing, BARCELONA, Spain

Van Weelde ZaalMon 10:00 - 11:00

Background: The complexity and difficulties involved with the development and implementation of health innovations such as advanced practice nursing roles, result in a slow and sporadic distribution internationally. To manage this complexity, it is recommended to expand the understanding of the context in which these innovation processes takes place. However, there is little research specifically concerned with contextual factors that influence the implementation of advanced practice nursing roles. Objective: to integrate and develop a comprehensive understanding of the contextual factors that inter-influence the development and implementation of Advanced Practice Nursing in two countries, Canada and Spain.

Method: The research method used was qualitative, descriptive and explanatory. Different qualitative methods, data collection process and perspectives from participants in different professional groups were used to triangulate the findings from both settings. Participants from diverse perspectives of practice, organization and environment levels, were engaged to participate in semi-structured focus groups in Catalonia and interviews in Quebec. Data gathered aimed to inform about different dimensions of the context: (1) perception/understanding of the role; (2) Felt needs or motivations to develop the role; and (3) Perceived barriers and facilitators present in the Catalan and Quebec

Results: Integration of findings reflected a vast predominance of convergent themes despite differences in context and population characteristics. The study identified common and diverge context factors of advanced practice role development and implementation across both countries.

Discussion: Understanding contextual factors will ultimately allow better understanding of complex phenomena in healthcare. To enhance implementation processes and knowledge transfer it is essential to understand contextualized health innovations. Further reporting of contextual factors that influence the development and implementation of advanced practice nursing roles in other countries is required to compare innovative processes.

International developments and collaboration
Context, Research, triangulation

Developing an evidence-based educational framework for implementing the APN-NP role into Abu Dhabi

Oral Presentation4Nikki Miller, Cleveland Clinic Abu Dhabi, Emergency Medicine Institute, United Arab Emirates

Van Weelde ZaalMon 10:00 - 11:00

Over the past several decades many countries have been confronted with issues related to healthcare and the shortage of primary care physicians (Pulcini, Jelic, Gul, & Loke, 2010). In an effort to resolve the emerging problem, these countries have turned to the nursing workforce to combat these needs especially focused on the Advanced Practice Nurse (APN) and Nurse Practitioner (NP) (De Geest, Moons, Gallens, Lindpaintner, & Spirig, 2008).

In late 2015 the Health Authority of Abu Dhabi (HAAD) agreed to license advanced practice nurses for use in the newly opened Cleveland Clinic Abu Dhabi (CCAD). A study was conducted to identify gaps in knowledge related to APN-NP scope of practice by those working alongside the APN-NP at CCAD. This study used a survey to identify staff knowledge about the APN-NP scope of practice. Findings from this assessment were used to develop an evidenced-based educational plan aimed at familiarizing the APN-NP role within the facility.

Data were collected from 239 returned surveys received from CCAD staff who work directly with an APN-NP. Twenty-two questions focused on the knowledge of the role and scope of practice recognized in the United States (US). Three of the 22 specific questions highlighted a lack of understanding of the role as it has been established and normalized in the US. The specific areas included the ability to diagnose illness and disease, develop treatment plans independently without the assistance of the physician, and prescribe controlled substances/narcotics.

APN-NP’s are an important part of the healthcare workforce (Horrocks, Anderson, & Salisbury, 2002). Staff working with the APN-NP must be well educated on the training, competencies, and scope of practice of the APN-RN if the role is to be embraced by regulating authorities in order to gain full scope privileges with minimal restrictions.

International developments and collaboration
Abu Dhabi, Advanced Practice Registered Nurse, Primary care, Research

Job satisfaction of nurse practitioners in The Netherlands. Facilitators and barriers.

Oral Presentation181Gerda Drent, Hanze University of Applied Sciences, Master Advanced Nursing Practice, GRONINGEN, Netherlands

Zeelenberg ZaalMon 10:00 - 11:00

Introduction

In the Netherlands the first nurse practitioners (NP) graduated in January 2000. In November 2017, 3300 NP’s were registered, their role expansion increased and the role is formalized by the Dutch law. Job satisfaction is an integral part of the performance of the NP, but little is known about job satisfaction of NP’s in the Netherlands.

Aim

This study aims to examine the level of job satisfaction of the NP in order to assess facilitators and barriers.

Methods

This study utilizes a cross-sectional survey methodology and a descriptive analysis. The survey was administered in September 2016 among 485 alumni and students of the ANP master course of the Hanze University of Applied Sciences. Respondents completed a survey consisting of: 1) demographic data, 2) job satisfaction, facilitators, barriers and career development. Job satisfaction and additional questions were measured on a 5-point Likert scale, ranging from 1 (never satisfied) to 5 (always satisfied).

Results

The survey was completed by 77 respondents. Most respondents were female (81%), age between 35 and 50 years old (42%), and most were alumni (81%). The mean job satisfaction was 4.23 (scale 1-5, sd 0.857), 39% were satisfied with their practice autonomy, 31% with patient contacts and 24% with using their competencies. The respondents were most dissatisfied with their positioning and appreciation (32%), workload (18%) and payment (13%). An important facilitator to become more visible in the landscape of health care can be provided by a professional organization (41% of respondents). Vision, embedding, job prescription and acceptation are seen as the most important barriers by 45% of the respondents.

Conclusion

Despite of the low response key components for improving job satisfaction of nurse practitioners are better positioning, adequate job prescription, higher acceptance and appreciation, acceptable workload and better payment.

Changing healthcare and the role of the NP/APN
Job satisfaction, Positioning, Research, Role expansion

Barriers to specialty practice: an international problem

Oral Presentation413Barbara Safriet, Lewis and Clark Law School, PORTLAND, United States of America

Zeelenberg ZaalMon 10:00 - 11:00

Introduction/Purpose:

The focus of this presentation is on the current issues of barriers to practice for individuals who specialize in Emergency NP and Clinical Nurse Specialist practice. Although individuals have been practicing in these positions for many years, their competencies, educational background and leadership are being challenged. The purpose of this presentation is to present these barriers and problem solve the issues.

Methods:

Data has been collected and analyzed from State Boards of Nursing, the CDC, Nurse Practitioner organizations, the National Center for Health Statistics, the American College of Emergency Physicians, and National Ambulatory Medical Care Survey.

Findings:

The findings show that there is a strong need for Advanced Practice Nurses in the Emergency Medicine area of practice. Barriers that need to be discussed are educational preparation to make one competent, what type of original practice degree is necessary prior to moving on to advanced curriculum for specialty practice, addressing issues from the nursing profession and their regulators and the overall goal of putting the patients’ needs first.

Conclusion:

This presentation will provide attendees with a broader understanding of expanded specialty practice that meets the needs of the public. An overview of barriers to practice and potential resolution of these issues will be discussed.

Changing healthcare and the role of the NP/APN
Professional Responsibility, Regulation of APN role

Task sharing and task shifting in nursing and midwifery: implications for policy development

Oral Presentation171Mmule Magama, University of Botswana, Centre of Academic Development, GABORONE, Botswana

Zeelenberg ZaalMon 10:00 - 11:00

Introduction: The world is faced with a critical shortage of health workers; in Botswana, nurses are often required to perform tasks that are frequently outside the scope of nursing practice without policy or legislative support. World Health Organization suggests task sharing and task shifting to address workforce shortages. The Purpose of the study was to inform development of a policy on task sharing for nurses and midwives in Botswana. The study explored task sharing and task shifting opportunities, barriers and their implications to policy development.

Methods: A descriptive cross sectional approach that triangulated quantitative and qualitative methods was used to conduct the study. Ten (10) out of 27 health management districts were purposively and systematically sampled. A random sample of 491 nurses at 22 Health facilities across the country was surveyed.

Results: Respondents preferred task sharing as opposed to task shifting; that respondents already had tasks shifted to them and a considerable number of tasks they shared with other health professionals. Three hundred and thirty four (70.3%) respondents were performing tasks shifted from other health care cadres, whereas 436 (87.9%) did not have their own tasks shifted to non-nursing cadres. Fourteen percent (14.3%) of respondents who shared tasks were supervised all the time while the rest did not. Forty six percent (46.4%) autonomously performed tasks while the rest did not and Sixty percent (63.7% n=283) received support for the task perform while rest did not. An overwhelming number experienced conflict over shifted or shared tasks. Sixty percent (63.7% n=283) received support for the task perform while 36.3% (n=161) did not.

Conclusion: While a few tasks are solely performed by nurses, midwives or doctors, a considerable number of tasks are shared between professionals, hence, there is need to consider involvement and acceptance of professional groups when developing a task sharing policy.

Health-care Policy
Nursing and Midwifery, policy development, Research, Task sharing and task shifting

11:30 - 12:30 Parallel Sessions Round 2

Poster & Pitch

Nurse practitioner driven primary care in the United States: a changing political climate

Poster & Pitch517Jean Aertker, Tampa Occupational Health and Wellness, TAMPA, United States of America

Arcadis Zaal corner BMon 11:30 - 12:30

The rapid growth and development of the nurse practitioner (NP) role in the United States has positively impacted a move to more evidence-based and accessible health care. However, NPs face a challenging and ever-changing political climate that impacts federal and state decisions on NP practice. The key messages recommended in the Institute of Medicine (IOM) 2011 report, the Future of Nursing: Leading Change and Advancing Health, acknowledges nurses should be change advocates by caring for all populations within a complex and fragmented health care system. To realize this goal of future health care, the IOM envisions the role of the advanced practice registered nurse (APRN) should be called upon to fulfill and expand their potential as primary care providers across practice settings based on their education and competency. Yet in the United States, change has been slow to advance NP practice. Modernizing laws to remove restrictions is a state by state feat, often taking years to accomplish. This poster presentation traces the impact of the change in our national NP practice environment and the concurrent political climate that resulted in removal of barriers or changed laws since 2010. A review of major state laws passed during this time that are favorable to NP practice are identified and categorized into three areas: Improved Access to Care, Organizational Enhancement or Reducing Cost-Fiscal Impact. The successful passage of laws to remove NP barriers was also examined for length of time to achieve a successful campaign and category of supporting stakeholders. Conclusions are presented to assist NP groups for how to analyze and positively move 'controversial' legislation from these successful methods and trends found.

Health-care Policy
Barriers to Practice, Health Policy, Practice Regulations

Validation process of clinical nurse specialist core competencies

Poster & Pitch112Krista Jokiniemi, University of Eastern Finland, McMaster University, Department of Nursing Science/ School of Nursing, KUOPIO, Finland

Arcadis Zaal corner BMon 11:30 - 12:30

Introduction:

The global development of advanced practice nursing roles, such as clinical nurse specialist, has stemmed from the increased demand for better access and higher quality care with decreased costs. To ensure the development of safe and effective practices and understanding of roles, there is an urgent need to define competencies in advanced nursing. However, there is limited research and discussion in the area of clinical nurse specialist competence internationally. The objective of this study was to develop and validate clinical nurse specialist core competency criteria in the Finnish healthcare context.

Method:

An exploratory sequential mixed-method study, involving four phases, was conducted between 2013 and 2017. Both qualitative and quantitative methods were used to analyze the data.

Results:

The findings from this mixed-method study shed light on the clinical nurse specialist core competency validation process. First the clinical nurse specialist competency criteria were teased out in a policy Delphi study (n=25, n=22, n=19). Thereafter, preliminary competency descriptions were cross-mapped against two international competency sets, namely the US and Canadian. Thirdly, through a content validity study (n=7, n=10) the criteria were made more concise, and the Content Validity Indexes computed. Finally, the extent to which validated competencies were used in current clinical nurse specialist practice was explored (n=16). The final competency set includes 50 criteria with a Scale Content Validity Index Average of 0.94. The clinical nurse specialists reported using the developed competencies broadly in their practice.

Conclusion:

This study contributes to the development of the clinical nurse specialist roles and competencies. The results suggest the potential of formulating consistent international clinical nurse specialist competency criteria to support global role understanding and development. Further research is needed in order to validate the content and construct of the formulated competency criteria in larger populations across countries.

Research
Advanced Practice Nursing, Clinical Nurse Specialist, Competency criteria, Research

From registered nurse to advanced practice nurse – implementing a national model in Finland

Poster & Pitch461Anna Suutarla, Finnish Nurses Association, HELSINKI, Finland

Arcadis Zaal corner BMon 11:30 - 12:30

Introduction: In 2016 an expert group established by the Finnish Nurses Association (FNA) formulated the nurses’ clinical career model. The model includes three competence levels: registered nurse, specialised nurse, and advanced practice nurse (APN), including the roles of nurse practitioner and clinical nurse specialist. Fostering further implementation of the model requires cooperation between various policy-makers: social and health, education, financial, regulatory, and labour.

Objectives: To implement the nurses’ clinical career model and as part of it, the roles of advanced practice nurses in particular, in cooperation with different stakeholders. The aim is for the model and the roles to be included in Finland’s new national social and health system structure, which is due for implementation in 2020.

Method: A seminar illustrating the subject from various national and global viewpoints was held in November 2017 by FNA, the Union of Health and Social Care Professionals, the Ministry of Culture and Education, and the Ministry of Social Affairs and Health. The seminar audience consisted of invited guests including participants from universities, universities of applied sciences, the Finnish Medical Association, regulatory and supervisory authorities, clinical practice, and ministries. The audience was asked to reflect on and anonymously share their views on why and how different stakeholders should further promote the roles of APNs.

Outcomes: The outcome will be the participants’ feedback, grouped by stakeholder type, illustrating the role of each one of the following in supporting role implementation: social and health professionals, citizens, regulatory and supervisory authorities, global partners, employers, higher education institutions, trade unions/professional associations, employers’ federations, ministries/politicians, municipalities, and others.

Conclusion: The feedback will form a picture based on the views of key stakeholders and will give some guidelines on how to further proceed with the national implementation process to foster APNs’ roles in future social and health structures.

Health-care Policy
implementation

Prescribing: is this a bridge too far for all nurses and midwives in Australia?

Poster & Pitch291Julianne Bryce, Australian Nursing and Midwifery Federation, Federal Office, Australia

Arcadis Zaal corner BMon 11:30 - 12:30

In a country as vast as Australia, it is widely acknowledged that many people have restricted access to health care services due to their geographical location, a shortage of health care practitioners or high demand on the health care system.

One way of improving access to health care, of bridging the gap in service provision, is to enable health practitioners to undertake the education required to safely and effectively expand their scope of practice.

For decades, registered nurses and midwives in Australia have engaged in a form of structured prescribing through the use of nurse/midwife-initiated medicines, standing orders and protocols. However, it wasn’t until 2000 that independent prescribing by registered nurses commenced with the establishment of the nurse practitioner (NP) role. Ten years later, in 2010, midwives with scheduled medicines endorsement were also permitted to prescribe independently.

In late 2017, the nursing and midwifery professions in Australia commenced work on developing potential future models of prescribing for nurses and midwives more broadly. The key elements of a nationally consistent prescribing framework for registered nurses and midwives are: education, competence, standards for practice, and legislation.

This paper will identify the challenges to expanding the scope of practice of registered nurses and midwives to prescribe. Bridging the gap provides the opportunity to develop innovative models of care enabling safe and effective access to essential medicines. The outcomes of the proposed new model, which will give registered nurses and midwives in Australia the right to prescribe medicines judiciously, appropriately, safely and effectively in accordance with their scope of practice, will be presented.

Nurse practitioners will have an essential leadership role in the success of this innovative prescribing pathway for Australia.

Health-care Policy
Best practice

Understanding the Variance across England of the advanced practitioner role

Poster & Pitch331Anna Neary, University of the West of England, Adult Nursing, BRISTOL, United Kingdom

Arcadis Zaal corner BMon 11:30 - 12:30

Understanding the Variance across England of the Advanced Practitioner Role

Key words: Advanced Role, Education, Challenges, Regulation

Introduction statement indicating purpose of presentation

The poster demonstrates the varying role of Advanced Practitioners in two areas of England: Manchester and Bristol. It further demonstrates role variance including job descriptions; underpinning academic qualifications and challenges encountered.

Brief description of pertinent research or other methods adopted

To investigate the varying role of Advanced Practitioners, a short questionnaire was designed and completed at the AAPE Conference in November 2017. Practitioners from these two UK geographical areas were chosen as they represent the north and the south of England, where there are identified challenges in the available medical resource to serve population needs.

Summary of new unpublished data and/or other relevant information

Role Titles: nurse practitioner; advanced clinical practitioner; advanced nurse practitioner

Academic qualifications: BSc (Hons) Nurse Practitioner; Masters Level module/s in Non-medical prescribing (NMP), physical assessment and clinical reasoning, minor injury/ illness.

Role and Responsibilities: minor injury/ illness assessment and diagnosis; on the day assessment appointments as well as whole episodes of care treatment and referral.

Challenges: medical attitudes to the role, patient misperception of skill levels of role holders and variance of role across different practice areas.

Role of HEIs: ongoing provision of multi-professional education and research facilitating role development and clinical supervision.

Other Comments: Regulation was stated as a key element to enable a national network of support and development.

Conclusion

Advanced practice roles are diverse with no clear standardisation in these two geographical areas in England. This is reflected in the literature available and supported by the variance in role titles and job descriptions. Practitioners, in the majority, are treating whole episodes of care on a wide demographic of patients with little support and/or supervision with limited levels of academic underpinning.

Collaboration and Inter-Disciplinary Practice
Advanced Role, Education, Regulation

An exploratory randomized controlled trial of anti-stigma program for people with schizophrenia

Poster & Pitch165Chiu-Yueh Yang, National Yang-Ming University, Nursing, Taiwan

Arcadis Zaal corner FMon 11:30 - 12:30

This study evaluated the effectiveness of an anti-stigma programme (ASP) for patients with schizophrenia. A total of 34 participants were assigned using a blocked randomisation into either an eight-week ASP (experimental group, EG) or a psychosocial education programme (control group, CG). Data collection occurred between May to Oct 2016. Generalized estimating equations revealed that the EG achieved a greater drop in the stigma resistance subscale of the Internalized Stigma of Mental Illness Scale than the CG at post-intervention and the three-month follow-up. The scores on the concerns over marital preclusion and self-deprecation subscales of the Perceived Psychiatric Stigma Scale and the Beck Depressive Inventory II in the EG had significantly improved more than those of the CG at the three-month follow-up. The ASP seems to be effective in improving self-stigma and depressive symptoms in patients with schizophrenia.

Research
anti self-stigma, depressive symptoms, Mental health, Research

Existential issues in treatment

Poster & Pitch188Janneke Hengeveld-Slöetjes, Dimencegroep, Netherlands

Arcadis Zaal corner FMon 11:30 - 12:30

Background: There is considerable evidence that existential issues are important in the life of and care for patients with anxiety or depression. These issues are typically related to worldviews and themes like hope, comfort, destination, meaning and suffering.

Objectives: Exploring the meaning of existential issues in treatment relationships between patients with anxiety and/or depression and nurses.Methods: Qualitative research, through a phenomenological approach, in order to investigate the nature of existential issues that are brought up as relevant in the interactions between nurses and patients with anxiety and depressive disorder. Open in-depth interviews were done with nurses and patients with anxiety or depression about existential issues in their communications and interactions. Data-analysis was done by the seven steps of Colaizzi (1978).

Findings: Existential issues appear to be embedded in embedded in the context of daily life, treatment and society. There is an association with available time, knowledge, and language. Existential issues are intrinsic to the treatment relationship and are conceived as an expression of holistic care. During the interviews the issues of hope and powerlessness were mostly brought up. Nurses suggest that they feel responsibility for the patient and for having an attitude of hope, trust, comfort and strength. Patients receive that attitude and suggest gratefulness. Both nurses and patients suggest that explicitly addressing existential issues might be beneficial for the quality of the professional relationship and could increase trust in the treatment process. Participants see a focus on existential issues as specifically belonging to the role of the nurse, more than to the role of psychiatrists, physicians, or psychologists. Conclusion: Existential issues are often and intrinsically interwoven with the interactions between nurses and patients with anxiety and depression. Further research could contribute to developing a body of knowledge, a broader vocabulary and integration of the existential dimension in treatment methods.

Research
existential issues, Mental health, Research, treatment relationship

Educational intervention for patients with behavioral health needs on medical-surgical units

Poster & Pitch160Diane Daddario, Wilkes University, Nursing, NEW BERLIN, United States of America

Arcadis Zaal corner FMon 11:30 - 12:30

This poster presentation shall describe the author’s Doctor of Nursing of Nursing project.

The literature has identified that mentally ill individuals experience chronic medical illnesses at a rate greater than the general population. When these patients are hospitalized on medical-surgical units (or other non-behavioral health units), they are often considered to be “difficult patients”. These undesirable perceptions toward patients with mental illness were found to compromise the staff’s ability to respond to medical symptoms. Nurses can play a crucial role in improving inpatient care of this vulnerable population with psychiatric needs in addition to their medical care. Alexander, Ellis, and Barrett (2015) did a review of the literature to explore nurses’ perceptions toward the care for mentally ill patients in medical-surgical settings and to highlight the current issues and challenges with this care. It included nine studies related to medical-surgical nurses’ knowledge, skills, and attitudes toward patients with severe mental illness. The nurses’ negative perceptions toward patients with SMI was found to compromise their ability to respond to medical symptoms and deliver quality, competent, compassionate, and holistic care.

This scholarly project provided an educational intervention on best practice for patients with behavioral health care needs while on medical-surgical units. There was the expectation that Medical-Surgical nurses will provide higher quality of care and be more comfortable providing care to these patients. This pilot project with descriptive correlational design used a pre-education and post-education test to determine medical-surgical nurses’ knowledge related to the care of patients with behavioral health needs. It also assessed the nurse’s comfort level with providing care to these patients with the additional behavioral health needs versus patients on their medical-surgical units without the additional behavioral health needs.

Research
Behavioral Health Care, Mental health, Research

Recovery-oriented care in the forensic psychiatry

Poster & Pitch96Inge Berends, VNN, Friesland, SNEEK, Netherlands

Arcadis Zaal corner FMon 11:30 - 12:30

Background. GGZ Friesland mental health care services in the Netherlands are implementing recovery-oriented care. This requires adjustments due to the specific characteristics of the target group. Specifically for groups like forensic patients by whom treatment affects social recovery. Aim. This study aims to identify experiences of impeding and promoting factors to achieve social recovery for forensic psychiatric out-patient. Methods. A qualitative exploratory descriptive research design with a phenomenological hermeneutical approach was used to conduct eight interviews in-depth. Data were collected between July 2016 to December 2016 and verbatim transcripts were analyzed by Atlas Ti.

Results. Four themes distinguished; personal experiences, treatment, support of others and society.

Conclusion. Intrinsic motivation is needed to achieve a turning point. The treatment and support of others is important for social recovery. The judicial framework is encouraging but too much supervision and agreements hinder social integration. In addition to criminogenic factors, the consequences of comorbidity, stigmatization and distrust in the environment are impeding factors for social recovery. It is recommended to use the International Classification of Functioning, Disability and Health (ICF) in addition to the risk-need-responsiveness model. Shared decision making gives rise to autonomy and, in cooperation with the client system and chain partners, is provided with more targeted interventions with potentially less helpers. This integrated collaboration is in line with a phase-oriented and dimensional approach for this forensic psychiatric target group in the development of recovery-oriented-care and helps reduce recidivism, decreasing stigmatization by restoring trust through the society.

Research
forensic, Mental health, Research,

Medication adherence through weekly use of antipsychotics?

Poster & Pitch72Arne Rijkeboer, Parnassia Groep, Netherlands

Arcadis Zaal corner FMon 11:30 - 12:30

Medication adherence through weekly use of antipsychotics? A quantitative non-experimental, correlational and comparative cross-sectional study into medication adherence in patients with a psychotic disorder.

Background 42% of patients with schizophrenia stop taking antipsychotics at some point. Three quarters of medication non-adherent patients relapse within a year, often with serious consequences. Penfluridol (ACEMAP in the Netherlands) has to be taken only once a week and may be effective in medication non-adherent patients who do not wish to receive intramuscular antipsychotics.

Objective To discover whether there is a correlation between medication adherence and the daily or weekly intake of antipsychotics, in order to improve prescribing practices in medication non-adherent patients.

Method A quantitative non-experimental, correlational and comparative study design. Medication adherence in patients with a psychotic disorder, from four FACT teams, was measured using the MARS-5 Medication Adherence Rating Scale (N=48).

Results Patients who took antipsychotics daily were significantly more medication adherent than patients who took this medication on a weekly basis.

Conclusions This outcome is useful for those prescribing medication to medication non-adherent patients with a psychotic disorder. However, it is important to consider other factors besides intake frequency. Randomized follow-up studies into medication adherence and weekly intake, focusing on a range of factors, are strongly recommended.

Keywords

Medication adherence, psychotic disorder, penfluridol

Research
medication adherence, Mental health, penfluridol, psychotic disorder, Research

Women with faecal incontinence – the lived experience and the importance of patient participation

Poster & Pitch397Frida Olsson, Uppsala University Hospital, Sweden

Arcadis Zaal corner JMon 11:30 - 12:30

Faecal incontinence (FI) is a relatively common condition, prevalence ranging from 3-24% (1,2,3,4). But there is an under-reporting due to patients' reluctance to talk about their symptoms and consult health care professionals about their problems. Problems related to FI are therefor often are underestimated (2,3,5). Living with FI affects the quality of life negatively and has a negative impact on family situations, social interaction etc. (3,6,7,8). The poster aims to describe women’s experiences of living with FI and how it´s affect daily life. The aim is also to address how the interprofessional team including the NP can support and address her care needs since NPs have access and equity to healthcare.

The case is taken from a study aimed to identify and describe the lived experience of living with FI and how it affects daily life. The results from the study show that living with FI is a complex problem affecting everyday life in a number of different ways. Living with FI is embarrassing, the worst thing to suffer. A positive approach from healthcare services and being seen as an individual is of great importance.

There is a lack of knowledge about experiences of living with FI and how it´s affects daily life. The results of the study can deepen the understanding of the complex problem around FI and thereby lead to that healthcare address these problems better. As a NP one can give more attention to the issues concerning FI and be a spokesperson to inform healthcare services and society about the condition. Since it is an individual and complex problem the patient's participation is of importance.

Patient participation
Best practice, Faecal incontinence, Patient experience

Growing up with Epilepsy A tool to help youth with epilepsy to discuss and develop their autonomy

Poster & Pitch597Marion van Ool, Kempenhaeghe, Poli epilepsie, HEEZE, Netherlands

Arcadis Zaal corner JMon 11:30 - 12:30

Growing up with Epilepsy

Implementation of a tool to help youth with epilepsy to discuss and develop their autonomy.

Objective introduction

The Epilepsy Growing-Up tool (EGU) is an item-list about nine fields (me, care, relation, study, work, living, transport, spare time, sport) for Youths with Epilepsy (YWE) and their parents. YWE are challenged by the consequences of epilepsy. Apart from an increased risk for behavioural problems, depression and anxiety, YWE are confronted with cognitive and academic problems, limitations to engage in social activities, social isolation, and worries about having seizures and using anti-epileptic drugs. In addition, sexual functioning may be affected. Next to the lack of privacy due to constant supervision and being confronted with (over)protective adults, the consequences of having epilepsy can seriously hamper the development of autonomy.

The EGU can be used for YWE from 7-17+ and their parents.

There is also a version for YWE with an intellectual disability (ID), age 7-21+ and their parents.

The nurse practitioner can use the EGU to stimulate the discussion between YWE and parents about developing autonomy and to make an action plan.

Methods

Literature research;Interviews: YWE, parents, professionals;Focus groups: YWE and their parents;Delphi- procedure: experts;Effect-research: YWE.

Results

Epilepsy negatively impacted the YWE’s physical health, psychosocial and cognitive functioning, and put pressure on the child parent relationship. In the focus groups YWE wanted to be autonomous, but showed a passive coping style regarding self-agency. In the effect-research YWE experience that there should be more room for talking about not-medical issues during consults.

Conclusion

YWE and their parents struggle with choices to be made regarding independence and autonomy. Health care providers, all above the nurse practitioner, as a clinical expert and communicator, can use the EGU to support YWE and their parents in the changing healthcare during the transition.

Patient participation
autonomy, Paediatrics, Research, tool

The ICF anchored in the work-related care nnovation plan for a new report form

Poster & Pitch566Marijke Roseboom-Coenen, Ro-Ad Arbodienstverlening, Netherlands

Arcadis Zaal corner JMon 11:30 - 12:30

Background and problem: Within the occupational healthcare, the report sent to customer and client after consultation is not always unambiguous and clear. The use of both a certain format and a methodology is required to guarantee the continuity of the re-integration process. The International Classification Functioning, Disability and Health (ICF) offers a structure that enables customer and client to take responsibility within the reintegration process by mapping out certain factors.

Objective: Develop the report in order to improve both the unambiguity in reporting as well as the continuity of the reintegration process.

Methods: As methodology the ‘Mixed-method’ has been applied on the various sub questions leading to answering of the main questions. Literature research was done into the use of ICF in the occupational healthcare. Next was a benchmarking exercise as to how reporting is performed within the occupational healthcare services in The Netherlands. Finally, verification of the observed results for correctness took place by telephone consultation with key players.

Results: Result of the ‘Mixed-method’ methodology showed that no literature has been found evidencing the application of the ICF methodology in reporting within the occupational healthcare. Benchmarking and key players confirm this result.

Design: Based on the literature found a set-up has been for the innovation applying ICF in reports. Hereby the workload model of Van Dijk (1990) has been incorporated.

Implementation: Implementation of the innovation will follow the roadmap of Grol (2011). An analysis of questionnaires about the innovation amongst occupational health professionals did not led to significant impediments for implementation.

Conclusions: Reporting can be done based on the ICF methodology. As framework the workload model of Van Dijk shall be used. To embed the ICF within the way of working in the occupational healthcare it is important to develop an implementation plan following existing models such as Grol.

Patient participation
ICF - International Classification of Functioning, Occupational health, Participation, Research

Needs and self-care competencies of humans with pancreatectomy

Poster & Pitch487Saskia Pavelcsik, Heidelberg University Hospital, Endocrinology, Germany

Arcadis Zaal corner JMon 11:30 - 12:30

Introduction:

In the endocrinology department of Heidelberg University Hospital, patients with complete removal of the pancreas (pancreatectomy) are increasingly being treated in recent years. The medical treatment refers primarily to the blood sugar adjustment and the optimization of the medication for nutritional support. From a nursing perspective, people with pancreatectomy show a wide range of complex need for care.

There are hardly any studies that deal with the special needs of humans with pancreatectomy. This research investigates of what knowledge and attitude those affected have before a pancreatectomy. This project focuses subjective health and disease concepts and the development of competence and coping strategies. It will also be found out which needs are in the foreground in the first weeks after a pancreatectomy and which competences they need in their everyday life. This research will initially focus what strategies are affected by humans with pancreatectomy in their everyday life in order to maintain or improve their quality of life.

Methods:

To assess the special needs of humans with pancreatectomy, a qualitative research design with episodic interviews at different times (preoperative, early postoperative, domestic coping) was chosen in order to generate implications for a needs-based training and aftercare concept.

Results:

Humans with pancreatectomy have a complex need for care, which according to experience relates to the areas of pain, fatigue, nutrition and diabetes management, as well as dealing with death and dying.

Conclusions:

Based on the findings, a training and follow-up concept will be developed, which is based on the needs of humans with pancreatectomy. The concept is intended to help those affected, despite their limitations, to make everyday life, to minimize the physical impact of the pancreatectomy and to maintain the independence as much as possible while minimizing the need for care.

Patient participation
Critical/ acute care, Pancreatectomy, Research, Self-Care Competencies

Concurrent Sessions

The role of nurse practitioners in a new healthy ageing approach

SpecialSPECIAL2Joost Degenaar, Hanze University of Applied Sciences, GRONINGEN, the Netherlands

Jurriaanse ZaalMon 11:30 - 12:30

Demographic Change and Health is an important theme all over the world. It is one of the grand societal challenges of the European Union: we have an fast ageing population, people live longer but with more chronic diseases, and the cost of health and social care increase. Solutions are to be found in prevention, innovation, technology and entrepreneurship.

Active and healthy ageing gives a fruitful approach to solve the challenges of demographic change and health. In the (northern) Netherlands, Healthy Ageing not mainly about older people with diseases: we have a life cycle approach, from growing up healthy to growing old. The focus is on functioning and health and participation. We use a new definition of health as the ability to adapt and selfmanage in the face of social, physical and emotional challenges.
Nurse Practitioners play an important role in this approach.

Healthy Ageing is a strategic theme of Hanze University of Applied Sciences and Healthy Ageing is firmly established in education, in practice-oriented research and many projects in public private partnerships. Questions and challenges from the professional practice are starting point for innovation, that’s why we mostly work in interdisciplinary collaboration.

The Centre of Expertise Healthy Ageing is a public private partnership, we collaborate with more than 150 partner organizations in about 20 innovation labs. Nursing research and education is an important part of our activities.

The roles of Nurse Practitioners in this Healthy Ageing approach:
- Strengthen selfmanagement and resilience of patients
- Contribute to prevention and health literacy of citizens
- Focus on functioning and the ability to adapt and selfmanage
- Use interdisciplinary and innovative methods in health improvement like the application of health technology.

ageing, Elderly care

Mastering muscular skeletal examination

Clinical WorkshopCW2Kim LaMarche, Faculty of Health Disciplines, Athabasca University, Canada

Van Rijckevorsel ZaalMon 11:30 - 12:30

This workshop is designed to provide APNs with a systematic and evidence based approach to MSK assessment. Findings from a proper musculoskeletal (MSK) examination are extremely useful in navigating the pitfalls of common primary care diagnoses and management.  The literature has demonstrated a specific gap in terms of MSK examination skills among clinicians. Combined with the increasing burden of MSK related diagnoses, the time is right for a review!

Target Participants: Students and practicing Advance Practice Nurses (APNs)

Workshop Format:  in a 60 minute time slot, the presenter will provide an overview of the essentials of a complete and focused MSK exam. Mini case presentations will be threaded throughout to review the essentials of MSK assessment including:
Comprehensive screening exam (ie for sports participation)
Focused diagnostic exam for singular joint/muscle pain (ie shoulder/knee pain)
Focused diagnostic exam for multiple joint/muscle pain (ie OA/autoimmune disease)

The presentation will include patient education resources, physical assessment essentials, history elements review and diagnostic adjuncts. Participants will receive summary handouts to take back to integrate into their practice.

Dr. Kimberley Lamarche, RN NP, DNP is Associate Professor for the Faculty of Health Disciplines at Athabasca University in Alberta, Canada. Furthermore, she is Primary Health Care Nurse Practitioner, Senior Practice Leader for Reserve Force Nursing with the Canadian Armed Forces. She is also Member of the Core Steering Group ICN NP/APN Network and a member of the Canadian Nursing Association.

Autism spectrum disorder in children: update for primary care providers

Workshop505Susan Van Cleve, Vanessa Kimm, University of Iowa College of Nursing, Iowa City, United States of America

Van der Vorm ZaalMon 11:30 - 12:30

The purpose of this workshop is to review current research on autism spectrum disorder (ASD) in children, present best practices regarding the assessment, screening, and diagnosis of the disorder; and describe evidence based treatments. The role of the nurse practitioner as a case coordinator and manager for the primary care needs of these children will be reviewed. Case studies will be woven into the presentation.

Autism spectrum disorder (ASD) encompasses a wide variation in the severity of symptoms and in the impact of functioning for children. The core features of ASD include impairments in social communication, repetitive behaviors and restricted interests. Studies performed in Asia, Europe, and North America have identified individuals with ASD with an average prevalence rate between 1% and 2%. The Centers for Disease Control in the United States now estimates that 1 in 68 school-aged children, or 2% of children ages 6–17 years have some form of ASD. Due to a shortage of psychiatrists and psychiatric nurse practitioners, primary care nurse practitioners are in the forefront in providing healthcare to this vulnerable population including early identification of children with ASD, referral for diagnostic evaluations, and providing ongoing pharmacologic and non-pharmacologic management in practice. This session will provide the primary care nurse practitioner with the background, knowledge and understanding of how to provide high quality care to children with ASD.

Evidence based clinical practice/scientific research
Autism Spectrum Disorder, Best practice, Paediatrics, Pediatrics

Interprofessional International Education Collaboration Preceptorships- Physicians and FNP Students

Oral Presentation607Caryn Scheinberg-Andrews, Simmons School of Nursing and Health Sciences, Nursing-EGL Scholar Program, BOSTON, United States of America

Eduard Flipse ZaalMon 11:30 - 12:30

Introduction: Interprofessional education (IPE) is reported to be the most successful educational model introducing a collaborative approach for students as future interprofessional team members, and promoting understanding of the roles within shared resources or settings. Healthcare outcomes for patients reportedly improve. Israel faces a shortage of physicians in both Jewish and Arab sectors, yet the Israeli Ministry of Health has not recognized FNPs as clinical providers. The purpose of this presentation is to show Israeli physicians’ willingness to provide family nurse practitioner (FNP) clinical education in an international US academic program and to highlight mutual learning.

Methods: This descriptive qualitative research design focused on physicians' experiences of precepting. With appropriate IRB approval of both institutions, physicians were asked open-ended questions about precepting FNP students and integration of future partnerships with FNPs. Interviewing continued until thematic saturation was reached with a sample of 10 physicians recruited from a larger pool of 50 preceptors.

Summary of Results: The ongoing interviews are conducted in Hebrew/ English, audio-taped, transcribed, translated to English and analyzed to assess for themes. Data analysis is in English. Preliminary results reveal common themes to date indicating that physicians anticipate hiring the FNPs they train, and share relational learning through a variety of teaching methods that enhance patient/family care through innovative interprofessional perspectives. The physician preceptors find working with FNP students encourages their own professional development; and emphasizes a holistic approach to family centered care.

Conclusion: The FNP is a new role in the Israeli HMO. Limited physician knowledge of FNP practice challenges the process. Using an IPE model, physicians are engaged in teaching students through “shadowing” and “mentoring” techniques. The students bring their academic evidence based knowledge and application to the preceptor’s’ practices. IPE is an iterative process in which the student also teaches the mentor.

Collaboration and Inter-Disciplinary Practice
FNP, HMO, IPE, Primary care, Research

Collaborative communication in nurse practitioner consultations: using open interaction styles

Oral Presentation467Julian Barratt, University of Wolverhampton, Institute of Health, WALSALL, United Kingdom

Eduard Flipse ZaalMon 11:30 - 12:30

Introduction -

Nurse practitioners increasingly conduct consultations with patients on the same basis as medical doctors. However relatively little is known about communication within nurse practitioner consultations. Research on communication in nurse practitioner consultations has identified nurse practitioners communicate with patients in a hybrid style, combining biomedical information with the discussion of subjective information from everyday life. Research has not fully explained why this hybrid style occurs in nurse practitioner consultations, nor determined its links to consultation duration, patient expectations, satisfaction, and enablement. The presented research study was developed to address these gaps in research of communication in nurse practitioner consultations.

Methods -

The study was conducted in a nurse-led primary care clinic providing general practice care. Within a case study research approach mixed methods were utilised, combining structured analysis of 30 video recorded observations of nurse practitioner consultations, 71 questionnaire-based measures of patient expectations, satisfaction, and enablement, and 14 interviews with some of the patient and nurse practitioner participants of the consultations.

Summary of data -

This study reveals nurse practitioner consultations comprise collaborative openness to peoples’ agendas and questions, expressions of everyday lifeworld experiences, expanded impressions of time, clear explanations augmented by integrated clinical reasoning, and participatory negotiations. Patients were highly satisfied and significantly enabled to manage their health after consulting with nurse practitioners, than has been seen in previous studies with other types of clinicians. The mean consultation duration of 10.98 minutes was not significantly longer than the mean time length of medical doctor consultations.

Conclusion -

An OPEN form of communication is a stylistic exemplar for good consultation communication practice, which facilitates shared decision-making, and demonstrates the importance of clinicians giving precedence to how they communicate and interact with patients so as to optimise their therapeutic outcomes without compromising the duration of consultations. References –

Patient participation
Communication, Consultations, Patient satisfaction and enablement, Primary care, Research

Bridging gaps - advancing practice through interprofessional education and collaborative practice

Oral Presentation503Bongi Sibanda, Independent, Zimbabwe

Eduard Flipse ZaalMon 11:30 - 12:30

Aim: To discuss the adoption of a conceptual policy framework in strategic planning and initiation of an advanced nursing practice project.

Background: Promoting Interprofessional Education and Collaborative Practice (IPECP) is a priority in academic and healthcare practice settings globally (WHO 2010, CAIPE 2017) However, its relevance as a platform to initiate advanced practice projects in a developing country is not known. Implementation of IPE alone can be challenging particularly in Sub- Saharan Africa where most healthcare systems are under economic, human resources pressures and hierarchical in nature. An initiative to develop APN roles through an IPECP workshop project will be discussed.

Method: The application of the Conceptual Policy Framework for Advanced Practice Nursing (Schober et al 2016) in strategic planning for APN initiative as part of the workshop and subsequent associated developments will be evaluated. Project planning over three months and a subsequent two day IPECP workshop delivery led by an Advanced Nurse Practitioner/DNP candidate in collaboration with international colleagues demonstrated an overall acceptance of IPECP and provided a platform to initiate an advanced nursing practice project.

Summary: The participation of other healthcare professionals resulted in promotion of advanced practice among Allied Health Professionals (AHPs), mirroring developments in United Kingdom. Largely, there was acceptance of advanced practice roles by senior medical colleagues and platforms for further collaborations were created. Conflicting views on APN scope of practice particularly around prescribing was observed.

Conclusion: There is scope for APN/NPs to advance practice through IPE and collaborative practice as healthcare education and delivery advance internationally. Emergency and Primary care education may provide suitable platforms to initiate both IPE and advanced practice if strategic planning is embraced and relevant conceptual frameworks adopted.

Collaboration and Inter-Disciplinary Practice
Collaborative practice, Emergency care, Interprofessional Education

Advanced Practice Nurse-led interprofessional collaborative practice: Outcomes and model evolution

Oral Presentation7Bonnie Pilon, Vanderbilt University, School of Nursing, NASHVILLE, United States of America

Hudig ZaalMon 11:30 - 12:30

Vanderbilt School of Nursing opened an interprofessional collaborative practice primary care clinic led by an advanced practice nurse in 2012. The clinic is a partnership among two universities and a local public housing provider in urban, underserved Nashville, Tennessee to provide access to primary care. The IPCP team members initially included 2 advanced practice nurses (family nurse practitioners), one pharmacist, one social worker, and one physician who collaborates by distance (Pilon et al. 2015; Gentry et al., 2016; Pilon, Ketel & Davidson, 2015).The goals of this clinic were to:

  1. Demonstrate improved health status among the target populations served by this IPCP model particularly in the areas of prevention and chronic disease management; and
  2. Provide interprofessional clinical training opportunities for advanced practice nursing students, medical students, pharmacy students, social work students and physician’s assistant students.

After 5 years, we report the outcomes associated with this clinic, including:

1. Chronic disease metrics: hypertension control, cancer screening, hemoglobin A1c, depression screening
2. Student metrics: number/type of trainees, post-graduation satisfaction with interprofessional clinical training, pre/post measures of interprofessional knowledge and skills
3. Interprofessional team development metrics--how the team evolves toward optimal functioning

The clinic team continues to expand to better serve this underserved population. In late 2017 we integrated an advanced practice mental health nurse practitioner and psychiatrist (distance collaborator) into this primary care setting, using an adaptation of the University of Washington's AIMS Center Collaborative Care Model. "Collaborative Care focuses on defined patient populations tracked in a registry, measurement-based practice and treatment to target." (AIMS Center, n.d). Initial behavioral health outcomes are reported in this presentation.

Conclusion: Advanced practice nurse-led interprofessional primary care teams are an effective strategy for addressing the complex health, social and behavioral needs of vulnerable populations. This strategy also enhances health professions student learning and influences future practice.

Collaboration and Inter-Disciplinary Practice
Best practice, Inter-professional, Nurse-led, Outcomes, Primary care

Knowledge of healthcare workers regarding psychotropic drugs and the matter of the NP

Oral Presentation377Steffy Greijmans, Reinier van Arkel, Netherlands

Hudig ZaalMon 11:30 - 12:30

Introduction

Last september I graduated as a Master in Nursing and Midwifery at the University Antwerpen. In my thesis I researched the knowledge and actions of healthcare workers regarding psychotropic drugs in the elderly care and psychiatric care. Meanwhile I started studying the Master Advanced Nursing Practice and started working at the High & Intensive Care (HIC) at Reinier van Arkel. This has led to a translation of my research into the daily practice of a Nurse Practitioner.

Preface

Between 1996 and 2011 the number of users of antidepressants and antipsychotics in the Netherlands has increased substantial (Trimbos-instituut, 2012). Within the acute psychiatry psychotropic drugs are prescribed often. Research has shown that skilled healthcare workers can be an instrument in providing high quality care (Perehudoff, 2015), but a lack of skills can cause a barrier for a safe medication management (Dilles, 2011). The aim of my research was to screen the knowledge and actions of healthcare workers, regarding psychotropic drugs.

Role Nurse Practitioner

The Nurse Practitioner of a HIC is the expert on integrating care and cure. Custom care and supportive recovery care are important aspects on this subject. Also, the Nurse Practitioner has a coaching task towards the nursing team, to accomplish the care policy in a qualitive way.

Findings thesis

Multivariate regression analyses showed a significant model with two positive predictors for a higher score in knowledge: having a nursing education and working within the psychiatry sector. There was also a significant model found within actions where multivariate regression analyses showed two predictors.

Conclusion

What do these findings mean for the daily practice of a Nurse Practitioner working in an acute psychiatric setting like the HIC? I shall inform you about this on the 10th ICN NP/APN Conference in Rotterdam.

Research
Mental health, Psychotropic drugs, Research

The NP brings specialistic care to immoble patients

Oral Presentation241Karin Timm- van Ruitenburg, Allerzorg, KRIMPEN AAN DEN IJSSEL, Netherlands

Hudig ZaalMon 11:30 - 12:30

Title:

Hospital on wheels: the nurse practitioner brings specialistic care to the immobile patients in primary health care.

Introduction statement:

The nurse practitioner (NP) as an independent professional in primary care, provides care at home: 'Hospital on wheels'.

Description:

Since April 2016 almost 100 patients with skin problems and complex wounds are visited, diagnosed and treated by nurse practitioners as an independent professional in primary health care. We cooperate with dermatologists, colleagues NP and specialist in elderly care. The NP’s visit the most immobile and/or mentally disturbed patients at home. By offering specialistic care at home we arranged that these 100 patients didn’t have to move to the hospital. Unnecessary costs for transportation and risks for infection could thereby be prevented. The care is provided based on the appropriate standards of care, guidelines and protocols and is adapted to the needs and demands of the individual patient. The NP bridges the gap between cure and care, ass well as between hospital care and primary care.

Summary: NP’s in heart failure, COPD, oncology, etc. are to do the same in the nearby future, as comorbidity in elderly patients is growing fast. The NP will be the specialist in the primary health care next to the general practitioner. Knowledge is shared with nurses and doctors (general practitioners and specialists elderly care) by bedside teaching as well. A e-health visit by video consulting is added to this care, so we can deliver this care throughout the whole country.

Conclusion: Hospital on wheels ensures that the care becomes more personal, efficient and cheaper: the proper care in the right place.

Changing healthcare and the role of the NP/APN
Best practice, Primary care

Developing an MSc advanced clinical practitioner apprenticeship programme

Oral Presentation346Ruth Pearce, University of Nottingham, School of Health Sciences, NOTTINGHAM, United Kingdom

Mees ZaalMon 11:30 - 12:30

Launched in England in the UK in September 2015, degree and masters level apprenticeships represent an opportunity to develop employer-focused higher education. This year an apprenticeship standard for an advanced clinical practitioner was published to support the development of experienced clinicians from a range of professions including nursing, pharmacy, paramedics and physiotherapy.

The purpose of this study was to develop an apprenticeship programme for advanced clinical practitioners. An action research approach was taken to document phases of action and evaluation. An action research approach was adopted as there was minimal evidence of best practice in the development of apprenticeship programmes within higher education, especially around supporting workforce planning. The preliminary approach includes documentary analysis and focus group data.

The programme has been developed in partnership with local NHS Trusts and community health services. The development of the MSc Advanced Clinical Practice Degree Apprenticeship has been designed to offer levy paying organisations flexible and optional pathways to develop workforce skills, knowledge and capabilities to match health service needs. The apprenticeship combines full-time work with studying for the masters degree qualification. Education is delivered via modular study at university, work-based learning and a two way knowledge transfer between the health service and academia.

The lessons learned so far are to approach partnership working transparently in order to build trust and the sharing of information from the onset. The action research cycles will continue to evaluate the experience of undertaking an advanced clinical practitioner apprenticeship and the impact on health service workforce planning.

Education
Advanced clinical practitioner, Apprenticeship, Best practice

The nurse practitioner: bridging the gap between scientific research and clinical practice?

Oral Presentation323Chulja Pek, Erasmus University Hospital Rotterdam, Surgery, ROTTERDAM, Netherlands

Mees ZaalMon 11:30 - 12:30

Purpose

In the past decade advanced nursing practice has been a growing professional group worldwide. Although literature is published about role development of nurse practitioners (NPs) in clinical practice there is no available data on the conduct of research in clinical practice by NPs. Therefore in 2015 a survey was performed among NPs to explore the extent to which NP’s perform research in the Netherlands. Almost fifty percent of the approached NP’s were performing research independently. We recently repeated the survey to determine of this percentage increased over the past two years.

Methods

This survey was conducted as an online questionnaire using Survey Monkey. The questions included demographics, involvement in research after the education of master advanced nursing practice, and questions concerning the role of the NP in conducting research. A hyperlink to the survey was sent by email to all members of the national association of nurse practitioners in the Netherlands (n= 2450). Nurse practitioners in training and unregistered NP’s were excluded.

Results

The overall response rate was 42,2% (n= 1033), 14 participants were excluded because they were not a NP, and 82 participants were NPs in training. Of the total remaining respondents (937 NPs), 57,2% (n= 536) were involved in research, of which 14,7% (n=79) responded to participate in research and 84,5% (n=453) are conducting research independently i.e.: writing grants (n=66), writing abstracts (n=308), presenting study results (n=258), and publishing scientific articles (n=139). Of the responders, 5,1% (n=48) indicates to be a PhD candidate, and 1,5% (n=14) obtained their PhD degree after MANP graduation.

Conclusions

There is a slight increase in the independent conduct of scientific research by NP’s. In the future we should explore which percentage of research conducted by NP’s would be most ideal for promoting and implementing evidence based research in general nursing practice.

Evidence based clinical practice/scientific research
Research, Research independetly, Research skills

The doctoral pathway for entry into advanced practice

Oral Presentation23Judy Honig, Columbia University School of Nurisng, NY, United States of America

Mees ZaalMon 11:30 - 12:30

We will present CUSON’s transformed Doctor of Nursing Practice (DNP) APN education. The presentation will include the context in which the curriculum was re-envisioned, the alignment of the CUSON DNP with national recommendations, linkages among the DNP competencies with content, learning activities and student achievements. Courses, innovative teaching methodologies and student outcomes will be described.

The National Academy of Medicine: Future of Nursing (2010) called for a more educated nursing workforce that will be better prepared to meet the demands of a changing health care systems. Several national and professional echoed this recommendation and provided the impetus to reshape nursing education. With a national landscape of change, nursing had external support to push the boundaries and to reform nursing education. In this context, Columbia Nursing (CUSON) undertook a critical review to examine its advanced practice (APN) curricular templates and the result is a re-envisioned APN education that advances the curriculum to the doctoral level with DNP degree for entry to APN.

The DNP curriculum is based on CUSON DNP Competencies and is conceptualized under the overall rubric of comprehensive care across the continuum of care. The DNP curriculum reconfigured coursework in a pedagogically sound and academically logical sequence and merged specialty course modules—didactic, clinical, and seminar—with the support doctoral core courses. To reinforce the important curricular thread, cornerstone core modules focused on comprehensive care across the lifespan serve as the foundation for all APN students and build on the underpinnings of nursing and biopsychosocial sciences to understand the trajectory of common acute and chronic illnesses and the impact to risk factors, comorbidities, and the social determinants of health on the wellness/illness continuum.

In summary, APNs with a doctoral education are poised to meet the evolving demands for healthy families and communities.

Education
Advanced Practice Nurse, Doctor of Nursing Practice, Primary care

Understanding nurse practitioner workload in acute, primary and residential care

Oral Presentation363Kelley Kilpatrick, Université de Montreal, Faculty of Nursing, Canada

Ruys ZaalMon 11:30 - 12:30

Introduction: Workload represents how adequately resources required for a task are matched by the resources a person has available. Time and motion studies include observations of provider activities that can be measured using observers, self-report, and timestamps. A key consideration to measure nurse practitioner (NP) workload is to measure all the dimensions of NP roles. The presentation reports on the time spent by NPs in different role dimensions and the factors that influence NP workload.

Methods: Time and motion studies (n=513 hours) were conducted with NPs in acute (cardiac surgery), primary and residential care. The validated tool includes 32 activities divided into clinical (direct and indirect care), education, research and administrative role dimensions. Analysis: Time spent in activities were summed by dimension. Descriptive statistics were generated.

Results: NPs in acute care saw from 12 to 17 patients per day. Differences were noted in the time spent in each dimension depending on NP decision-making autonomy. Time spent in the clinical dimension represented 61% to 73% of work time. Preliminary analyses indicate that NPs in primary care saw an average of 5.83 patients per day. NPs in primary care saw 5 to 11 patients per day; NPs in residential care saw 13 patients per day; and NPs in home care saw three patients per day with travel representing 9% of work time. Time spent in the clinical dimension represented more than 95% of work time in some settings. The time spent in education, research and administrative role dimensions varied considerably according to the needs of patients, teams and organizations.

Conclusions:A better understanding of the factors that influence the time spent by NPs in different role dimensions will support health human resource management and planning. Patient outcomes were not taken into account in the determination of time spent in NP role dimensions.

Research
Research, role dimensions, workload

Measuring the productivity of inpatient Nurse Practitioners: objective measure of productivity

Oral Presentation286Katherine Curci, Penn State Health, Advanced Practice, HARRISBURG, United States of America

Ruys ZaalMon 11:30 - 12:30

Although Nurse Practitioners (NP) contribute a great deal to the care of patients while they are hospitalized their contribution is rarely captured. Historically productivity is measured in billing data and reported as work Related Relative Value Units (wRVUs). This data is attributed to the attending physician burying the work of the nurse practitioner. Studies have been done reflecting when a nurse practitioner is added to an inpatient care team length of stay is decreased, patients are more satisfied and throughput is improved. Although this is valuable information it does not reflect an objective measure of NP productivity. In this changing health care environment each team member must be able to demonstrate their contribution to patient care and the value they bring to the team.

The purpose of this project is to develop objective metrics that reflect nurse practitioner contribution to the care of inpatients. Working with a data analyst from Penn State Health and a data analyst from the vendor of the electronic medical record (EMR) the EMR was explored as a potential source of productivity data. Time and document measures were identified. Using these data a measure reflecting the volume of work completed by a nurse practitioner in an eight hour period of time was identified. This measure parallels the wRVU creating a “virtual wRVU”. Institution benchmarks are now being developed.

This information will be useful to leadership as well as to the individual nurse practitioner. Institutional leadership can use this information to make decisions regarding workforce development and deployment. Nurse practitioners will have a means of demonstrating what they contributed to a patient’s inpatient treatment. Knowing when and when not to add a nurse practitioner to a team will prevent over hiring and go a long way in the prevention of future workforce reduction involving nurse practitioners.

Health-care Policy
Critical/ acute care, Inpatient, Nurse Practitioner, Productivity

Organizational and system factors Influencing nurse practitioner patient panel size in primary care

Oral Presentation360Faith Donald, Ryerson University, Daphne Cockwell School of Nursing, TORONTO, Canada

Ruys ZaalMon 11:30 - 12:30

Introduction: Nurse practitioner patient panel size is defined as the total number of patients regularly under the care of a nurse practitioner, and may be called a caseload or roster. Policy makers and administrators require accurate information regarding factors that influence nurse practitioner patient panel size in primary care settings. Knowledge about these factors can inform policies and decisions to optimize the role of the nurse practitioner; thus contributing to improved health workforce planning, interprofessional team functioning, and timely access to care. This presentation aims to describe the organizational and system factors that influence nurse practitioner patient panel size in primary care settings.

Methods: Mixed methods, case study approach using 1) a scoping review of the literature; 2) time-motion observation of nurse practitioner activities over a five-day period at eight sites, two practices within four models - Family Health Teams, Nurse Practitioner-Led Clinics, Aboriginal Health Access Centres, and Community Health Centres; and 3) interviews with 18 nurse practitioners, eight administrators, eight receptionists, and six physicians at those sites.

Summary of Results: Examples of factors that increased panel size at the organizational level included the nurse practitioner working as an equal member of the team; a multidisciplinary team approach; autonomy to use knowledge and skills; number of exam rooms; use of non-traditional visits (groups, telephone, email); staff support; number of practice sites; home visits; and technology. At the healthcare system level, some factors that influenced nurse practitioner patient panel size included education, regulation, legislation, and secure funding for the nurse practitioner position.

Conclusion: Organizational and system factors that influence nurse practitioner patient panel size are complex and context-dependent. This study provides information to advise administrators’ and policy makers' decisions regarding nurse practitioner patient panel size, organizational structures and supports, and health workforce planning in primary care.

Research
Nurse Practitioner, Panel Size, Primary care, Research

From hospital to homelessness: re-implementing a program to prevent discharge to “No Fixed Address”

Oral Presentation594Cheryl Forchuk, Lawson Health Research Institute, Canada

Schadee ZaalMon 11:30 - 12:30

The discharge of psychiatric patients from the hospital into homelessness remains a prevalent issue that has many health, social, and economic implications (Forchuk et al., 2008; Gaetz, 2012). Lack of stable housing for discharged clients results in negative health outcomes and increased health care expenses. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. This presentation will emphasize the importance of improving accessibility of housing and financial support resources for patients who are at risk of homelessness.

The “No Fixed Address” version 2 (NFA v.2) project tests the efficacy of a potential best practice program that places housing and social supports on-site at hospital psychiatric wards. Housing and financial support is placed directly at participating hospitals via access to housing rental and social assistance databases. A four time-point, repeated measures design will be conducted to capture factors related to housing stability. Descriptive and statistical analysis will be sought where necessary. Data will be collected from administrative sources through the Institute of Clinical Evaluative Sciences, local hospitals, and shelters. Qualitative data will be obtained from participants and staff via interviews and focus groups.

A pilot project (Forchuk et al., 2006) found that all seven participants randomly assigned to the intervention remained housed at 3 and 6 months’ follow-up, while individuals in usual care were unhoused or had entered the sex trade. In a following scaled-up phase (Forchuk et. al, 2008), 92.5% of those who accessed the service and were at risk of homelessness were connected with affordable accommodation.

Locating safe housing for psychiatric patients may have a positive impact on treatment, rehabilitation, and the system as a whole. The findings of this project will be discussed in relation to the role of the Advanced Practice Nurse.

Research
Best practice, homelessness, hospital discharge, Mental health

APN education in mental health - a case example of network program by 4UAS in Finland

Oral Presentation349Nina Kilkku, Tampere University of Applied Sciences, Finland

Schadee ZaalMon 11:30 - 12:30

The purpose of this presentation is to describe the co-operational model of the Master’s level mental health education by four Universities of Applied Sciences in Finland. This co-operation was launched in 2011 and ever since new groups have started every other year. Master’s level studies in UAS in Finland differ from other university studies, as students need to have three years of working experience before entering the studies. In the education, this means a tight co-operation with working life, acknowledgement of previous experiences of the students and collegial co-operation between the students and teachers. This model have enabled also international co-operation, in which students were included in the project to enhance the Master’s level mental health nursing, the eMenthe project.

In the presentation, this money-saving model will be presented with its benefits and challenges together with the description of development process during the years, the experiences of students and teachers as well as experiences from working-life representatives. Latest information also on the eMenthe project will be included. This data has been gathered during the life span of the education and has not been presented this way before.

In general, the experiences have been very good, both the students and teachers have been very satisfied with this model and there are new similar kind of development programs starting. This model can be easily adapted in other branches of nursing -and in other education programs.

Education
Best practice, Mental health

Creating “Smart Environments” for Clients with Severe Mental Illness: The Smart Homes Project

Oral Presentation593Cheryl Forchuk, Parkwood Institute, LONDON, Canada

Schadee ZaalMon 11:30 - 12:30

INTRODUCTION: The World Health Organization identified mental illness as one of the greatest challenges in the coming decades (WHO, 2013). The economic cost of mental illness to Canada was recently estimated at $23.8billion in 2015 (MHCC, 2016). New technologies are being rapidly developed with no clear consistent means of implementation into care environments for testing and evaluation.

METHODS: Individuals with functional issues tend to be higher users of the mental health system and require more support. These individuals will be the focus for this project. Up to 20 participants (aged 18-85) who are inpatients at two psychiatric facilities and meet inclusion criteria will be recruited. The technological supports will include text-messages sent to smartphones as well as self-assessments, prompts, reminders and secure face-to-face communication in the home using smart mirrors, tablets, and/or TVs (depending on client preference) via the Collaborative Health Record (CHR) program developed by InputHealth. USB/Bluetooth-enabled health devices such as blood pressure monitors and weigh scales will be linked to the CHR. The project will utilize two hospital apartments for further prototype development and testing as well as teaching and support. Furthermore, this project has garnered significant community support including 104 community homes in which to implement the technologies in the future. This study will utilize mixed-methods through individual interviews and focus groups with staff and clients.

CONCLUSION: Our project demands close collaboration between technology design experts, front-line mental health care providers and clients. This approach will enable us to attend to the life circumstances of those with mental health issues through the development of equitable, efficient, and effective health care innovation. Testing and evaluating Smart solutions will have many implications for Advanced Practice Nurses. The findings of this project may influence the way in which nurses provide care to clients who are reintegrating back into the community.

Innovation
Mental health, Research, Smart Homes

Complexity and addiction in older adults: the role of the Advanced Practice Nurse

Oral Presentation200Adam Searby, RMIT University, Australia

Van Beuningen ZaalMon 11:30 - 12:30

In the older adult population, alcohol and other drug addiction is often accompanied by many layers of complexity; this includes psychosocial, mental health and medical complexity. Accordingly, research indicates that many older adults with addictive disorders will be initially assessed and treated in general hospital settings as opposed to specialist addiction treatment services. This places advanced practice nurses in the role of having to correctly assess and commence treatment of older adults with addictive disorders.

This presentation, based on research conducted with older adults who use alcohol and other drugs in Melbourne, Australia, will describe the complexities associated with this population and the impact on treatment of these issues. It also looks at a case study involving advanced practice nursing and treatment for alcohol addiction in a general hospital setting.

This research explores both the experiences of older adults who use alcohol and other drugs and their prevalence in both mental health and general medical settings. It will also examine referrals of individuals to a complex care hospital admission reduction program with alcohol and other drug use. The presentation will argue that addiction treatment for older adults is within the realms of all nursing scope of practice, and that advanced practice nurses are effectively at the front line of effective addiction detection and treatment for older adults; the presentation will also explore some strategies to improve addiction awareness and pathways to treatment in the advanced practice nursing profession.

In conclusion, data indicates a potential increase in older adults presenting to general hospital settings with varying degrees of complexity and alcohol and other drug use. This contrasts with the notion that mental health and addiction services are the primary recipients of this cohort.

Changing healthcare and the role of the NP/APN
Addiction, Best practice, Complexity, Elderly care, Older Adults

The lived reality by relatives of residents with dementia and staff perceived challenging behaviour

Oral Presentation163Helmi Ijntema, GeriCare, Brabant, RAAMSDONKSVEER, Netherlands

Van Beuningen ZaalMon 11:30 - 12:30

This study was designed to enable nurses to increase their understanding of how qualitative research can support and enhance their practice. A professional aim was developed to explore the relatives’ experiences and perspectives regarding developing partnerships in the multidisciplinary care for nursing home residents with dementia and staff perceived challenging behaviour.

Within the Netherlands, the healthcare sector faces major challenges from the increasingly aging population with chronic diseases, including dementia. More than 90% of those with dementia, exhibit behavioural and psychological symptoms, such as aggression. The Dutch Healthcare Inspectorate has developed eight core elements for professional caregivers, regarding multidisciplinary care and/or treatment of this complex problem. One of these emphasises the involvement of relatives in all aspects of care and medical treatment of their loved ones. Therefore, professional caregivers need knowledge of the relatives’ perspectives; to what extent they want to contribute to this multidisciplinary care.

Charmaz’ Grounded Theory Approach was used, emphasizing on, hearing the relatives’ views and visions regarding the multidisciplinary care for their loved ones, and their own role in that process. Nine interviews were conducted. The Board of Client Governors was included as an expertpanel.

A discursive narrative emerged, telling the story of the relatives. Their story revealed a process of ‘changing relationships’, starting with ‘losing the familiar relationship’, followed by ‘regaining the relationship with their loved one’ and having to ‘build relationships with professional caregivers’. The way the participants experienced this process, has implications for developing partnerships in care.

Besides the appeal to contribute in care and treatment of challenging behaviour, the unmet psychological needs of the relatives also have to be taken into account. As a result the support needed becomes clear and interventions can be agreed to enhance the resilience of the relative and, additionally, the development of partnerships in care.

Changing healthcare and the role of the NP/APN
Dementia, Elderly care, Grounded Theory Approach, Partnerships in care, Research

Stroke care, the best practices for APNs across the globe

Oral Presentation73Varsha Singh, Optum, Adult/Geriatric Medicine, United States of America

Van Beuningen ZaalMon 11:30 - 12:30

The purpose of the symposium is to share the best practices/protocols or case studies for APNs while providing an emergent, acute or post-acute care for Stroke patient that results in a better patient outcome.

Stroke is a unique cardiovascular diagnosis where APNs have a significant opportunity to function as the lead clinician, making a remarkable difference to the patient outcomes.

Stroke is a leading cause of serious long-term disability and fifth leading cause of death.Stroke is also the first leading cause of disability in the United States. (Mozzafarian, D.,2016). According to the World Health Organization and other leading stroke experts, stroke claims 6.2 million lives each year.

Every minute that delays the stroke care,2 million neurons in the brain are at risk for death. (AHA,2015)

Dalton conducted a cross-sectional study to understand the APN role perception within a hospital system. The study revealed that more education was needed across the span to emphasize how an APN can function within their full scope of practice.

Edwards conducted a literature review to identify how the content and delivery of educational programs for nurses actively working in stroke units meet their needs for their role, how this education can impact their practice and influence the patient outcomes. Edwards focused on the content, methods of delivery, nurse’s perception of their educational needs and impact on the nursing practice.

Stroke is a unique cardiovascular diagnosis where APNs have a significant opportunity to function as the lead clinician, making a remarkable difference to the patient outcomes.

APNs awareness of the best practices can result in the superior outcomes and reduce the disability and mortality associated with Stroke. Despite the active and valuable contribution to the patient care, the APNs may not be aware of simple stroke care algorithm that can simplify and enhance their practice.

Collaboration and Inter-Disciplinary Practice
Best practice, Critical/ acute care, Neuroscience APN, Stroke

Project to regulate APN in Switzerland

Oral Presentation125Maya Zumstein-Shaha, Bern University of Applied Sciences, Department of Health, Division of Nursing, BERN, Switzerland

Van Weelde ZaalMon 11:30 - 12:30

Increased care needs of an aging population suffering from chronic diseases, e.g., diabetes, cancer, depression, dementia as well as polymorbidity, require new models of care based on coordination and continuity of care, self-management support and interprofessional collaboration. Within these new models of care, due to their specific educational profile, Advanced Practice Nurses (APN) play a central role (1). APN contribute to affordable, easy accessible and patient- and family-centred healthcare. For APN to unfold their full scope of competencies, role clarity is essential. Regulation of APN roles is key toward achieving role clarity on the structural level (2, 3). In Switzerland, a new law for nursing’s graduate level education (Bsc) is being implemented. As a separate regulation for the APN level (MSc) could not be achieved, a project has been initiated to develop a regulatory framework for APN roles, the definition of a self-regulatory body, and to contribute to clarity of educational and clinical requirements to register as an APN.

The project includes a steering group consisting of key stakeholders from nursing education, clinical practice, nursing associations and APN representatives. Delegates from each of these stakeholders are in the work group. The Swiss Association of Nurses SBK-ASI coordinates this project. The overall goal is the regulation of the roles of Advanced Practice Nurses APNs, including both profiles clinical nurse specialists (CNS) and nurse practitioners (NP) to contribute to high quality health care for all residents of Switzerland in the future. The following three objectives guide the project: 1) defining the role profiles of the CNS and the NP within one APN framework (e.g., Hamric et al. or Canadian framework (4, 5)); 2) formulating main elements for APN regulation ; and 3) formulating requirements for a regulatory body and its elements. The project is ongoing and should end in 2020.

Changing healthcare and the role of the NP/APN
APN, Regulation

A description of the role of advanced geriatric nurses in Norway – a qualitative study

Oral Presentation330Silje Henni, University of Oslo, Institute of Health and Society, Department of Nursing Science, Norway

Van Weelde ZaalMon 11:30 - 12:30

Introduction: Municipal care of older adults is becoming increasingly complex and actualizes the need of nurses with advanced qualifications. Lack of qualifications to meet the needs of older adults may lead to insufficient patient treatment, because nurses do not notice early signs of deterioration. To meet the need of nurses with advanced qualifications, advanced geriatric nurses (AGNs) have been introduced in Norway. This study describes the role of AGNs caring for older adults.

Methods: We interviewed the total population (n=21) of nurses who had undergone a master’s program to become AGNs in Norway in 2016. Data was analyzed with content analysis.

Summary of data: The role of AGNs varied according to the personal interests and workplace conditions. The majority of the AGNs expressed that their core task was clinical care. However, the role ranged from leader with administrative tasks to expert in the geriatric field with responsibility for internal training. Common for all the AGNs was a description of a new gaze that they had developed based on a combination of their knowledge and systematic clinical assessment skills learned at the master’s program, and previous experience from the geriatric field. This gaze led to a broader and deeper understanding of the patient’s health and life situation and the system in which they worked, and this gaze guided the AGNs’ understanding and actions. The AGNs perceived the patient’s problems at an earlier stage than before the education and they had the knowledge and skills to address these problems. Prevention of medical and psychosocial problems was therefore an important dimension of their role.

Conclusion: The role of the AGNs differed among the AGNs. Common for all the AGNs was an ability to prevent deterioration of diseases because they saw patients and the system in which they worked with their new gaze.

Research
care of older adults, Elderly care, nurse roles, Research

Improving access through the integration of the nurse practitioner in a Saudi Arabian walk-in clinic

Oral Presentation89Angela Wilkins-Bassett, Johns Hopkins Aramco Healthcare, Primary Care Department, DHAHRAN, Saudi Arabia

Van Weelde ZaalMon 11:30 - 12:30

Introduction statement indicating purpose of presentation:

Advanced practice nurses are in a unique and pivotal position to impact care. Research demonstrates that NPs improve access to care in many settings (Iglesias et al., 2013; Naylor & Kurtzman, 2010). The aim of this quality improvement project was to demonstrate the feasibility of improving access to care through the integration of the nurse practitioner in the walk-in setting in an NP-naïve setting.

Brief description of pertinent research or other methods adopted: Â

Taking evidence from an integrative review the introduction of this role in walk-in settings was piloted and outcomes measured to demonstrated improved access (Kinnersley, 2000; Villasenor & Krouse, 2016). This was a quality improvement project measuring the impact of the introduced NP role in a primary care clinic in Saudi Arabia. Outcomes measured included patient satisfaction, productivity, healthcare utilization, and quality of care.

Summary of new unpublished data and/or other relevant information:

The introduction of the new role resulted in positive patient satisfaction, comparable productivity and healthcare utilization, and appropriate quality of care measures.

Conclusion:

The introduction of the role demonstrated positive outcomes and improved access. Future implications of these findings include the development of an advanced practice education pathway and the expansion of the nurse practitioner role within the Kingdom to improve access to care.

Changing healthcare and the role of the NP/APN
access, Best practice, Primary care

Association of physical activity and sitting time with physical function in hemodialysis patients

Oral Presentation464Xingjuan Tao, Shanghai Jiao Tong University, School of Nursing, China

Willem Burger ZaalMon 11:30 - 12:30

Introduction

Impaired physical functioning increases the risk of hospitalization and mortality for hemodialysis patients. Fortunately, physical activity appears to be a promising intervention to improve functioning. Differentiation of physical activity classes is more informative than overall physical activity. The purpose of this study was to examine the relationship among physical activity levels (sitting, light, moderate, and vigorous), physical function and nutrition status in hemodialysis patients.

Methods

This cross-sectional study included a total of 130 Chinese outpatients who were receiving maintenance hemodialysis. Self-reported physical activity levels and sitting time were measured by the International Physical Activity Questionnaire. Physical function was assessed by the 10-repetition sit-to-stand (10-STS) test. Nutritional parameters were retrieved from the medical records.

Results

22.3% of hemodialysis patients were inactive, and 75.4% of patients were classified as minimally active. The mean time required to completing 10-STS was 29.55(16.39) seconds. The 10-STS performance was negatively associated with time spent in light physical activity (Beta -0.201, p=0.010), but not with time spent in moderate physical activities. There was no association between the time required to completing 10-STS and sitting time. Positive associations were observed between 10-STS performance and serum albumin (Beta -0.172, p=0.043) and pre-albumin (Beta -0.253, p=0.003). The plasma C-reactive protein concentration was positively correlated with the time required for completing 10-STS (Beta 0.195, p=0.016).

Conclusion

Daily activity and physical performance are substantial impaired in hemodialysis patients. Patients should be encouraged to incorporate light intensity physical activity into their daily routine in order to maintain their functioning. However, whether light physical activity coupled with adequate nutritional support being effective to further improving hemodialysis patients’ functioning requires longitudinal and experimental studies.

Evidence based clinical practice/scientific research
functioning, hemodialysis, Non-communicable diseases, Research

Best practices and development of community health heart failure, diabetes, and telehealth programs

Oral Presentation420Mary Ann Rosa, Queensborough Community College, NEW YORK, United States of America

Willem Burger ZaalMon 11:30 - 12:30

The purpose of this presentation is to discuss how nurse practitioners can develop community health disease management programs to address the public health emergency of people living longer with multiple complex illnesses. Approximately 18-22% of patients 65 years and older, discharged from the hospital, are rehospitalized in 30 days. (N. Engl J Med, 2009; 360 (14);1418). Polypharmacy or mismanagement of medications, poor follow up, not identifying early manifestations of an exacerbation, and nonadherence are among some of the common reasons. Hospitals and community agencies are penalized financially when patients are readmitted within 30 days. The IOM states that frequent readmissions are an indication of poor care or missed opportunity to better coordinate care (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). A substantial number of these hospitalizations are avoidable. Circulatory diseases, particularly heart failure, and diabetes account for the majority of these hospitalizations (CDC). Patients are older, with multiple comorbidities and have more complex management issues. Evidence tells us that intensive disease management interventions can prevent these readmissions (Costantino, Frey, Hall, & Painter, 2013). Disease Management is a collaborative, interdisciplinary approach which promotes patient centered care. Telehealth is also widely used as disease management strategy. There is a national initiative to decrease these hospitalizations, disease progression and complications, and therefore, decrease costs and improve quality of care and life in our communities. There is a national initiative to improve chronic disease management and transitional care. Payment systems have changed. Learn evidence based strategies for chronic illness management from a nurse practitioner that has developed a heart failure, diabetes and telehealth community health program, and who is also published in these areas and who speaks locally and nationally on illness management, improving adherence, and decreasing readmissions.

Changing healthcare and the role of the NP/APN
Best practice, Chronic Illness Management

Self-management education in patients with bronchiectasis

Oral Presentation437Inge Bergsma- de Guchteneire, Radboudumc, Pulmonary diseases, GROESBEEK, Netherlands

Willem Burger ZaalMon 11:30 - 12:30

Self-management education in patients with bronchiectasis

Bronchiectasis is a chronic condition characterized by irreversible dilatation of the bronchi and frequently results in a continuous productive cough or recurrent respiratory infections. Symptoms include chronic cough, mucus production, dyspnoea, haemoptysis, malaise, weight loss and repeated exacerbations. As this is a long-term condition, patients have to cope with these symptoms over the course of their life. Patients report a reduced quality of life and loss of control to manage this disease.

To create the holistic care this patients need, we opened a multidisciplinary bronchiectasis clinic. During the appointments a patient is seen by a pulmonologist, clinical nurse specialist, physiotherapist and dietician. The treatment exists of non-medical as medical interventions based on the national guideline for bronchiectasis.

In our clinic the clinical nurse specialist plays a crucial role. To assess the integral health status we use the NCSI (Nijmegen clinical screenings instrument), this web based questionnaire results in a PatientProfileChart (PPC). The PPC offers a visual and therefore easily interpretable picture of the integral health status of an individual patient. The clinical nurse specialist invites the patient to explore treatment goals using this PPC and coaches the patient how to achieve them.

As bronchiectasis is rare, patients report problems with accessibility to medical facilities in times of a exacerbation. Because most patients are able to differentiate symptoms between stable and exacerbation phases, the clinical nurse specialist develops together with the patient a tailored self-action plan to enable self-management. This plan describes the daily activities as airway clearance, exercise and daily (inhaled) medicine, but above all describes the actions which can be taken in case of an exacerbation. We provide antibiotics at home so patient can start if needed.

The clinical nurse specialist is daily accessible for patients facilitated by e-health.

Patient participation
Best practice, bronchiectasis, Non-communicable diseases, patient-participation, self-management education

From principal physician to managing caregiver and the NP role

Oral Presentation245Jacob Kappert, V&VN Verpleegkundig Specialisten, AMSTERDAM, Netherlands

Zeelenberg ZaalMon 11:30 - 12:30

Nurse Practitioners (NP) in the Netherlands have been introduced in 1997. In mental healthcare (MHC), as in other healthcare sectors, the introduction of NP was a codification of decades-long growth in mental health nurses responsibility for medical and nursing treatment. However, a psychiatrist or a clinical psychologist remained the principal caregiver.

An independent report ordered by professional organisations in MHC concluded in 2015 the term “principal caregiver” was without substance in the age of shared responsibility over treatment and should be replaced by the term “managing caregiver”, whose role and responsibility the report defines. The managing caregiver has a substantial role in treatment, but treatment being a shared responsibility the term marks there is often no most important caregiver. The introduction of the managing caregiver opened a possibility for others than psychiatrists or clinical psychologists to claim the position of managing caregiver. This was debated by the Dutch Professional NP Organisation (V&VNVS) and several individual NP. A model for qualitative care was defined.

This qualitative model describes that the managing caregiver is the professional who is most able in view of the client’s need and preference, the proposed treatment and the phase of treatment. With help of V&VN VS the NP is given this role in both general (basic) MHC as in specialised MHC.

Each MHC institution was required to translate the role and responsibility of the professionals involved in the local situation. This resulted in each MHC institution adopting its own local version of the model for qualitative care which took effect on 1 January 2017.

MHC was the first sector in Dutch healthcare where the term principal caregiver was relinquished, and gave the status of the NP Mental Healthcare a significant boost. V&VNVS tries pro-actively to initiate the same changes in all other sectors of the healthcare system.

Changing healthcare and the role of the NP/APN
Best practice, managing caregiver, mental healthcare, model for qualitative care

A national evaluation of new legal independent rights for Dutch nurse practitioners

Oral Presentation191Daisy de Bruijn, MUMC+, Patient & Zorg, KEMTA, MAASTRICHT, Netherlands

Zeelenberg ZaalMon 11:30 - 12:30

Introduction

New temporary legislation in Dutch healthcare authorises nurse practitioners (NPs) and physician assistants (PAs) to independently indicate, perform and delegate specified medical procedures, formerly reserved to physicians.

Objective

To evaluate the effects of granting above independent rights to NPs/PAs and to support ministerial decision-making.

Methods

A nationwide triangulation mixed methods design was used to collect quantitative (Pre-post test design) and qualitative data between 2011 and 2015. Surveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross compliance requirements. Interviews and focus groups focused, among others, on competence, NP/PA role, acceptance, collaboration, NP/PA positioning and adherence with protocols.

Results

Quantitative data included 1251 NPs, 798 PAs and 504 physicians. Interviews with 33 healthcare providers and 28 key stakeholders and, additionally, five focus groups were held.

After the law amendment the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93% respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54 respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4 respectively). Implementation of the independent rights was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross compliance requirements were mostly fulfilled.

Conclusions

Informal practice was legalised. The opportunities to independently perform catheterizations, injections, prescribing, punctures and small surgical procedures were highly utilized. Care processes were organized more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to make NPs/PAs independent rights permanent.

Research
independent rights, Research, reserved procedures, supporting ministerial decision making

14:30 - 15:30 Parallel Sessions Round 3

Poster & Pitch

Comparison of anxiety in people subject to venous blood collection: syringe vs butterfly needle

Poster & Pitch609Michele Massaro, University of Foggia, BARLETTA, Italy

Arcadis Zaal corner CMon 14:30 - 15:30

Introduction

Peripheral blood sample collection is an invasive practice and not at all free of psychological repercussions. Anxiety and pain are variables related to blood sampling are a short-lived experience, and in this context it is required that the procedures performed without proper control of the same can cause many negative emotions, which in turn can induce pain, conditioning the relationship with health professionals.

Aims

analyze the correlation between anxiety and pain during the peripheral vessel blood sampling procedure; check whether the difficulty in sampling and the stasis of tourniquet induce an increase in anxiety

Materials and methods

Sample: Patients in September - October 2017, at the Pennetti Analysis Laboratory in Barletta (Puglia, Italy). Inclusion criteria: Absence of haematological diseases or coagulopathies; absence of pathologies that can alter the result.

Recording of data by occult observation and transcription of pre-post venipuncture anxiety using the MDAS scale

Results

314 subjects involved in the study (188 females, 126 males), mean age 46.6, St.Dev. 23.3. Devices used: syringe with 22 Gauge needle (224 patients - 71%); Butterfly needle 23 Gauge (90 patients - 29%). Mean stasis time of tourniquet: syringe, 42s, needle butterfly, 76s. Anxious pre-post sampling patients (MDAS scale): Syringe, 40.1% - 12.7%; Butterfly needle, 15.9% - 24.2%. Mean pain (VAS scale): syringe, 1.3; needle butterfly, 2)

Discussion

Blood sampling with syringe induces anxiety decreases immediately after the procedure, while the butterfly needle sampling has less anxiogenic impact on the patient, but its use on patients with difficulty in finding a venous access causes correlation with negative sensations, despite the device being less physical and visual impact.

Research
anxiety, Primary care, Research, venipuncture

Personal attention to lifestyle and health

Poster & Pitch584Noortje Wijnekus, GGzE/ Opleidingsinstelling Geestelijke Gezondheidszorg Verpleegkundig Specialist, Netherlands

Arcadis Zaal corner CMon 14:30 - 15:30

A phenomenological study into motives of patients with severe mental illness for participating in a metabolic polyclinic

Background

Patients who suffer from severe mental illness (SMI) are subject to an increased risk of metabolic syndrome. Improvements in lifestyle can prevent the development or reduce the severity of the syndrome. This study looks into the motives of the target group for participating in a metabolic polyclinic, which focuses on individual lifestyle interventions.

Method

A phenomenological study based on ten in-depth interviews with patients with SMI who participated in a metabolic polyclinic. Data was collected and analyzed using Colaizzi’s method.

Results

Five themes were identified that typify the motives of the target group for participating in the polyclinic: direct invitation and follow-up, monitoring need, awareness and desire to learn about health and lifestyle modification, the experience of the personal contact as well as feeling more in control of their lives.

Conclusion

Participation in a metabolic polyclinic by the target group improved as a personal approach could be tailored to the patient’s individual needs.

Recommendations

Continue using a personal approach. Clear communication about the range and nature of care and meeting the needs of the individual, help to improve treatment engagement. Supplementary, accessible healthcare for groups is desirable. Further qualitative studies of patients who were disinclined to participate in the metabolic polyclinic, could help to gain more insight into factors influencing the choice to participate or not to participate.

Research
lifestyle intervention, Mental health, metabolic syndrome, Research, severe mental illness

Research into experiences of mental health treatment to women with a depression during pregnancy

Poster & Pitch572Maaike Jongma, Dimence, Netherlands

Arcadis Zaal corner CMon 14:30 - 15:30

Background

Due the complexity of pregnancy and depression, mental health treatment is desired which besides depression also focuses on pregnancy. Little is known about which form of mental health treatment is the most effective to women with a depression during pregnancy.

Objectives

The purpose of this study is to explore the experience of women with a depression during pregnancy with the mental health treatment they receive.

Method

Qualtitative research with a phenomenological design was used and seven open, in-depth interviews were held. The analysis has been conducted by the Colaizzi method.

Results

Most respondents reported that during the referral phase taboo around pregnancy and depression was a prevalent problem, which caused a delayed start of mental health treatment. Women were content with the treatment although the contact frequency was high. The availability of therapists and the collaboration with other involved caregivers were desirable. Within the mental health treatment for depression attention to pregnancy-themes as an integrated treatment was mentioned as important. Women expressed the need for education about various maternity subjects. For the prevention of postpartum depression, postpartum consultation was essential. Alert plans provided tools to signal and/or reduce symptoms.

Conclusion

Results suggest that accessibility of mental health care, integrated treatment of mental healthcare and pregnancy issues, education and prevention of postpartum depression are important themes in the mental health treatments of women with a depression during pregnancy. We recommend to investigate the effect of online interventions as part of the treatment and whether alert plans can be effective in the prevention of postpartum depression.

Research
Depression, Mental health, Mental health treatment, Pregnancy, Research

The timed up and go test time is associated with frailty in older persons with schizophrenia

Poster & Pitch230Mei-Yeh Wang, Cardinal Tien Junior College of Healthcare and Management, Taiwan

Arcadis Zaal corner CMon 14:30 - 15:30

BACKGROUND

Compared with the overall population, persons with schizophrenia have accelerated rate of physical aging. Frailty is a progressive physiological decline in multiple body systems with aging. The Timed Up and Go (TUGT) time has been supported as a predictor of sarcopenia, which as the biological substrate for the development of physical frailty. The purpose of the present study was to investigate the association between the TUG time and frailty in a group of middle-aged and older persons with schizophrenia.

METHODS

The level of frailty was assessed based on the Study of Osteoporotic Fractures (SOF) frailty index and were classified as frail, prefrail, or robust. The TUGT was assessed by measuring the time that a participant needed to stand up from a seated position, walk 3 meters and then return to a seated position on the same chair as quickly as possible.

RESULTS

A total of 80 patients were assessed. Male patients constituted 77.3% of the total sample. Participants ranged in age from 55 to 78 years and had a mean age of 61.36 ± 4.92 years. The mean TUGT time was 10.50 seconds (SD: 3.23; range: 6.36-25.73). 13.8%, 40.0%, and 46.3%, of participants were identified as frail, prefrail, and robust, respectively. Frailty status was significantly associated with the TUGT time (p = 0.04) after adjusting for age, sex, BMI, fall history, depression level, and cognition level.

CONCLUSION

Results of this preliminary report support the association between the TUGT time and frailty in middle-aged and older persons with schizophrenia. Given that the TUGT is easily implemented and inexpensively obtained in a few minutes in the clinical setting, the TUGT can be recommended for measuring risk of frailty in this population.

Research
frailty, Mental health, Research

Improving the physical health of people with severe addiction problems

Poster & Pitch28Jackie Middeldorp, Jellinek ARKIN, UTRECHT, Netherlands

Arcadis Zaal corner CMon 14:30 - 15:30

Improving the physical health of people with severe addiction problems: physical examination by addiction nurses.

Working as a Nurse practioner MENTAL HEALTH CARE within the long-term care and treatment of drug addicts at Jellinek in Utrecht I am dealing with the implementation of the somatic (interference) care in Addiction Psychiatry . I prefer to share the knowledge on addiction and somatic care by explaining the developing of the Utrecht Somatic Screening list (USS 2.0.). The USS 2.0 has been developed especially for the long-term addicts and/or psychiatric patients who avoid medical care and are not, or rarely, in the picture by their general practitioner. The USS 2.0. screens for most of the serious somatic diseases this group suffers from.

Changing healthcare and the role of the NP/APN
Best practice, Mental health, physical examination, severe addiction

Understanding NP roles and services from an Australian perspective

Poster & Pitch454Grainne Lowe, Deakin University, School of Nursing & Midwifery, BURWOOD, Australia

Arcadis Zaal corner GMon 14:30 - 15:30

Introduction of NPs in Australia followed the lead of the US, Canada and the UK. Whilst Australian research highlights NPs showing improvements in patient outcomes high levels of patient satisfaction and delivery of safe, high quality care to date the evaluation of NP services has often been based on small scale or individual models.

To better evaluate NP roles, an understanding of how practice is translated into organisational contexts, particularly in relation to specific patient encounters is required.

For sustainability of NP roles, translation of improved services into practice is vital to highlight areas of excellence or areas requiring support. We look at the role from a Victorian (Australia) perspective.

The method is a quantitative survey design, adapting a previously developed tool for online use. The questionnaire has a) questions relating to the participant’s organisational context of practice and b) questions relating to specific practice patterns during patient care episodes.

Sample: All Victorian NPs are eligible for participation (currently 247 fully qualified)

Analysis: Upon completion of data collection in January 2018, Stata 12 will be used in the data analysis.

Evaluation of health service innovations is necessary to determine the value add in response to the intervention. NPs are acknowledged as one of the solutions to delivering better healthcare, particularly in an overcrowded and underserviced areas. NP services are currently underutilised; clearer understanding of their roles and potential roles will improve patient services and outcomes.

This study will inform future research on NP practice and service delivery.

Whilst undertaken in one state of Australia, outcomes are expected to provide multiple benefits, applicable internationally; providing a better understanding of the NP roles in differing organisational contexts; practice patterns associated with specific areas of clinical practice; providing an updated data collection tool which can be used in any setting.

Changing healthcare and the role of the NP/APN
future, Research

A comparison of training and scope of practice of neurosurgery NPs in Australia & US

Poster & Pitch364Andrew Scanlon, Montclair State university, School of Nursing, MONTCLAIR, United States of America

Arcadis Zaal corner GMon 14:30 - 15:30

Purpose: Worldwide those in the delivery of healthcare are interested in the transferability of skills, training and qualifications from one international healthcare setting to another. To date most publications comparing Australian and United States NP roles and models of care have not described their service particulars. The following examines the practice of two Nurse practitioners specialized in the practice of neurosurgery. One from Australia and another from the United States. Requirements for practice will be explored such as training and endorsement and credentialing as well their practice. How these roles differ and what each role could learn from the other will be examined.

Methods:

A review of the current requirements for NP endorsement or certification will be explored for both countries. Additionally, the current scope of practice as well as how care is delivered will be examined to determine differences or similarities in care between the two nurse practitioner role located in Australia and the United States were explore with a view to transfer these skills and practice.

Results:

Results from the comparison of training, scope of practice as well as care delivered demonstrates many similarities. However there were areas which diverged in relation to training, scope of practice as well as transferring of credentials and qualifications nationally and internationally.

Conclusion:

There is little doubt the Nurse practitioners provide a vital service to the delivery of healthcare. Although there have been comparisons in the past of NP practice internationally none have explored the specific specialty of neurosurgery. From this process it is evident that there are similarities in practice but also lessons which could be learnt in the delivery of neurosurgery care by both Australian and US neurosurgery Nurse practitioners

Changing healthcare and the role of the NP/APN
clinical practice, Critical/ acute care, Neurosurgery, Nurse Practitioner

Pain assessment the first step for pain management

Poster & Pitch339Cecília Rodrigues, Centro Hospitalar do Porto, PORTO, Portugal

Arcadis Zaal corner GMon 14:30 - 15:30

Background:

Assessment of pain is a critical step to providing good pain management and general healthcare quality, which can lead to better patient outcomes. The most critical aspect of pain assessment is that it is done on a regular basis (e.g., once a shift, every 8 hours) using a standard format. Quality indicators for pain include: the intensity of pain is documented with a numeric or descriptive rating scale and the pain intensity is documented at frequent intervals.

Objectives

Identify if hospitalized patients have the pain intensity documented at frequent intervals this is, once a shift and at least at every 8 hours.

Methods

In a 580-bed adult teaching hospital, between August and October 2017, on random days of each month, patients were audited by nurses for pain intensity documentation.

Results

In the 3 months studied 216 patients were audited. Of the patients audited, 152 (70.4%) had pain intensity documented once a shift and at every 8 hours. The rate of correctly pain intensity documentation increased progressively over the months: in the first month (August 2017) 52.8% of patients had pain intensity documented once a shift and at every 8 hours; in September 2017, this rate was 72.2%; and in October this rate was 86.1%. The partial results of this audit were released by email monthly and were disclosed in a general continuous improvement quality meeting with clinical services in September 2017.

Conclusion

Improving the frequency of records of pain intensity in hospitalized patients was an opportunity of quality improvement. The auditors believe that clinical audit together with the strategy of results dissemination by email in short intervals justify the improvement rate verified (change from 52.8% to 86.1%).

Changing healthcare and the role of the NP/APN
Best practice, pain management, quality indicators

Reducing the inequities and decreasing the disparities of muslim patient with chronic kidney disease

Poster & Pitch182Emily Wellerritter, Augsburg University, United States of America

Arcadis Zaal corner GMon 14:30 - 15:30

An ethical dilemma may be occurring in dialysis units. Heparin, a porcine product, is being given to Muslim patients’ while on dialysis. Nursing staff in the dialysis units are not disclosing that Heparin is a derivative of porcine, thus acting in a paternalistic manner in the nurse patient interaction. It is possible that the dialysis units have created an environment of disempowerment, by taking away the Muslim patients' rights to shared decision-making. Boyte (2008) stated 'Disempowerment often happens through professional rescue that erodes peoples sense of their own powers and capacities.' With the increase in globalization in 2015, there were approximately 3.3 million Muslims living in the United States. Rochester Minnesota has approximately 110,000 residents, of that, between 2.3% and 7.5% are Muslim (Press Bulletin, 2014). Since the attacks on the World Trade Center in New York in 2001 there has been an increase in the fear of Muslims (Islamaphobia) which has increased the inequities and marginalization of this population. Hate crimes against Muslims have increased, and in 2015 there were 257 incidents of hate crime, which was a 67% increase from the year prior. (Kishi, 2016). The purpose of this DNP project is to explore the inequity faced by the Muslim population on dialysis specifically, the administration of Heparin to Muslim patients, search for possible alternatives to the use of Heparin and also look at reducing the inequities by creating cultural inclusion through increasing cultural competence of dialysis nursing staff, utilizing Josepha Campinha-Bacote’s “Model of Cultural Competence”, as well as explore shared decision making in the nurse patient interaction and provide the nurse with a decision aid for use in that interaction.

Changing healthcare and the role of the NP/APN
Best practice, Chronic kidney disease, inequality, Muslim, Non-communicable diseases

Let's talk sooner about later

Poster & Pitch136Nathalie van Elck, General Practice, Family Medicine, RENKUM, Netherlands

Arcadis Zaal corner GMon 14:30 - 15:30

Background: As a result of ageing of the Dutch population-, and the policy of encouraging people to live in their own homes for as long as possible, the number of dementia sufferers who depend on general medical practice is growing. End-of-life conversations with this group are relatively uncommon, and their individual wishes and values often remain unclear. Professional and informal caregivers must therefore sometimes make choices about care and treatment without knowledge of a patient’s preferences.

Aims: To investigate the level of support for Advance Care Planning (ACP) among informal caregivers and general practitioners. To establish the appropriate moment and manner in which to offer ACP to those diagnosed with dementia and their loved ones.

Method: The relevant literature was researched in order to examine present expertise on the subject. Questionnaires were distributed among informal caregivers and general practitioners. Semi-structured interviews were conducted with informal caregivers and experts. The opinions of two other experts’ opinions were obtained.

Results: ACP is useful for to informal caregivers and general practitioners. No general statements can be asserted about the timing of ACP and the manner in which it should be undertaken. Although it is not possible establish an ACP protocol for dementia sufferers, certain agreements can be reached. Effective record-keeping and communication are necessary in order to implement the plans made in the ACP conversation between the practitioner and the patient. Visualizing the course of the disease may increase understanding of it.

Conclusion:ACP for dementia sufferers is eminently a person-centered form of care. Adequate communication skills and accurate record-keeping are indispensable if ACP is to succeed. This approach to caring requires time, which is not always available to a general practitioner. However, nurse practitioners, in consultation with the general practitioner and an informal caregiver, is capable of providing the person-centered care required

Changing healthcare and the role of the NP/APN
Advance Care Planning, Dementia, Person Centered Care, Research

The impact of clinical nurse spesialist in neurosience nursing – ten years experience

Poster & Pitch579Jaana Kotila Kotila, Helsinki University Hospital, Neuroscience, HELSINKI, Finland

Arcadis Zaal corner KMon 14:30 - 15:30

In Finland, the first CNSs positions were established in the early 2000s in Helsinki University Central Hospital. Since 2007 clinical nurse specialist has been practicing in the department of Neuroscience. The aim of this position is to improve nursing care for neurology and neurosurgery patients. CNS operates in four domains; Clinical Care, Managing Changes, Advancement of nursing practice and Evaluation and research.

Object is to illustrate the impact of CNS from various domains of CNS’s work within Neuroscience Nursing.

Ten years outcomes are described and analyzed in four domains to summarize the results of this expertise and collaboration.

The outcome is groped with different domains to illustrate the role of each one in CNS’s work. Clinical Care; Disseminated EBP best practice guidelines in day to day clinical nursing such as pain management, preventing falls and pain ulcers. Gathered evidence to support clinical decision making such as Nursing Management protocols. Advancement of nursing practice; influencing on nursing processes via educating staff such as unifying orientation protocols and organized induction, mentoring and research clubs. CNS teaches and guides multidisciplinary team within own specialty area. Managing Changes; On organisation level CNS acts to achieve organizational strategy supporting its goals, such as involving and creation of intervention of nursing career model. Participates in national and international cooperative projects, such as Health Village project and digital patient pathways. Evaluation and research; CNS applies research evidence into nursing practice, such as participating on writing guidance to nursing and on national nurses database and creating handbooks e.g. Neuroscience nursing. CNS assesses nursing quality by using e.g. Nurse Competence Scale. Disseminating conferences and publishing is equally important.

The Domains of influence on CNS work will form a picture based on the view of CNS in Neuroscience and will give some insight on how to foster CNSs’ role.

Changing healthcare and the role of the NP/APN
Best practice, Role of CNS

Advanced nursing care for people with systemic lupus erythematosus and neuropsychiatric symptoms

Poster & Pitch394Liesbeth Beaart-van de Voorde, LUMC, Rheumatology, LEIDEN, Netherlands

Arcadis Zaal corner KMon 14:30 - 15:30

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the immune system can attack cells, tissues and organs including the central nervous system (CNS).

The Leiden University Medical Center (LUMC) is a tertiary referral center for people suffering from SLE and neuro-psychiatric (NP) symptoms (NPSLE). Since 2007 a medical multidisciplinary team and an advanced nurse practitioner have been working together. This collaboration concerns a 1-day diagnostic program and structured team-meetings resulting in diagnoses and treatment advices based on the assumed etiology of the NP symptoms. Besides the one-day diagnostic pathway the team-goal is to increase the understanding of CNS-involvement and improve patientcare. The aim of our recent study was to investigate quality of life (QoL) of patients with SLE and NP-symptoms.

The research group comprised 248 NPSLE patients. Data were collected retrospectively and partially prospective. The Short Form 36 (SF-36) was used to evaluate QoL. Compared to the general Dutch population, the NPSLE-clinic-patients show a significantly reduced QoL on all subscales. The summary scores indicate a significantly decreased QoL in both overall physical and mental aspects. In comparison with patients suffering from other chronic diseases, the NPSLE-clinic-patients are more severely impaired in nearly all dimensions of QoL and overtime their QoL remains low.

The above results illustrate the need for biopsychosocial care in patients with NPSLE and at the same time, this study raises the awareness of the key-role of the nurse in optimal care. With adequate support and education, skills that pre-eminently belong to the domain of nurses, patients can be more actively involved and perceive an increased sense of control, which is beneficial for QoL. Through lessons learned from our medical approach of the last 10 years, we have developed team-care which includes focus on educational and supportive nursing care.

Changing healthcare and the role of the NP/APN
Best practice, NPSLE

May we interfer? Ambulatory care in the city council of Nieuwe Waterweg Noord

Poster & Pitch243Lisanne van de Graaf, Antes, Netherlands

Arcadis Zaal corner KMon 14:30 - 15:30

By 2020 the number of beds in the psychiatry and the addiction care in the Netherlands must be reduced by one third compared to 2008. To succeed this ambulatory switch, it means a different way of looking at what someone needs to live as well and as normal as possible. In stead of taking care of the patients, we need to empower them and help them through the stages of recovery in their own environment. In 2012 Machteld Huber introduced the concept of positive health in the Netherlands. In this concept, health is no longer seen as the absence or presence of a disease, but as the ability of people to deal with the physical, emotional and social life challenges as much as possible. Cooperation seems to be the key word for successful implementation of this new approach of positive health in the neighborhood. The city council of Nieuwe Waterweg Noord has made an agreement with Bouman GGZ. Bouman GGZ is a mental health care organisation, specialized in addiction and psychiatric care. Bouman provides outreaching care (meddling care) and actively seeks the connection and cooperation with the district teams. With this poster (presentation) we would like to inform the audience about this new way of cooperation between a mental health organisation and the city council of Nieuwe Waterweg Noord and the role of the advanced practice nurse within this ambulatory transition.

Changing healthcare and the role of the NP/APN
Addiction, Ambulatory care, Best practice, Mental health

Advanced Practice Nurses: their role in complexity and addiction in older adults

Poster & Pitch201Adam Searby, RMIT University, Australia

Arcadis Zaal corner KMon 14:30 - 15:30

In the older adult population, alcohol and other drug addiction is often accompanied by many layers of complexity; this includes psychosocial, mental health and medical complexity. Accordingly, research indicates that many older adults with addictive disorders will be initially assessed and treated in general hospital settings as opposed to specialist addiction treatment services. This places advanced practice nurses in the role of having to correctly assess and commence treatment of older adults with addictive disorders.

This poster expands on research conducted in the older adult cohort and demonstrates practical strategies and research directions to improve detection and treatment of alcohol and other drug use in the older adult cohort by advanced practice nurses. These recommendations are based on research conducted in both older adults with co-occurring alcohol and other drug use and mental health issues, and individuals referred to a hospital admission risk program.

Research indicates that older adults who use alcohol and other drugs go largely undetected in general hospital settings, in addition to referral to ongoing treatment being poor. This poster argues for a changing paradigm, with assessment of alcohol and other drug use in older adults becoming routine. With this, a change to referral and notions of contemporary drug treatment will be explored.

In conclusion, research indicates a potential increase in the older adult population with high degrees of complexity and alcohol and other drug use. Advanced practice nurses are at the forefront of detection and treatment initiation in this population, and need to be armed with tools to address this issue as a matter of urgency.

Changing healthcare and the role of the NP/APN
Addiction, Best practice, Complexity, Elderly care, Older adult

Concurrent Sessions

We have a dream: the leadership role of APNs in developing a model of community health care

Workshop288Ursula Klein, Spitex Zürich Limmat, Switzerland

Schadee ZaalMon 14:30 - 15:30

In our ageing society the number of people dependant on nursing care is continuously growing. Many people cope with multiple co-morbidities and psycho-social demands.

Economic aspects as well as best practice recommendations shape the development of outpatient healthcare facilities, such as integrated community care models.

Spitex Zürich Limmat is a nurse led community care organisation. Our nursing staff care for 10’000 patients yearly in their own homes. As a team of APNs we facilitate the management of increasingly complex patient-situations in the community, and ensure high quality of care.

ANPs coordinate and deliver clinical care to patients and their families in situations with chronic illness, in palliative situations and to persons in need of psychosocial support. An important part of the ANP-role is coaching in patient-selfmanagement, patient-education and collaboration within the extended primary health-care team including family doctors.

As well as delivering direct patient care our APN team has leadership responsibilities. We work closely with nursing staff and the management of our organisation to develop good quality nursing care to meet the needs of patients and family care-givers. We also work on developing integrated models of care that strengthen close collaboration with other healthcare providers and social services.

Since 2014.we are involved in a continuous ANP role-development process. Good collaboration enables us to merge our expertise and to deliver effective care of patients in their homes, which would otherwise not be possible. These developments are possible due to visionary management: we are encouraged to dream big now, and to actively prepare for the future in community health care.

In this workshop, we will:

share our experiences in role development with the participants,

develop a vision for effective APN-nursing care for complex patients in the community,

formulate strategic steps in communicating and implementing this vision.

Leadership
APN role development, community health care

How to implement nurse practitioners in primary care and elderly care, and what is the impact?

Workshop526Anneke van Vught, HAN University of Applied science, Faculty of Health and Social studies, Netherlands

Hudig ZaalMon 14:30 - 15:30

Introduction statement indicating purpose of presentation

In the Netherlands about 300 nurse practitioners (NPs) are employed in general practices, including out-of hours primary care services. An equal number works in nursing homes. Most NPs work in hospitals or in mental health care.

The implementation of NPs in primary care and elderly care faces several challenges, for instance workforce shortage of nurses and physicians. For successful implementation of NPs in these settings it is necessary to get insight in the barriers and facilitators in the implementation of NPs and the impact on patient outcomes, quality and costs of care.

The workshop aims to transfer knowledge about the implementations of NPs in primary care and elderly care in the Netherlands and besides to discuss optimization of the implementation of NPs in those healthcare settings in different countries.

Brief description of pertinent research or other methods adopted

Several studies were conducted recently on the implementation and impact of NPs in primary health care and elderly care. The designs used were a quasi-experimental and qualitative study in primary care, and a literature study and multiple case studies in nursing homes.

Summary of new unpublished data and/or other relevant information

The NP contribute to the safety, quality and costs of care. There are barriers and facilitators for implementation of the NP in primary care and elderly care on the level of the patient; individual practitioner; professional interactions/collaboration; incentives and resources; capacity for organizational change; social, political and legal factors; and guideline or innovation factors (TICD-framework).

Conclusion

During the workshop we explore how the implementation of NPs in primary care and elderly care could be optimized in different countries using results from recent Dutch studies on barriers and facilitators and the impact of the NP on patient outcomes, quality of care and costs of care.

Changing healthcare and the role of the NP/APN
NP, Primary care, Research

Management of the 10 most common infections worldwide

Clinical WorkshopCW3Lorna Schumann, American Academy of Nurse Practitioner Certification Board/Heritage UGM Center, United States of America

Van Rijckevorsel ZaalMon 14:30 - 15:30

According to WHO in 2011 there were 12,420 different infectious diseases. This presentation will cover the top 10 diseases seen worldwide. Among the top 10 infectious diseases are Hepatitis B, Malaria, Hepatitis C, Dengue Fever, Tuberculosis, HIV, Chlamydia, Gonorrhea, HPV and Influenza. A case study approach will be used for the presentation. The focus of the presentation will be on patient management of the diseases.

Biography

Dr. Schumann is recognized for her global clinical expertise. Her clinical expertise is varied and includes inpatient and outpatient work. In 2011, she was the recipient of the International Nurse Practitioner of the year award for her work in countries that lack adequate resources for health care and health education.

She is a Champion for the Shot@life, a program under the UN Foundation that serves to provide vaccines to millions of children in countries that lack resources. This program provides vaccines for Measles, Pneumonia, Polio and Rotavirus. She volunteered in Infectious Disease Clinic for many years.

Evidence based clinical practice/scientific research
Infections

Implementing the advanced practice role in the Africa region: opportunities and challenges

Symposium262Eileen Stuart-Shor, Seed Global Health, BOSTON, United States of America

Eduard Flipse ZaalMon 14:30 - 15:30

Introduction and Purpose

WHO estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic healthcare and to respond to emerging and more complex needs – a vicious cycle that has profound implications for health security. Advanced practice nurses (APN) have been shown to deliver high quality care and to improve outcomes for underserved populations but the models and outcomes for this role have primarily been reported in developed countries. The purpose of this symposium is to discuss the opportunity for the APN role in the Africa region to contribute to improving the health of the population. Cultural context will be considered.

Brief description of the symposium

The exemplars included in this symposium provide an overview of the opportunities and challenges encountered in developing APN roles in 2 countries: the family nurse practitioner (FNP) role in Swaziland, and the Pediatric Clinical Nurse Specialist (CNS) role and a midwifery- led hospital ward in Malawi. The PEPPA framework is used to assess the need and scope of practice for the APN role.

Summary of relevant information

A landscape assessment is underway to assess scope of practice and value added of the FNP role in Swaziland; pilot projects assessing implementation of the CNS role and Midwifery-led model ward are underway in Malawi.

Conclusion

Through the 3 exemplars presented in this symposium we hope to raise important questions about the opportunities and challenges in tailoring and implementing the APN role in the Africa Region. Acknowledging the impact of material and human resource scarcity on the development and implementation of the APN role in the Africa region is an important first step in creating a locally-relevant APN role that can improve the health of the Africans.

International developments and collaboration
Best practice, Disparities, Global Health

International collaboration and consensus on curricular standards for nurse practitioner education

Symposium167Ruth Martin-Msener, Dalhousie University, School of Nursing, HALIFAX, Canada

Jurriaanse ZaalMon 14:30 - 15:30

Introduction:

The overall goal of this interactive symposium is to obtain input from international participants on recommendations for strengthening and harmonizing the curriculum of NP education programs within a global context.

Symposium Methods/Format:

An international research team will share the results of a scoping review of published and grey literature examining the core curriculum features of NP education programs. Specific health care system, organization, and individual factors that influence the design, delivery, and outcomes of NP education programs around the world will be identified from the international literature. Similarities and differences in the philosophical underpinnings, learning activities, and student assessment methods of NP programs across six countries (Canada, United States, Finland, Norway, Netherlands, Australia) will be examined in more detail through an analysis of the grey literature from each of these countries.

Through small and large group discussions, symposium participants will identify the implications of the scoping review findings and generate priority recommendations for enhancing NP education at national and international levels. Strategies to promote international research collaborations to support the development of advanced practice nursing roles around the world will also be discussed.

Significance/Impact:

This symposium will demonstrate the importance of optimizing the development of NP roles through international nursing leadership and collaboration amongst NPs and NP educators and researchers. Scoping review results and key recommendations arising from symposium discussions will increase understanding about NP education across different healthcare systems and countries. The potential for international consensus on core curricular elements of NP education programs will emerge along with new pathways and priorities for strengthening NP education. All participants will receive a briefing note summary of the symposium findings.

Education
curricular education standards, international, Research

Effects of competence-focused education in a Dutch advanced nurse practitioner education program

Oral Presentation220Ercolie Bossema, HAN University of Applied Sciences, Master Advanced Nursing Practice, NIJMEGEN, Netherlands

Mees ZaalMon 14:30 - 15:30

Introduction

Competence-focused education (CFE) requires activating and participating techniques that offer sustained skills development. This should stimulate ‘deep learning’. This study examined whether CFE improves students’ performance and satisfaction with the education program.

Methods

This quasi-experimental study included students who in 2015 or 2016 started the two-year dual advanced nurse practitioner education program of the HAN University of Applied Sciences in Nijmegen, the Netherlands. In two courses, the class of 2015 received the usual program, including meetings in which the study materials were clarified, and the class of 2016 received the ‘deep learning’ program, including web lectures, peer group sessions, and meetings with immersive assignments. Outcome variables were the students’ performance on a final course assignment (literature study and article review, respectively) and satisfaction with the education program (grade given by the student).

Results

The web lectures and immersive assignments were assessed as informative and useful. The students appreciated being able to watch a web lecture when and where they wanted. Peer group sessions stimulated the students ask questions to each other instead of the teacher and also dealt with related topics, such as educational feasibility. The meetings required less preparation from the teachers and were more interactive. The grades for the literature study did not differ between the two years, but the class of 2016 obtained lower grades for the article review. Satisfaction with the first course neither differed between the two years, but satisfaction with the second course was higher for the class of 2016.

Conclusion

The web lectures and immersive assignments have added valued, according to students. The added value is reflected in the students’ satisfaction with only one of the courses, however. As the students’ performance in precisely that course was lowest, we wonder whether this lower performance could be attributed to the introduction of CFE.

Education
Blended learning, Competence-focused education, Deep learning, Research

Development of national master competences for regulating APN

Oral Presentation126Maya Zumstein-Shaha, Bern University of Applied Sciences, Department of Health, Division of Nursing, BERN, Switzerland

Mees ZaalMon 14:30 - 15:30

In September 2016, the Swiss parliament passed a law for non-physician graduate health professionals. The law regulated nursing, midwifery, physiotherapy, occupational therapy, nutrition and dietetics, speech and language therapy, optometry, and osteopathy. The law is basis for the accreditation of educational programs for these professions in Switzerland at university level; for the regulation of independent practice; as well as for a register for all nurses. Currently, the necessary bylaws and regulations are being prepared on the basis of the CanMeds framework (1, 2). The Ministry of Health supervises the implementation of this law and is responsible for the elaboration of the bylaws and regulations. Therefore, each profession was called to provide Bachelor and Masters competencies. Between April and September 2017, two groups from the nursing profession in Switzerland worked on producing the requested Bachelor and Masters competencies. The Bachelor group included representatives of all educational institutions offering Bachelor, Masters and doctoral programs in nursing, representatives of the Swiss Nurses Association, the Association of Nursing Research in Switzerland, the Association of Advanced Practice Nurses in Switzerland, the Swiss Nurse Leaders, and the Swiss Inter-Branch Organisation of Education in Healthcare. To improve comprehensiveness, the 2012 frame of reference for nursing education at Universities of Applied Sciences in Switzerland (3), the ICN competencies for advanced nursing practice (4), and the competencies of palliative care formulated for Switzerland (5) were consulted.

For the Master competencies, a second group from the Bachelor group was formed. The Master group met three times on its own. Another four meetings occurred with the Bachelor group to insure coherence. The formulation of the delta between the Bachelor and the Master competencies was essential. Within the seven CanMed domains, 37 competencies for Master of Science-prepared Advanced Practice Nurses were defined.

Health-care Policy
Competencies, Master of Science in Nursing, Regulation

Convening a consensus based work group to identify common competencies across four APRN role

Oral Presentation19Karen Kesten, George Washington University, WASHINGTON, United States of America

Mees ZaalMon 14:30 - 15:30

Nurse educators have led in the identification of behavioral competencies as a framework for assessment in education and practice for decades. In APRN education, national organizations have identified and accepted competencies that have provided a foundation for curricular development and student assessment for each of the four APRN roles. However, the work has occurred in parallel processes with little cross-organizational dialogue. Moreover, the profession has not adopted a common definition of competency or a common framework for competency-based education, and many of the competencies vary in scope and measurability. Use of a common taxonomy will allow multiple stakeholders to “speak the same language”, potentially share learning and assessment materials; and provide a common understanding of the expectations for APRN clinical education experiences. As the move to interprofessional education and practice advances, the use of common language to describe expectations across health professions also becomes even more critical.

In 2016 the American Association of Colleges of Nursing convened the APRN Competency-Based Education for Doctoral-Prepared APRNs Work Group to identify definitions and common competency taxonomy. The group was charged with delineating doctoral-level competencies common to all APRN roles. The work group consisted of members representing the four APRN roles and 25 organizations involved in APRN education, licensure, certification and accreditation.

This presentation will highlight the consensus process used to establish cross-organizational dialogue on competency-based education. The group adopted common definitions of terms competence, competency, and a health professions competency framework. The framework, which builds on the work of the Interprofessional Education Collaborative comprised of ten health professions, identifies eight broad domains of competence. The workgroup reached consensus on common doctoral-level APRN competencies in each of the eight domains as well as progression indicators described in observable, realistic, and measurable terms expected at entry into clinical practice and at graduation.

Education
Advanced Practice Nursing, competency-based education

Your patient served in the military, now what? NPs/APNs caring for veterans in civilian practice

Oral Presentation511Alicia Rossiter, University of South Florida, TAMPA, United States of America

Plate ZaalMon 14:30 - 15:30

Over 2 million Americans have served in the military on Active Duty or in the Reservists/National Guard since September 11, 2001. When they retire or return to their civilian lives, military service becomes far less visible. However, the time in the military has created varied, and at times, significant health risks that require special screening and monitoring. Often civilian healthcare providers are these veterans only or primary source of health care. With greater than 85% of veterans seeking care in the civilian sector rather than within the VA, many civilian providers lack knowledge regarding the military, the military culture, and the effect of military service on the overall mental and physical health of veterans. This can leave the veteran at a significant disadvantage in regards to their overall healthcare needs.

NPs/ANPs are on the frontlines of healthcare often working in clinics, hospitals, and community agencies, and may be the first to encounter a veteran in crisis or experiencing physical and/or psychological co-morbidities secondary to military service. Due to the potential correlation between military service and physical and psychological health comorbidities, it is imperative for NPs/APNs to screen veterans for a history of military service and to be educated on how to provide appropriate care to this vulnerable population. In addition, knowledge regarding resources and referrals available to veterans in the community is critical to meeting the needs of veterans and their families. Prompt identification and treatment is imperative in order to decrease the deleterious health consequences related to military service and to improve healthcare outcomes of veterans receiving in the civilian sector. This presentation will discuss the gaps in research and policy and provide guidance to reduce barriers to access, decrease knowledge deficits of healthcare providers, and/or improve consistency in healthcare delivery to those who have served in harm’s way.

Changing healthcare and the role of the NP/APN
Best practice, military, Primary care, veteran healthcare, veterans

CANCELLED: The evaluation of a hub and spoke model for supporting advanced practice education in primary care

Oral Presentation543Lucy Tomlins, University of Salford, School of Health and Society, MANCHESTER, United Kingdom

Plate ZaalMon 14:30 - 15:30

In 2015 an enhanced training practice employed 14 advanced practitioners in training (APiT) using a hub and spoke model to support smaller practices within the Salford area with training Advanced practitioners (AP’s). An evaluation of this model using a realist qualitative approach has been conducted to evaluate the academic, stakeholder, individual and service perspectives.

General practitioners help ensure effective coordination of care for their patients including social care and services outside of the NHS. General practice involves 90% of NHS activity for only 7.5% of the cost, and is facing increasing pressure in the UK due to increased demand for access to services and a medical workforce shortage with difficulties recruiting medical staff to work in primary care.

Advanced practitioners can play a significant role in general practice by providing high quality care to patients and meeting service needs.

Salford Health Matters (SHM) in conjunction with Salford Clinical Commissioning Group (CCG) proposed to create a centre of excellence for AP training through the use of a hub and spoke model. The organisation, being the hub employing all 14 trainees, affiliated the APiT’s to practices within the Salford area to learn and develop the skills and knowledge required to function as AP’s in primary care.

This realist qualitative study utilises an evaluative research design to explore and capture the individual, service, and stakeholder’s perspectives and academic achievement. Semi structured interviews have been undertaken with transcription and thematic analysis currently still in progress. Analysis of service impact and academic achievement are still being collected through the APiT’s academic portfolio

The APiT’s perceptions of their practice in relation to the four pillars of Advanced Practice (NES, 2007) and the NHS Concordat (NHS Northwest 2009) are currently being analysed.

Evaluation is essential to inform future options for supporting APiT in primary care.

Education
Advanced Practice, Hub and spoke, Primary care, Research

The evidence-based practice competencies: a framework for EBP integration into academic programs

Oral Presentation525Cindy Zellefrow, The Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare, The Ohio State University College of Nursing, COLUMBUS, United States of America

Plate ZaalMon 14:30 - 15:30

Introduction

Future Nurse Practitioners (NPs) and Advanced Practice Nurses (APNs) will only be as good as the education they receive today. The purpose of this symposium is to discuss how the Evidence-based Practice Competencies for Practicing Registered Professional Nurses (Melnyk, 2014) serve as a framework for EBP integration across curricula.

Description of pertinent research

Nursing academicians are key to preparing the NPs and APNs of the future to be clinical and professional practice leaders in healthcare transformation. (1) A plethora of literature exists that supports EBP is the way to quality and safety. NPs and APNs must graduate as competent, evidence-based practitioners if they are to keep up with the rapidly changing landscape of healthcare and provide current, quality and safe care (2,3). The EBP competencies provide the perfect framework for nursing academicians to integrate EBP into curricula in an intentional, meaningful and applicable way. Melnyk, et al. created The EBP Competencies using delphi methodology to identify 24 competencies;13 for all practicing nurses and an additional 11 competencies for NPs and APNs (4).

Summary of relevant information

A plethora of literature suggests that EBP is key to improved quality, safety and better outcomes for all. NPs and APNs are poised to be clinical and professional practice leaders. However, nursing academicians must properly prepare our future NPs/APNs to be competent in EBP. When EBP is integrated across the curriculum, graduates leave academia with the knowledge and skills necessary to lead EBP as a means to improved quality, safety and outcomes for all.

Conclusion: EBP must be integrated across curricula in order to create NPs and APNs who have EBP competence needed to remain current practitioners while taking their place as clinical and professional practice leaders in transforming healthcare. The EBP Competencies provide a framework for nursing academics to accomplish EBP integration.

Education
Best practice, Curricula development, EBP Integration

Added value of orthopaedic nurse practitioner and physician assistants in the Dutch care and cure

Oral Presentation303Keetie van de Hei-Kremers, Canisius Wilhelmina Hospital Nijmegen, Orthopedic, ZEELAND, Netherlands

Ruys ZaalMon 14:30 - 15:30

Introduction

In order to investigate the effects of nurse practitioners (NP) and physician assistants (PA) on orthopedic care in the Netherlands a national study was conducted. We studied the effect on quality, accessibility and costs.

Methods

In the period July to September 2016 we sent a digital survey to all 57 members of the NP/PA workgroup from the Dutch Orthopedic Association. This survey contains 47 questions, open and closed. The answers were analyzed and described in a final report.

Results

The response was 63%. Most respondents have more than seven years of orthopedic work experience, and most work full-time (average 33,3hr). Almost all professionals have both clinical and outpatient patient related tasks. The vast majority of the NP and PA also have tasks in the areas of quality, science and education. At the outpatient clinic, the majority of the respondents treat both new and control patients. In the clinic, most of the NP and PA are responsible for the entire orthopedic patient population and are employed in the function comparable to a hospital doctor. Because the NP and PA performs a lot of patient consultations independently, the doctor can focus on more complex cure. In addition, the accessibility is increased because of the flexibility of the NP and PA.

Conclusion

The orthopedic NP and PA had a clear added value. They have tasks in the clinic, outpatient clinic, and in the field of quality, education and science what benefits the quality of care and cure. Accessibility can be guaranteed and costs can be monitored by providing routine care and cure through the NP and PA.

With a clearly formulated and organized task reorganization, an efficient organization can arise with personal attention for the patient and a more focused deployment of the specialist

Collaboration and Inter-Disciplinary Practice
accesibility, added value np pa, quality, Research, tasks

Increased fracture risk in elderly patients with a hip fracture: treatment for osteoporosis

Oral Presentation97Sophie Osseweijer, Spaarne Gasthuis, Geriatrie, HILLEGOM, Netherlands

Ruys ZaalMon 14:30 - 15:30

Introduction In the Netherlands, each year, over 13,000 patients aged 70 years and older receive a hip fracture.

Although diagnosis of underlying osteoporosis is recommended by guidelines. The expectation is that many of these patients should be treated with calcium regulating therapy. However, only 25% of the patients return for further diagnostics. The purpose of this study is to obtain information about treatment indications with calcium regulating therapy in this patient population and the influence that age, gender, type of fracture or co morbidities have on it. Method The research population consisted of patients aged 70 years and older with a hip fracture (n=341) of the Spaarne Gasthuis Hoofddorp, of which 237 patients underwent diagnostics for osteoporosis. All data is collected from electronic patient records. After univariate analyzes, a logistic regression analysis was performed at p <0.20. To determine a cut-off value on age, a ROC-curve is performed. Results The percentage of patients witch should be treated with calcium regulating therapy was 88% (209/237). At age 80 and above, this was 94% (156/166). Age has been found to be the only predisposing factor for a treatment indication with calcium regulating therapy. The risk increases by 16% (OR (95% -BI) 1.16 (1.08-1.24)) per year. A cut-off value was found at 79 years. Conclusion 94% of 80-year-old patients with hip fracture have an indication for treatment with calcium-regulating therapy. It is not a problem to treat patients aged 80 and above with a hip fracture immediately without performing additional diagnostics. In daily practice, this saves cost and effort for diagnostics and the necessary treatment can be started earlier. By removing the barrier of diagnosis in elderly patients with hip fractures in the Netherlands, more elderly people will be treated with calcium regulating therapy, which will prevent fractures in the future.

Evidence based clinical practice/scientific research
Elderly, Elderly care, Osteoporosis, Research

Impact of orthogeriatric treatment on 1-year mortality in elderly with hip fracture

Oral Presentation68Ellis Folbert, Ziekenhuisgroep Twente Almelo-Hengelo, Traumasurgery, ALMELO, Netherlands

Ruys ZaalMon 14:30 - 15:30

Purpose

The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors.

Method

This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008.

Results

The 1-year mortality rate was 23.2% (n=197) in the CvGT group compared to 35.1% (n=188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4–5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1–2 OR 1.46, CCI 3–4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). Conclusion

After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. Risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.

Evidence based clinical practice/scientific research
Elderly care, Elderly patients, Hip fracture, Orthogeriatrics, Research

Advanced nursing practice for patients with lymphoma and autologous stem cell transplantation

Oral Presentation489Simone Lena Stamm, Inselspital University Hospital, Medical Oncology, BERN, Switzerland

Van Beuningen ZaalMon 14:30 - 15:30

Patients with lymphoma undergoing high dose chemotherapy and autologous stem cell transplantation (ASCT) and their families are confronted with a complex therapy causing multiple side effects, psychological and social burden. Ambulatory care lacked continuity and coordination among the interprofessional team. A for the Swiss context innovative advanced nursing practice (ANP) service was thus initiated, with the following aims: 1) to ensure a continuous, needs-oriented care during preparation, treatment and follow-up, 2) support patients’ and families’ self-management, and 3) coordinate interprofessional collaboration. Development, implementation and content of the service will be presented.

A participatory action research approach, a model for advanced practice nurse (APN) role development and the description of ANP by Hamric et al. provided guidance. Based on a literature review and a stakeholder analysis, the ANP service was designed, assessment instruments, care plans and written information for patients were chosen or developed, processes defined and tested. Currently, the pilot phase is ongoing with an APN and a registered nurse (RN) providing the service. During the pilot phase data regarding process and structure are collected.

The APN/RN first meet patients and families when an ASCT is proposed. They introduce their role as constant contact persons and offer contact by phone or e-mail as needed. Based on an assessment that includes the “Distress Thermometer”, they provide individual information, brief patients and families regarding symptoms and conditioning treatment and involve additional professionals (e.g. social worker) as needed. Over the hospital stay for ASCT they may support discharge planning. During follow-up, they mainly support symptom self-management. An additional focus of the APN/RN is the coordination of procedures among clinicians.

So far the ANP service ensures a constant contact option for patients and families; interprofessional collaboration is optimized. Additional results on processes and structures will be presented at the conference.

Innovation
Advanced Practice Nursing, Lymphoma, Stem Cell Transplantation

An advanced practice nurse (APN) in the sarcoma center – which patient needs are addressed?

Oral Presentation499Sabine Kaufmann, University hospital Inselspital, Switzerland

Van Beuningen ZaalMon 14:30 - 15:30

Sarcoma is a rare, life threatening disease, impacting high burden on patients and families. Little is known, however, regarding specific needs of these frequently young affected persons. Following a complex diagnostic procedure, treatment may include surgery and (neo)adjuvant chemotherapy and/or radiotherapy by a highly specialised, multiprofessional team. To improve continuity and coordination of care and address patient needs from suspected diagnosis to survivorship, an APN was integrated in the sarcoma center of Inselspital. The APN – a new role in the Swiss context - provides a single point of contact for patients and families. Following an assessment, she consults regarding physical and psychosocial needs and optimizes collaboration of the multiprofessional team. Patient needs, how the APN addressed them and descriptive data on her consultations over the first two years will be presented.

For all patients with sarcoma, the APN continuously recorded her activities. These data and routine clinical data were analysed using descriptive statistics. Qualitative data on patient needs were systematically summarized and categorized.

The patient group cared for by the APN, her activities and patient needs will be described and illustrated with examples. Patient needs concerned lack of information, physical, psychosocial and practical issues. The APN thus informs on e.g. diagnosis, treatment or financial assistance. She supports symptom self-management, provides emotional support and consults e.g. regarding coping and decision making. She coordinates care, e.g. by organising round table discussions, and facilitates the organisation of daily life. Individual care, therapeutic relationships with patients and families, and shared decision making are key for the APN. According to patients’ feedbacks, she is a trusted contact person and they benefit from her support.

The presented data will add to the yet small knowledge base on needs of patients with sarcoma and show how an APN can be successfully integrated in the sarcoma center.

Changing healthcare and the role of the NP/APN
APN, Needs, Sarcoma

Providing advanced care through gynaecological cancer treatment in a Swiss university hospital

Oral Presentation365Catherine Gassmann, University Hospital Basel, Switzerland, Gynaecologial Oncology, BASEL, Switzerland

Van Beuningen ZaalMon 14:30 - 15:30

Introduction

Women suffering from gynaecological cancer have a high symptom burden. Physical symptoms as well as psychological issues are highly prevalent. Gynaecological cancer treatment affects parts of the body that represent normally an intimate zone. Therefore, women may feel alone and experience stigma.

Aim

Aim of this project was to develop and implement an APN role to provide advanced and continuous nursing care. The focus lies on how to cope with physical and psychological symptom burden and to prevent complications related to female genitals (e.g. vaginal stenosis after pelvic radiotherapy) with the purpose to foster sexual rehabilitation as well as to maintain medical examination.

Method

Criteria of the APN role were depicted following the participatory, evidence-based, patient-focused process. This framework was introduced to develop, implement and evaluate APN roles (Bryant-Lukosius & DiCenso, 2004). Description of the actual model of care was undertaken by document analysis and by interviewing patients (n=7) and professionals (n=4). Data were analysed through thematic content analysis. Results were discussed in strategic workshops.

Results

Patients experience the treatment process as fragmented. Particularly they do not perceive continuity in nursing care when they change from in- to outpatient and through radiotherapy. Nursing continuity therefore is provided by consultations taking place depending on the women`s individual needs and through regular follow ups. Scope of practice comprises clinical practice, interprofessional collaboration and practice development. Systematic assessment of disease burden is carried out focussing on changes in body image and sexuality. Consultation for vaginal dilation is available for all women undergoing pelvic radiotherapy. A telephone hotline was established to provide low-threshold consultation.

Conclusions

First experiences indicate that the implementation of an APN may be a supportive and effective intervention for a highly vulnerable patient group. Patients report to feel supported by the APN in a susceptible phase of their illness.

Changing healthcare and the role of the NP/APN
Best practice, gynaecological oncology, Women's health

Introduction of the advanced nursing practice in heart failure management in Cyprus

Oral Presentation427Paraskevi Christofi, Limassol General Hospital, Intensive Care Unit A, LIMASSOL, Cyprus

Van Cappellen ZaalMon 14:30 - 15:30

Introduction statement indicating purpose of presentation: Advanced Practice Nurses (APNs) in Cyprus are prepared with the appropriate knowledge, skills and expertise for the management of Heart Failure (HF) patients. As the APN role is relevantly new for Cyprus, organized efforts are being made from the professional association and an academic institution for its integration and implementation. The current model of care for HF patients in Cyprus is very poor, without primary care services and 6 months follow-up. The purpose of this presentation is the introduction of APNs’ in the HF management in Cyprus.

Brief description of methods adopted: Nurse led management programmes are found to be successful (Lambrinou et al 2012). A nurse-led management programme was designed by APNs, under the umbrella of research, for the optimal management of priority problems emerging from the poor interaction of patients with the current health services. This consisted of an interventional programme with noninvasive mechanical ventilation for cardiogenic pulmonary edema and an RCT for chronic HF including education and telephone interventions. Strategies for embracing change were followed.

Summary of new unpublished data and/or relevant information: Despite that both programmes are found to be successful, it is demonstrated that the traditional paternalist medical model as well as the culture of all health professionals, administrators and other stakeholders is difficult to change. Policy makers are still concerned for the possible financial requirements of APNs, although the short-term and long-term cost effectiveness of the integration of APN role has been well established through the research projects.

Conclusion: Evidenced based practice and stakeholders’ embracement strategies are inadequate measures for the full integration of APN role in Cyprus. Thus, the support of Cypriot APNs from APN international bodies, as well as the enrollment in international programmes aiming to APN development and implementation, seem to be fundamental for Cyprus.

Changing healthcare and the role of the NP/APN
Best practice, Heart Failure Management

Advanced practice nurse development in Singapore

Oral Presentation483Mylene Koh, Ministry of Health, Office of the Director of Medical Services, Singapore

Van Cappellen ZaalMon 14:30 - 15:30

Singapore’s Ministry of Health (MOH) in 2002 recognised the need to strengthen the developmental pathway for clinical nurses and meet professional nursing aspirations, in alignment with the development of nursing internationally. Thus it adopted the International Council of Nurses’ recommendation that Advanced Practice Nurses (APN) be educationally prepared at Master’s degree level; the first cohort of APNs in Singapore graduated in 2004 and the APN title became a protected one under the Nurses & Midwives Act. To-date, more than 200 APNs have been certified by the Singapore Nursing Board.

Initiatives have been implemented along the way to strengthen APN preparation. In 2014, a competency-based training framework for internship was introduced, and the oral examination was substituted with an Objective Structured Clinical Examination (OSCE) as part of the certification process to ensure that APNs had acquired the advanced clinical knowledge and skills for competent practice.

With an increasingly aging population, there is a need to shift healthcare provision beyond the hospitals into the community, and nurses will play an increasing role in providing care to patients in their own familiar environment. More expert nurses will be needed for this endeavour. APNs developed thus far have been very acute-care centric and need to be equipped with the necessary skills to value-add to care in the community.

MOH convened an APN Development Committee (APNDC) to make recommendations to increase the pipeline of APNs, enhance their educational preparation and to review their professional development pathway, their career development and remuneration with the aim have sufficient APNs to meet healthcare needs of 2030.

This paper shares the journey and outcomes of the APNDC’s review.

Changing healthcare and the role of the NP/APN

Development and status of nurse prescriber education in Finland

Oral Presentation518Johanna Heikkilä, JAMK University of Applied Sciences, School of Health and Social Studies, JYVÄSKYLÄ, Finland

Van Cappellen ZaalMon 14:30 - 15:30

Nurse prescribing was introduced in 2010 through legislative changes in Finland. The first nurse prescribers graduated in 2012 from the postgraduate education which is 45 ETCS consisting of 20-22 contact days. In 2018, there will be over 400 nurses will have prescriptive right. An evaluation report by a national working group appointed by the Ministry of Social Affairs and Health summarized in 2015 the outcomes of nurse prescribing and changes needed. The material was collected widely from stakeholders by electronic questionnaires. The education was evaluated by the nurses having the right to prescribe, physicians, and universities.

The analysis revealed that most of the nurses evaluated the mentoring doctor to have supported the achievement of learning objectives during the clinical learning well or very well. Universities evaluated that mentoring clinical learning and evaluating the patient case diaries by the mentoring physician were realized mostly very well or well. The methods used in ensuring the competences: the national final exam, pharmacology exam, OSCE, and patient case diaries were assessed to be very suitable and valid assessment tools for competence development by the nurses, guiding doctors and the universities. Most of the nurses and mentoring doctors evaluated the content of the postgraduate training to appropriately correspond to requirements set by working life. Nurses would have liked more clinical examination included in the training and to learn about the diseases of the patient. Most of the nurses and mentoring doctors evaluated that the training yielded competences necessary for prescribing requirements.

The working group proposed that the prescribing additional training would be continued as a regulated postgraduate training including clinical learning in a health center. They proposed that the education should be included to Advance Nurse Practitioner training on Master level. Changes on legislation being prepared mean that the training must be developed further.

Education
Education, evaluation, Nurse prescriber, Research

Epilepsy and pregnancy

Oral Presentation223Carly Jansen, Kempenhaeghe, Academic Centre of Epilepsy, HEEZE, Netherlands

Van Weelde ZaalMon 14:30 - 15:30

Introduction:

In order to enable women with epilepsy (WWE) and their partners to make informed decisions before, during and after pregnancy, it is of great importance that WWE have access to information and counseling.

Practice-oriented research within two specialized epilepsy centers in the Netherlands showed unmet needs of WWE concerning pregnancy. Also it was found that there is no clear policy in the way treatment of WWE is embedded in routine care.

Objective:

Development of a care pathway in the two mentioned specialized centers in order to provide WWE best practice care in an evidence based, structured and multi-disciplinary way before, during and after pregnancy.

Our aim is to optimize quality of care for WWE and their partners.

Method:

Combined research was conducted consisting of:

Qualitative research

Systematic literature research

Benchmarking epilepsy centers

For development, implementation and evaluation of the care pathway the quality cycle ‘Plan-Do-Check-Act’ is being used.

Results:

The care pathway ‘Epilepsy and Pregnancy’ has embedded the identified best practice into routine care and resulted in a clear treatment policy and optimization of the quality of care. Improvements have been made in accessibility, in multidisciplinary cooperation, in communication and integral patient care. The WWE and their partners are placed at the central focus of care.

Conclusion:

At the two specialized centres the care pathway is secured and WWE are before, during and after pregnancy at central focus and thereby receive the care of the highest level.

The nurse practitioner has taken a leading role in the development and implementation of the care pathway and fulfils a coordinating role in operating the interventions.

Recommendations:

To develop a national multidisciplinary care pathway involving neurologists, gynaecologists, midwives and patient organisations.

To share experiences and inspire nurse practitioners from other countries, with the aim to optimize care of WWE worldwide, before, during and after pregnancy.

Collaboration and Inter-Disciplinary Practice
Best practice, Care pathway, Pregnancy, Women with epilepsy, Women's health

NP scope of practice in an Interprofessional primary healthcare practice model in Canada

Oral Presentation139Roberta Heale, Laurentian University, School of Nursing, SUDBURY, Canada

Van Weelde ZaalMon 14:30 - 15:30

Introduction Statement: There has been a significant increase in Nurse practitioners (NPs) working in primary healthcare in Ontario, Canada, especially in the physician-led, interprofessional Family Health Teams (FHTs) practice model. NPs practicing in these models can be expected to offer a broad basket of services. However, NPs identify that the primary care provider role signifies working to full scope of practice. The purpose of this presentation is to describe the characteristics of NP practice in FHTs and to provide reflections on the NP scope of practice in this model.

Methods: This is a cross sectional descriptive study of NP service and diagnostic code data collected for NP patient encounters. These data were compared to a number of other provincial datasets including physician service and diagnostic codes, as well as chronic disease datasets.

Findings: NPs cared for people of all ages, for acute episodic, chronic disease management and for one to more than 5 problems per encounter. Proportionately, NPs saw 3.7% of patients greater than 70% of the time in a given year. The remainder of the care was either shared with the physician (6.5%), or provided mostly by physicians (89.8% seen greater than 70% of the time).

Conclusion: NPs practice in FHTs is comprehensive not focused on a specific age group or disease condition, which reflects full use of knowledge and skill in responding to patients needs. However, NPs appear to be providing gap care, rather than taking a primary care provider role. A potential drawback to this model of care is that the NPs are less likely to develop a strong therapeutic relationship with the patient, knowing the full history and coordinating monitoring and follow up. Nevertheless, the limitations of the data are such that these conclusions should be viewed with caution and clarification with further research is required.

Collaboration and Inter-Disciplinary Practice
Primary care, Research, Scope of Practice

Transforming the advanced practice landscape in Scotland

Oral Presentation127Eddie Docherty, NHS Dumfries and Galloway, DUMFRIES, United Kingdom

Van Weelde ZaalMon 14:30 - 15:30

Like many other countries across the world, nursing roles in Scotland have evolved to meet changing demographics and healthcare needs. The Advanced Nurse Practitioner role has developed to expand the nursing role and has grown in response to local service and workforce needs. The integration of health and social care in Scotland requires new models of care which will be delivered by integrated multidisciplinary teams. As senior clinical decision makers the ANP will play a prominent role in many of these new models.

This presentation will discuss the work of the Chief Nursing Officer for Scotland’s Transforming Roles work to maximise the contribution of Advanced Nursing Practice (CNOD 2017). It will look at how Scotland is shaping the characteristics of the ANP role not only to give greater clarity to local services, but to also to maintain alignment with the internationally accepted definition (ICN 2002) and the new Royal College of Nursing definition (RCN 2017). It’ll describe how consensus was reached between stakeholders including practitioners, Scottish Executive Nurse Directors, the Royal College of Nursing and the Scottish Government. It’ll describe the process to identify and report on the ANP workforce across the National Health Service (NHS), Independent Care home and General Practice sectors in Scotland, how a country wide Education Needs Analysis was conducted, how high-level competences were identified for broad groups of ANPs, and recommendations made for improving governance and measuring the impact of ANP services . It will also look at the guidance that’s been developed for NHS Boards and employers.

Finally, there will be discussion on how the recommendations are being taken forward through NHS Boards and Integration Authorities as well as the role of the new Advanced Practice Academy(s) to provide guidance and support, and how the Scottish Government are supporting ANP education through £3m investment.

Changing healthcare and the role of the NP/APN
Establishing consistency, Health and care services, Scotland

The development of district nurses in advanced practice

Oral Presentation612Heather Bain, Robert Gordon University, School of Nursing and Midwifery, ABERDEEN, United Kingdom

Van der Vorm ZaalMon 14:30 - 15:30

The district nurse is a registered nurse with a specialist graduate-level education and specialist practitioner qualification recorded with the Nursing and Midwifery Council (NMC 2001). However, there has been a lack of direction in district nursing within the UK, with a decline in numbers of district nurses being educated and outdated NMC standards supporting district nurse education.

This study aimed to explore the unique knowing of district nursing in practice and how knowing develops. A qualitative interpretative approach within a case study design was adopted involving three Scottish Health Boards. Within each Health Board, interviews with key informants, and group interviews with district nurses were undertaken, using photo elicitation as a focusing exercise. The data was collected in 2013/14 and were analysed using framework analysis (Spencer et al. 2003).

This paper will focus on the following research questions:

What formal educational frameworks in curriculum and policy might best support the development of district nursing at an advanced level?How do different workplace elements help develop the practice of district nurses?

The participants recognised that due to the complexity of the district nurse role and its continuing advancements, that district nurse education needs to move to Master’s level preparation with the principles of advanced practice embedded within. The recognition that district nurses require high-level generic competences has since been recognized by the chief nurse in Scotland (Scottish Government 2017). Furthermore, the findings of this study demonstrate that the development of this knowing does not happen in isolation and is complex. In addition to formal education developing knowing consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. The study findings therefore have implications for both nurse educators and organisations to support the preparation for advanced practitioner level district nurses.

Changing healthcare and the role of the NP/APN
district nurse, Primary care, Research

Enhanced well child visits in primary care

Oral Presentation57Amra Dizdarevic, Copeman Healthcare Centre, Canada

Van der Vorm ZaalMon 14:30 - 15:30

Context:

Nurse practitioners have a tremendous potential to positively affect outcomes through regular contact with children and families, not only in the early years, but throughout childhood. However, in Canada, there are no regularly scheduled well child visits between 18 months and preschool years and none after school entry – this creates a gap in care.

Objective:

Nurse practitioners can address this gap in care in collaboration with other health care providers by providing regular and structured well child visits for all children and adolescents up to the age 18. The purpose of the presentation is to inform other nurse practitoners/advance practice nurses how to structure enhanced well child visits, which tools to use, and how to incorporate it into electronic medical records.

Methods:

Rourke Baby Record

Greig Health Record

Ages and Stages Questionnaire

Modified checklist for autism in toddlers

Strengths and Difficulties Questionnaire

Results:

For the past five years, nurse practitioners in collaboration with family physicians at our clinics have been providing regularly scheduled, enhanced well child visits for children up to age 18. Each well child visit is structured to include a health supervision guide. Additionally, development is assessed regularly, and children are screened for autism spectrum disorders at 18 and 24 months. Older children and adolescents are screened for anxiety, depression, ADD, behavioural or developmental issues, bullying. Anticipatory guidance and health education is provided at every visit. Children and families demonstrate increased knowledge and change in their health behaviours when they are contacted for follow-up or at their next health visit.

Conclusion:

The provision of enhanced well child visits annually to all children up to age 18 results in improved health behaviours of children and families and higher satisfaction with care.

Innovation
Best practice, Enhanced well child visit, Primary care

Factors determining the need for youth-ACT

Oral Presentation10Richard Vijverberg, GGZ Delfland/VU University Medical Center Amsterdam/APH, Department of Psychiatry, DELFT, Netherlands

Van der Vorm ZaalMon 14:30 - 15:30

Introduction statement

The aim of this study was to assess child- and family factors to determine the need for intensive outreach treatment for children. Findings and clinical implications will be presented.

Method

A cross section comparative study, was conducted in de southwest of the Netherlands. Child- and family factors were assessed from 246 included families referred to an outpatient clinic (n=123) or intensive outreach team (n=123).

Results

Preliminary analysis suggest that, compared to the outpatient group (N-123), in the intensive outreach group (N=123) (1) children and adolescents were associated with numerically higher HoNOSCA sum score. (2) Parents were associated with numerically higher HoNOS sum scores and parental stress scores. Further, more sophisticated analyses will be conducted and will yield definitive results. The results will be presented during the symposium.

Conclusions

Preliminary results of this study indicate that child- and family factors determining the need for intensive outreach might be similar to the need for inpatients care (1, 2, 3).

Research
assertive community treatment, assertive outreach, child and adolescent psychiatry, Mental health, Research

Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist.

Oral Presentation391Miarca Ten Broeke, Medisch Spectrum Twente, ENSCHEDE, Netherlands

Willem Burger ZaalMon 14:30 - 15:30

- Introduction

Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery (Rudolph et al., 2009). The purpose of the presentation is to notice that it is important to prevent the negative side effects of deli

Evidence based clinical practice/scientific research
cardiac, delirium, Elderly care, postoperative, Research

Quality improvement and research in cardiac surgery, role of the nurse practitioner

Oral Presentation193Richard van Valen, Erasmus MC, Cardiothoracic surgery, ROTTERDAM, Netherlands

Willem Burger ZaalMon 14:30 - 15:30

The role of the nurse practitioner has been researched extensively. The role a nurse practitioner can play within research and the kind of topics that are explored, is less well known.

In my thesis, research has been performed to enhance patient care using both medical as well as nursing topics. We describe the efforts to reduce complications during and after cardiac surgery and to enhance the quality of patient care during the in-hospital stay after surgery.

1) The effects of a protocol on cessation of anticoagulants and platelet-inhibiting medication on perioperative blood loss.

2) The effect of a novel approach to preventing postoperative wound infections: applying negative topical pressure on a closed wound.

3) Improving pain management after cardiac surgery with a nurse-driven pain protocol.

4) Improving knowledge about the management of rare complications after cardiac surgery by investigating and describing the diagnosis and management of atrio-esophageal fistula after the totally thoracoscopic maze procedure and of prosthetic valve endocarditis with Propionibacterium acnes (P. acnes).

In the thesis the role of the nurse practitioner is also discussed. I would like to present on the last topic using examples from my research.

Changing healthcare and the role of the NP/APN
Best practice, Critical/ acute care, quality improvement, thesis

Cardiovascular risk in familial hypercholesterolemia patients using optimal lipid lowering therapy

Oral Presentation77Annette Galema-Boers, Erasmus MC, Internal medicin, ROTTERDAM, Netherlands

Willem Burger ZaalMon 14:30 - 15:30

Introduction

Despite lipid-lowering therapy (LLT), patients with Familial Hypercholesterolemia (FH) still develop cardiovascular events. Data about the quantification and factors contributing to this residual risk are lacking.

This study assessed how many FH patients still develop a cardiovascular event despite optimal long-term LLT and which factors contribute to this risk.

Methods

We performed a time-dependent analysis in a cohort of consecutive heterozygous FH patients using optimal LLT to evaluate first and subsequent cardiovascular events. A univariate and multivariate regression analysis was conducted to study the association between clinical characteristics and cardiovascular events.

Results

Of 821 FH patients (median age 47.4 (IQR 35.3-58.3) years) treated with LLT for a median period of 9.5 (IQR 5.1-14.2) years, 102 patients (12%) developed cardiovascular disease (CVD) in 8538 statin treated person years. Patients who developed a cardiovascular event had a median age of 52.0 (IQR 43.8-59.3) years. These patients more often had previous cardiovascular events (32% vs 9%, P<0.001), a family history of premature CVD (58% vs 40%, P=0.001), hypertension (70% vs 22%, P<0.001), higher on-treatment LDL-cholesterol (162±54 vs 135±58 mg/dL, P<0.001), lower on-treatment HDL-cholesterol (50±15 vs 54±15 mg/dL, P<0.001), and were smokers (32% vs 14%, P<0.001), compared to patients without cardiovascular events. In 31 patients (30%) a subsequent cardiovascular event occurred with a median interval of 5.7 (IQR 2.4-9.3) years between events. They were more often smokers (32% vs 10%, P=0.01) and had hypertension (84% vs 63%, P=0.06) compared to patients with a single cardiovascular event. Conclusion

Despite optimal LLT FH patients still develop cardiovascular events and especially subsequent events. Classical risk factors such as smoking and hypertension are driving factors for this risk, indicating the high priority of lifestyle modification in addition to maximum LLT.

Research
familial hypercholesterolemia, lifestyle modification, Prevention and public health, Research, residual cardiovascular risk

Exploring the ANP’s value in The Dutch general practice on patient healthcare consumption outcomes

Oral Presentation384Brenda Baar, University of Utrecht, Netherlands

Zeelenberg ZaalMon 14:30 - 15:30

Introduction: The demand for primary care is increasing since reforms are shifting care from hospitals to the community. Changes in healthcare workforce skill-mix are needed to enhance efficacy and quality of care with better patient satisfaction and lower costs. One of the interventions might be the deployment of Advanced Nurse Practitioner’s (ANP’s). However, little is known about the role and impact of the ANP in primary care on patient outcomes in the Netherlands.

Objective: To explore the role and impact of care provided by the ANP in general practice on healthcare consumption compared with care by the General Practitioner (GP). Differences between patient characteristics, health status, and satisfaction of patients will also be analyzed.

Methods: An explorative quantitative prospective study will be conducted between January–May 2018 in the Netherlands. In total, three ANPs and six GPs working in five general practices will participate. All general practice patients visiting the ANP are eligible, GP patients will be matched on illness. Healthcare consumption such as the number of primary care contacts, medication use and referrals to hospital will be collected three months after the general practice visit. Patient characteristics such as age, sex, illness at the visit, multimorbidity, medication, and polypharmacy from both the ANP and GP will be extracted from a database. General health status (SF-12 questionnaire) and patient consult satisfaction (in general, how satisfied are you with the care you get from your GP/ANP?) of patients =18 years will be measured during a four-week timeframe.

Results: Results of approximately 1200 patients will be presented at the conference. Data regarding healthcare consumption of patients at three-months follow-up will be presented stratified per care provider (ANP versus GP). Furthermore, patient characteristics, health status and patient consult satisfaction stratified by care provider will be presented.

Research
Advanced Nurse Practitioner, General Practice, Healthcare consumption, Primary care, Research

A description of work processes used by clinical nurse specialists to improve patient outcomes

Oral Presentation354Janet Fulton, Indiana University School of Nursing, INDIANAPOLIS, United States of America

Zeelenberg ZaalMon 14:30 - 15:30

Introduction Clinical Nurse Specialists (CNS) are expected to contribute to improved patient outcomes. System-level factors are known to influence CNS practice; however, little is known about how CNSs achieve outcomes for improving health care. Purpose This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes. Methods Qualitative descriptive methods; purposive sampling from among juried abstracts describing project-related outcomes was used to form focus groups. Participants shared stories about the process of achieving project outcomes, focusing on the thinking that guided the project. Qualitative descriptive methods were used to analyze the narratives; demographic data used descriptive statistics. Human subject approval was obtained. Findings Seventeen CNSs (USA and Canada) participated. They described moving a project from initial problem identification to the endpoint of success and sustainability. Situating Work involved fitting the work to context. Categories of processes surrounding situating work included: Identifying a Problem, Engaging Stakeholders, Forecasting, Providing Feedback, Interfacing with the System, and; Disseminating reports. Building Trust included learning trust of others, using purposeful strategies to build trust, and being trusted in the present and as capital for the future. Having Self-agency described foundational characteristics representing a culmination of education, experience, and emotional intelligence, creating a sense of self-reliance that leads to willingness to take responsibility and to lead though influence. Conclusion This study provides insight into the often invisible work processes used by CNSs. CNS work is articulation work; unacknowledged management of awkward intersections among the social worlds of people, technology and organizations, that is facilitated by self-agency. The findings lend credibility to the CNS’s leadership abilities, and help explain why the CNS role and practice is often invisible and considered ambiguous.

Changing healthcare and the role of the NP/APN
Clincal Nurse Specialist, Outcomes, Research, Work Processes

The contribution Advanced Nursing and Midwifery Practitioners to patient outcomes

Oral Presentation8Mary Casey, University College Dublin, UCD School of Nursing, Midwifery and Health Systems, DUBLIN, Ireland

Zeelenberg ZaalMon 14:30 - 15:30

Introduction

Patient-related outcomes are those outcomes that effect patient perceptions, preferences or knowledge. The purpose of this presentation is to provide the findings on the impact of advanced practice roles on the health system and patient outcomes.

Design. A rapid review of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses’ and midwives’ advanced practice roles was undertaken as well as semi structured interviews with key stakeholders (n=15).

Background

Evidence of the impact of advanced nursing roles in terms of patient outcomes has never been in greater need with a growing elderly population and subsequent increased health care demands in areas such as cancer, chronic disease and mental health. Studies have measured the effect of ANP/NPs on patient satisfaction, quality of life, patient access to care, health care utilisation, patient adherence with treatment plans, cost savings, decreased length of stay, and decreased readmission rates, changes in patient clinical parameters (McDonnell et al., 2015) and symptom management (McCorkley et al., 2015).

Findings

Data was analysed using thematic analysis. Two primary themes were identified that directly related to the impact of these roles on patient outcomes. These themes were the contribution made by ANPs/NP working within a team and providing more appropriate levels of care, and enabling the medical staff to cater to the more serious cases.

There was also recognition for the role in educating patients, mothers, nurses, midwives and medical colleagues. Consistency in care and easier access also feature. Empowerment of patients was also highlighted as a positive feature.

Conclusion

While there is evidence of positive impact of these advanced roles there is a need for further research to quantify this impact in financial terms as well as in the overall provision of quality of care.

Changing healthcare and the role of the NP/APN
Advanced Practice, ANP/AMP, Nursing, Research

16:00 - 17:00 Parallel Sessions Round 4

Poster & Pitch

Metrics: measuring the impact of advanced nurse practitioners on care and service delivery

Poster & Pitch495Eddie Docherty, NHS Dumfries and Galloway, DUMFRIES, United Kingdom

Arcadis Zaal corner DMon 16:00 - 17:00

It is recognised that Advanced Nurse Practitioners (ANPs) positively impact on patient care and system outcomes. In addition they play a key part in developing and sustaining the capacity and capability of the health and care workforce in Scotland (CNOD 2017a). However, there is also increasing need for ANPs to be able to continuously demonstrate their impact and contribution to safe, effective, person centred quality care and the delivery of health and care policy.

This poster compliments the oral presentation ‘Transforming the Advanced Practice Landscape in Scotland’, and illustrates how a basket of metrics, can be applied to demonstrate the impact of ANP roles. This project was one element within the Transforming Roles – Advanced Nurse Practitioner initiative commissioned by the Chief Nursing Officer for Scotland (CNOD 2017b).

The poster will reference the link between ANP metrics and Excellence in Care (EIC) (Scottish Government 2015) which is Scotland’s national approach to assuring nursing and midwifery care and focuses on a person centred approach. It will describe the relationship between these national core measures and measures sensitive to ANP practice.

The poster will identify the principles underpinning the development of metrics to ensure the delivery of high quality care and improved patient outcomes by ANPs, demonstrating how these apply to the three key themes of safe, effective and person-centred care. Within these three themes, exemplars of metrics designed to measure the impact of an ANP will be provided. The poster will also highlight that there is a lack of specific ANP sensitive metrics and a requirement for further research in this area.

Changing healthcare and the role of the NP/APN
Best practice, Impact of ANP role, Metrics, Scotland

Enhancing quality of care and developing the own function as an ANP through the master thesis

Poster & Pitch585Jean-Jacques Georges, Hogeschool Utrecht, University of Applied Sciences, UTRECHT, Netherlands

Arcadis Zaal corner DMon 16:00 - 17:00

Introduction

In order to get their graduation at the end of the two years during course students Master Advanced Nursing Practice (MANP) at the Hogeschool Utrecht have to write a master thesis.

This work is based on a researchproject on an important issue form their own organization and directed to developing/redesigning an intervention. As such this innovation would essentially add to the quality of care for own patients and be a contribution for further implementation of one’s own function as an ANP after graduation.

Aim

The aim the presentation would be first to give more insight into the journey of students MANP through this research project when accomplishing their master thesis, secondly to describe results of the research projects in term of quality-of-care, thirdly to describe how this work has contributed to the development of their function.

Methods

Content analysis of data from several projects of students, specifically in the fields of oncology and of palliative care, in nursing home, hospices and general practice.

Semi-structured interviews and focus group interviews with the graduated students about their experience through their journey as student and their function as a nurse practitioner.

Results

This project in progress, will lead to gain insight in the way students have develop themselves through the curriculum of the training as critical and more autonomous thinkers and about their expertise in action as advanced nurse practitioner. Further the results will focus on describing how the design or redesign of interventions has led to promoting the quality of care, patients outcomes and collaboration with other professionals within the own organization and outside. Finally a description will be given about the way working on the master thesis has contributed to developing the own function as advanced nurse practitioner as an academicals expert.

Changing healthcare and the role of the NP/APN
Best practice, Research project and Practice, Role development

Finnish multi-professional network of health care professionals with advanced clinical expertise

Poster & Pitch368Tiina Stenman, Arcada University of Applied Sciences, Helsinki, Finland

Arcadis Zaal corner DMon 16:00 - 17:00

Background

The first APN jobs were established in Finnish university hospitals at the beginning of the 21st century. In 2012, graduating nurse practitioners (NP) established a joint network for NPs aimed at sharing expertise. Today, this network connects approximately 350 individuals. The network has members from different health care disciplines which include, nurses, midwives, bio analysts, paramedics, physiotherapists and radiographers. Thus far, the degree has remained relatively unknown, impacting career paths. Therefore, aims that increase the exposure of the degree program may result in increased employment opportunities for new graduates. In order to meet this goal, the network shall continue development by pursuing recognition as an official registered network.

Current Situation

In Finland, the dual model in higher education divides APN studies to universities (CNS) and universities of applied sciences (NP) with the degree programme for clinical expertise (NP) being 90 ects. At present, Finland is facing healthcare reform, which brings expansion to the job descriptions of health care professionals. Thus, there is a need for the development of APNs encompassing a wide range of competencies with multi-professional aspects.

Conclusions

Additionally, APNs could benefit from standardization and regulation, as doing so, would match current international standards. In order to accomplish this, legislative changes should be implemented on national level. For example, the title of APN should to be registered by the National Supervisory Authority for Health and Welfare (Valvira). Additionally, a national impact study is needed, including the extended job descriptions of NPs. Through these concrete steps, it is hoped that the employment of APNs will be bolstered. In conclusion, APNs in society can be considered an untapped resource and therefore, continued development and exposure of this advanced clinical expertise is warranted.

Changing healthcare and the role of the NP/APN
Multi-professional, Network

Safeguarding professional quality by the Certified Nurse Specialist

Poster & Pitch315Bas Vogel, Registration Commission for Nurse Specialists V&VN, UTRECHT, Netherlands

Arcadis Zaal corner DMon 16:00 - 17:00

Participants understand how legally certified nurse specialists safeguard the quality of education and professional practice of their own profession.

Content

In the Dutch system there is a fixed method for quality control for both the medical- and nurse specialists. The method is based on the principle of ‘the separation of powers’#_ftn1, and therefore consists of three ‘branches’. Nurse specialists are the majority-representatives in each of these branches.

The first branch, the legislature, is the Council for Registered Nurse Specialists (CSV). The CSV determines the requirements for the educational program, for registration, and re-registration. They also determine the specialisms in which the profession is categorized.

The second, executive, branch is the Registration Commission for Nurse Specialists (RSV). The RSV executes the rules set by the CSV, through a system of control of the educational program and a system for (termination of) registration and re-registration of nurse specialists.

The third, judiciary, branch, is the independent Commission for Objection and Appeal (CvBB). Every person affected by a decision made by the RSV, can object to or appeal that decision through the CvBB.

Nowadays, nurse specialists audit their own MA-program, both the theoretical part taught in schools and the apprenticeship in healthcare institutions. They also oversee the quality of re-registration and assess portfolios of their fellow-practitioners who have not met the re-registration requirements.

Method

First, an introduction into the different bodies that are responsible for quality control of the nurse specialist profession. Focus will be on the role played by nurse specialists themselves. Subsequently, a dialogue is sought with the audience, to discuss how this is organized in other countries.

#_ftnref1 as described by Montesquieu

Changing healthcare and the role of the NP/APN
Participation, Profession

New roles for nurses in municipal healthcare in Norway

Poster & Pitch333Jarle Grumstad, Norwegian Nurses Organisation, Department of Nursing and Health Politic, OSLO, Norway

Arcadis Zaal corner DMon 16:00 - 17:00

Background:

Patients experience today’s healthcare services in the municipalities as fragmented and incoherent. This pertains especially for patients that receive multidisciplinary services. Patient’s needs for coordinated services are unmet, and therefore insufficient. The growth of advanced healthcare services in the municipalities must rapidly change. This calls for an expansion in the nurse’s role, requiring increased specialization, expertise and competency.

Method:

Data is based on several studies from healthcare services in the municipalities, conducted by NOVA-Norwegian Social Research on behalf of the Norwegian Nurses Organization (NNO).

Results:

There is a gap between the population's need for healthcare services, the quality of services, and health personnel’s expertise and competence. The need for advanced clinical nurses is growing. The government has granted a three-year pilot study for primary healthcare teams. The teams will consist of three general practitioners (GP), one advanced clinical nurse and one health secretary. Target groups are: patients with chronic disease, frail elderly, and people with mental health problems and addiction. Advanced clinical competence is required to provide systematic health assessments and self-care abilities. The goal is to ensure accessible, improved coordinated service.

Discussion of main points

NNO has called for action to develop improved expertise and competency in healthcare services. The organization has provided input to healthcare political processes, nursing education, and developing new roles for nurses in the municipal healthcare services.

NNO will continue to participate in the design of the pilot study. It has been challenging to find funding, developing a model for organizing the service with a mandate acceptable for all stakeholders. NNO is convinced that advanced clinical nurses will play a vital role in primary healthcare teams. This pilot study will provide the government essential knowledge concerning advanced clinical nurses’ role in primary healthcare teams.

Changing healthcare and the role of the NP/APN
new roles, Prevention and public health

International transferability of nurse practitioner licenses

Poster & Pitch338Andrew Scanlon, Montclair State university, School of Nursing, MONTCLAIR, United States of America

Arcadis Zaal corner DMon 16:00 - 17:00

Purpose:

Currently there is a significant primary care provider shortage globally and it has been postulated to remain so for the foreseeable future. Primary care is the area in which practice NPs have traditionally filled in many countries. To address this shortage of NPs , suitably trained internationally have filled the gaps. Unfortunately, global reciprocity of NP licensure is not a reality and NP’s international mobility is stifled. The purpose of this presentation is to describe, compare and contrast the requirements for NP licensing in Australia, Canada, Ireland, New Zealand and United States and explore the process for an internationally educated NP can obtain a license to practice in another country.

Methods:

A review of all boards of nursing within Australia, Canada, Ireland, New Zealand and United States was conducted to determine the requirements for initial license application for IENPs. Through this process we explain the application and validation required for IENPs for each country as a whole with some specific state or province variations details.

Results:

After review of the federal and state or province boards of nursing within Australia, Canada, Ireland, New Zealand and United States there is some variation in basic requirements for initial application. Most countries require the applicant to obtain a registered nurse license first. Further validation of qualifications and in some instances national board examination is to obtain NP license however in some cases only national approved courses are eligible to sit the national board examine for nurse practitioner.

Conclusion:

The variation of education, license and scope of practice of IENPs impedes and in some instances prevents international transferability of these skilled nurses. Further work needs to performed at not only the international level but also nationally at State and Federal levels to address ease of appropriately qualified candidates from one country to another.

Changing healthcare and the role of the NP/APN
Licensure, Nurse Practitioners, Prevention and public health

What retains primary health care in The Netherlands from implementing the nurse practitioner

Poster & Pitch576Gerda Holleman, University of Applied Sciences Utrecht, Master Advanced Nursing Practice, UTRECHT, Netherlands

Arcadis Zaal corner HMon 16:00 - 17:00

Introduction: Primary health care in the Netherlands experience an increase of chronically ill people as a result of the rearrangement of inpatient health care. In the inpatient health care the nurse practitioner already contributes to optimize this care. Our question was whether the nurse practitioners can use their competences in a comparable way to coordinate and treat the chronically ill in primary care.

Method: Questionnaires focusing on critical professional activities were disseminated to nurse practitioners (n = 32) working in primary care. General practitioners and managers of home care organizations and psychiatric institutions (n = 142) received an online questionnaire. Additionally, managers in primary care participated in in-depth interviews (n = 5).

Result: In 2016, a total of 2638 nursing specialists were employed in the Netherlands, mainly in hospitals and nursing homes. About 11% (n = 278) are employed in general practice medicine and 9% (n = 236) in (basic) mental health care, with regional differences. Results show a discrepancy between the actual situation and the desired situation concerning the performance of critical professional activities. General practitioners and managers of healthcare organizations are convinced that a nurse practitioner increases the quality of care, improves the efficiency of the care performed, improves the coordination of care, provides more continuity of care which leads to higher patient satisfaction. The most important factor for not employing a nursing specialist is the employee's funding. Nurse specialist state that while the work is diverse, they are able to independently perform treatment care relationship with a specific patient group, with a preference for general practice.

Conclusion: The implementation of the nurse practitioner in primary care is an ongoing process. This concerns the jointly determining of the added value of the nurse practitioner, the absence of a pay title, insufficiently defined guidelines and streamlining of referrals.

Changing healthcare and the role of the NP/APN
implementation, Primary care, Research

Barriers and opportunities in implementing Nurse Practitioners in Norwegian Primary Health Care

Poster & Pitch389Elisabeth Holm Hansen, University College of Southeast Norway, Department of Nursing and Health Sciences, PORSGRUNN, Norway

Arcadis Zaal corner HMon 16:00 - 17:00

Introduction

Nurse practitioners (NPs) are a rapidly growing workforce in many countries in Europe due to the growing amount of elderly with chronic diseases and multi-morbidity in primary health care. By improving nurse`s competence level the access to health care services may improve along with the quality of care. NPs roles are internationally well established, and Norway is in the first phase of implementing NPs.

Methods

Thematic analysis was used to interpret data about barriers and opportunities from nurse leaders and General Practitioners (GPs) in primary health care. Written reports from meetings (11) and sound records (6) from 2015-2017 from four municipalities were analysed using Clarke and Brown 6 phases analysis.

Results

Five themes were identified: Enhanced clinical competence among nurses, clarification of new roles and tasks, re-organization of work, negotiation professional jurisdiction barriers, economic challenges.

Leaders and GPs in primary health care were generally positive towards NPs, but had challenges in clarifying their roles and how to organize them. This was due to economy, different needs between the departments and shift work. Leaders and GPs stated in several meetings that the NPs should not replace the GPs, but keep doing nurses tasks in a more expert way for better patient safety and adequate communication with the GPs. It was important to gain trust in the new roles, not only by the GPs but also by nurse colleagues.

Conclusion

Leaders and GPs all agreed on the need to enhance the nurse’s clinical competence in primary care. The leaders expressed challenges in defining the NPs roles and how to organize them. The NPs had to convince both colleagues and GPs in clinical practice that they earned their trust. Task shifting between GPs, NPs and RN was a continuing topic along the implementing process, but not stated as a barrier.

Changing healthcare and the role of the NP/APN
attitudes, barriers and opportunities, Nurse practicioner, role expectations

A multi-dimensional diagnostic tool; experiences of frequent attenders and general practitioners

Poster & Pitch388Nancy Karimbeg - Turkstra, Gezondheidscentrum Amsterdam Zuidoost, Netherlands

Arcadis Zaal corner HMon 16:00 - 17:00

Introduction

Frequent attenders(FA’s) increasingly burden primary and hospital care leading to longer waiting times and discontent in Fas This problem is especially urgent in multi-ethnic urban areas. Research has shown that multi-dimensional approach with longer consultation time give rise to lesser costs and higher Quality of Live in patientsThe Healthcare Center Gein in Amsterdam has approximately 10,000 patients with various ethnic backgrounds. FAs increase the workload of all healthcare professionals at the center including seven GPs, a Nurse Practitioner (NP), practice nurses and medical attendants. Moreover, FAs visit the emergency room or a GP in a hospital, when their GPs are not available the same day.

Aim

The NP implemented the 4D-model developed by Volte in the regular consultation of GPs and the NP with FAs. By using this model, the GPs and the NP aim to relieve the complaints of the FAs, reduce their number of visits and reduce the workload at the center.

The purpose of the presentation is to share the experiences with the implementation and the use of the 4D-model in primary healthcare for FAs.

Method

The NP will conduct qualitative research regarding the experiences of FAs and GPs with the 4D-model, and its usability and feasibility. Semi-structured interviews will be done with ten FAs and two GPs, and all GPs receive seven closed questions by e-mail.

 

Results

The interview of three FAs before the intervention showed that they preferred a smaller healthcare centre, more personal contact and an increase of consultation time with their GP.

Possibilities are made for FAs and GP to increase the workload and uplifting the self-care for FA’s.

 

Conclusions

The final results and conclusions are available in June 2018.

Changing healthcare and the role of the NP/APN
4D-Model, frequent attenders, Primary care, Research

Nurse practitioner in primary care (urgent care unit)

Poster & Pitch381Karin Nobbe-de Graaf, Centrale Huisartsen Posten Rotterdam, Huisartsenpost Sint Franciscus Gasthuis, KRIMPEN AAN DEN IJSSEL, Netherlands

Arcadis Zaal corner HMon 16:00 - 17:00

Abstract poster presentation

In Rotterdam the Centrale Huisartsenpost Rotterdam Rijnmond (five urgent care centres) provides urgent care by general practitioners during evenings and nights for the patients of 450 general practitioners in an area of more than 1.000.000 inhabitants.

The senescence of the Dutch population will have a large impact on the need for urgent care, in size and origine. Also the individualization and the growing diversity in the society will, together with growing wealth and availability of information, be a cause of growing need for (more personalized) healthcare (Raad voor de volksgezondheid en zorg, 201; Pauw, 2016).

In primary care the amount of patients visiting urgent care centres is growing and causes a growing workload for general practitioners (Giesen, Huibers & Krol, 2011; NHG standpunt huisarts en spoedzorg, 213; Pauw, 2016). We have a challenge to keep healthcare lasting and affordable, while the amount of patients keeps growing . For urgent care centres this implies that solutions have to be found to prevent decline in quality, availability and manageability of urgent care.

From July 2017 a project with nurse practitioners in the urgent care units in Rotterdam has started. NP’s are treating patients with physical complaints as beforehand listed. Treatment includes anamnesis, physical examination, describing medication and minor surgical treatment.

From January 2018 an evaluation will be held to measure the project results as reducing the caseload for GP’s, reducing waiting time for patients and contribution to safety and quality of healthcare in the urgent care units.

In the presentation the results of this evaluation will be shown on a poster.

Keywords: primary care, urgent care, nurse practitioner’s role

 

 

Changing healthcare and the role of the NP/APN
Best practice, nurse practitioner’s role, Primary care, urgent care

A study on the frailty of older people who did not consult their GP for more than a year

Poster & Pitch376Ingrid Janssen-Berendsen, General Practice, Duiven, DUIVEN, Netherlands

Arcadis Zaal corner HMon 16:00 - 17:00

Introduction Older people consult their general practitioner (GP) for various reasons and with various frequencies. Those with the most consultations receive the most care, however, are not always the most frail people. The current study examined the frailty of older people who did not consult their GP for more than a year.MethodsIncluded were all people (=75 years) of a general practice in Duiven, the Netherlands, who did not consult their GP for more than a year (index group). Their frailty was compared to a consecutive sample of people (=75 years) who were referred to a nurse practitioner (in training) for a frailty screening (reference group). Frailty was assessed with the 'Groninger Frailty Indicator’ (GFI-score =4) and a ‘Frailty Index’ (FI-score =0.08). In addition, demographic and healthcare variables were assessed.ResultsThe index group (n=34) had lower scores than the reference group (n=39) at the GFI (4.0 versus 8.0, p<0.001) and FI (0.18 versus 0.58, p<0.001). In the index group, 11 persons (32%) were frail according to the GFI, 23 persons (68%) according to the FI, and 8 persons (24%) according to both instruments. In the reference group, all persons were frail. The index group – and also the most frail people in this group – was younger, was more often married, more often had higher education, and less often had homecare support and checks by a practice nurse than the reference group (p<0.05).Conclusion Older people who did not consult their GP for more than a year are less frail than older people who did consult their GP. This might be related to their lower age or higher education, for example. However, at least one third of those people might be regarded as frail. Identifying them enables offering them the care they might need.

Changing healthcare and the role of the NP/APN
Best practice, General practitioner (GP), Older people, Prevention and public health

Based on the nurse's multi-point career, the network alliance model was constructed

Poster & Pitch311Qianqian Liu, Zhengzhou university first affiliated hospital, China

Arcadis Zaal corner LMon 16:00 - 17:00

Objective: in view of the basic condition of the nurses' multi-point practice, the network guidance alliance model of tumor hospital oncology nurses is promoted based on the demand of each tumor hospital.

Methods: using quantitative and qualitative research methods, including literature retrieval, in-depth interview, questionnaire survey, statistical analysis, etc.

Results: the tumor specialist nurse network alliance of a regional tumor hospital covered 64 member hospitals in henan province. The core hospital has received high praise from the member hospitals, and it is widely recognized that the network guidance alliance model of tumor hospital oncology nurses can improve the college level of tumor.

Conclusion: for tumor specialized subject development needs, through the ministry of health, '3521' health informatization construction of the machine, a remote tumor specialist nurse network alliance information system, perfect the 'tumor specialist nurse network guidance' build alliance mode, explore senior clinical nurse practice more, really play the role of tumor specialist senior clinical nurses.

Changing healthcare and the role of the NP/APN
Net, nurses multi-point occupation, Oncology nurse, Research

How to find patients who need specialized care - implementing Advanced Practice Nursing in Hamburg

Poster & Pitch307Inke Zastrow, University Medical Center of Hamburg, Patient- and Care Management Head Office, Hamburg, Germany

Arcadis Zaal corner LMon 16:00 - 17:00

The increasing complexity of patient care is one reason why we need more specific qualifications in nursing practice. For this reason, the University Medical Center of Hamburg (UKE) developed a competence model to be able to present vocational qualifications in nursing in a transparent manner. One part of this model is the Advanced Nursing Practice (ANP) level. Our first step towards realization of this model is to conduct a pilot study in the neurosurgery department.

To find an adequate patient group in respect to diagnosis groups and readmission rate, controlling data of inlayers of the neurosurgery department were extracted from January to June 2016. Furthermore, we searched for abnormalities in terms of the types of diagnosis group in relation to the frequency of emergency readmissions.

In the study period, a total of 1.065 patients (1.275 cases) were analyzed. It was found that 78 patients (164 cases) had more than one stay (1 - 3), with 19 patients (40 cases) hospitalized as emergency readmission. There is a tendency that the more frequently readmission took place, the more likely an emergency readmission occurred. Patients with the main diagnosis neurosurgical malignancies were found to be the most frequent group with emergency readmissions.

Our data indicates that patients with the main diagnosis neurosurgical malignancies are at high risk for emergency readmission. Previous studies from the USA have shown success in reducing the re-hospitalization rate, lowering the length of stay and reducing care costs when patients with a high risk of re-hospitalization were cared for by an APN. These facts can help us to find a suitable working environment for APN and to identify strategies to achieve a better outcome for high risk patients. More data analysis and evaluation are needed for a holistic implementation of ANP in the department of neurosurgery at the UKE.

Changing healthcare and the role of the NP/APN
Advanced Practice Nursing, patient outcome, readmission, Research

NP's in the ED- perceived benefits and areas for improvement of increased role responsibilities

Poster & Pitch283Mary Schucker, The Children's Hospital of Philadelphia, LANSDOWNE, United States of America

Arcadis Zaal corner LMon 16:00 - 17:00

Introduction

Can full scope of practice may increase role satisfaction and improve patient access to a provider? Over the last 2 years pediatric emergency department nurse practitioners (EDNP) in an urban pediatric emergency department have been able to practice independently as a departmental innovation to improve patient care, access and safety.

Methods

18 EDNP with full scope of practice completed a survey about their experiences. Data analysis included descriptive statistics for each survey question. Open-ended questions were coded manually into themes of benefits and disadvantages of role expansion.

Summary

Unequivocally EDNPs’ report that congruence between scope of practice (granted by the state board of nursing) and the actual ability to practice this way increased their role satisfaction. Overall the group reported that they would have benefited from training in medical decision making, documenting for maximum reimbursement and legal/liability issues before having to assume this responsibility.

?Patient safety was the NP's most pressing concern. Despite this concern, EDNPs had favorable 72 return visit rates. Most revisits for EDNPs were for progression of disease, not missed diagnosis. Other concerns relate to the increase in workload and responsibility without increase in compensation.

Conclusion

There was no doubt that despite the initial challenges of increased responsibility practicing at a higher level that was in line with education and training lead to increased role satisfaction. Of an ED FY2017 total volume of 97,143 children, EDNPs independently managed and requested 3rd party reimbursement for 8,170 of these patients. A crucial part of role satisfaction is the belief that full practice authority adds value and contributes to the ED mission.

The perceptions of the EDNP are being used to provide appropriate training in the areas noted above to improve practice for all EDNPs and the continued implementation of full practice authority.

Changing healthcare and the role of the NP/APN
Access to care, Emergency care, Patient Saftey, Role Satisfaction

Evidence-based change through a new APN role in an acute medical hospital in Germany

Poster & Pitch272Julia Kary, University Hospital Heidelberg Germany, Cardiology, LEIMEN, Germany

Arcadis Zaal corner LMon 16:00 - 17:00

Introduction: Workforce shortages and a dynamically changing health care environment continue to challenge nursing leaders to find new solutions for maintaining quality patient care outcomes with available resources within local priorities. Empirical evidence links the role of advanced nurse practitioners to improved care outcomes and patient satisfaction [1]. In 2017, the first Master-qualified advanced practice nurse was appointed within the medical nursing service at the University Hospital Heidelberg, Germany. In collaboration with the medical nursing director, a key early priority has been the review of workflow and resource allocation in the nursing team to improve effectiveness and quality of care. As a result, a first formal point-in-time audit and analysis of skill-grade-mix across this medical nursing service is being conducted. The aim is to produce up-to-date, reliable data within the local institutional context and promote evidence-based decision-making.

Methods: Skill-grade-mix data were collected via an in-house Qualification-Matrix-Database and one medical ward was selected to pilot this project. Data were analyzed quantitatively.

Results: Skill-mix findings from the pilot ward showed 73.5% of the nursing team were registered nurses with an average experience of 5.5 yrs. There was a low percentage of unqualified housekeeping staff and other assistants. Grade-mix findings included 1 Master-qualified APN. Additional certifications held by RNs included: 5 preceptors, 2 stoma/continence nurses, 3 wound experts, 2 pain nurses and 1 nurse with a nutrition-dementia-infection control certificate. Gaps in RN certifications relevant for the pilot ward were oncology/chronic care nursing as well as nephrology.

Conclusion: Results of this skill-grade-mix audit will be valuable in a forthcoming review of local nursing team structures. Integration of an APN role in the medical nursing service at the University Hospital Heidelberg has been an important strategic change that is contributing towards evidence-based nursing processes and improving quality in patient care.

Changing healthcare and the role of the NP/APN
Best practice, change management, Critical/ acute care, nurse specialist, skill-grade-mix

Development of APN in Singapore: KKH Experience

Poster & Pitch271Julia Eng, KK Women's and Children's Hospital, Nursing, SINGAPORE, Singapore

Arcadis Zaal corner LMon 16:00 - 17:00

APN development in Singapore started back in 2004, and its training has since evolved with structure internship program and OSCE exam. APN journey in KKH started in 2006 with 3 specialty nurses. They successfully completed their Master of Nursing in 2008 and exited in 2009. Role of APN in KKH then concentrate mainly in the clinical care of patients in the wards and outpatient settings. As the APN matures, the role evolved, and we begin to develop nurses who are interested to be aspirated as an APN. We also recognized the needs of APN services in pediatric setting and a curriculum was developed in 2011 cater for Paediatric APNs. We then successfully trained our first batch of APNs in Peadiatric in 2014 and they exited as full licensed APN in 2015. As a very specialized hospital, APN in KKH continue to practice with a broad-based model of care, co-managing patient with the physician and surgeon. These has resulted in better patient satisfaction, reduce length of hospital stay from 8 to 5 days in the surgical oncology wards, successful transition of 40 adolescent with diabetic per year to community care, and reduce waiting time in the paediatric outpatient clinics to 1 week instead of 15 weeks in the physician clinic.

As we progressed, we also recognized the needs to develop our nurses and initiated APN-led nursing round, creating a learning platform and to develop a learning culture for nurses in the ward. Nurses are also encouraged to present at the monthly training specific to their needs.

Moving forward, development of APN will continued and expand from their clinical setting to development of their research skills to guide their practice and to explore other area that will improve patient care eg clinical education and publication

Changing healthcare and the role of the NP/APN
APN Development

Concurrent Sessions

So you thinks it's dementia

Clinical WorkshopCW4Mary Steinke, Indiana University, KOKOMO INDIANA, United States of America

Van Rijckevorsel ZaalMon 16:00 - 17:00

In this workshop, we will examine the pathophysiology,evidence-based research, review 1 or more case studies and review the assessment and management of the 2 most common types of Dementia, and discuss types that are not as prevalent. We will also discuss “stereotype threats” when it comes to diagnosing and treating Dementia.

Biography

Mary K. Steinke has been an adult nurse practitioner for over 25 years, and has worked in a variety of settings, ranging from occupational health to internal medicine and geriatrics. She is currently the director of the FNP program at Indiana University Kokomo. She also serves on the core steering group as liaison for the practice subgroup of the International Council of Nurses. She has been a member of medical teams which have served people without the means or access to medical care in Nicaragua, Haiti and Indiana. Mary enjoys time with her family and friends, as well as travelling as much as possible.

Evidence based clinical practice/scientific research
Dementia, Elderly care

NP/RN care coordination for chronic disease management in Rural America

Symposium195Patricia Vanhook, East Tennessee State University, College of Nursing, JOHNSON CITY, United States of America

Eduard Flipse ZaalMon 16:00 - 17:00

There are many definitions for care coordination. For this talk the AHRQ definition will be used:“Care coordination is the deliberate organization of patient care activities between two or moreparticipants (including the patient) involved in a patient’s care to facilitate the appropriatedelivery of health care services. Organizing care involves the marshalling of personnel and otherresources needed to carry out all required patient care activities and is often managed by theexchange of information among participants responsible for different aspects of care.' (AHRQ, 2014). People living in rural areas lack access to primary healthcare providers, specialty providers, and many resources to assist with chronic disease management. In many rural areas in America, primary care is provided by Nurse Practitioners. Nurse Practitioners and Registered Nurses have key roles in the management of chronic disease management. Hypertension, diabetes, and obesity are reasons for early mortality in rural America. Many barriers to the management of chronic diseases are the lack of access to specialty care, social determinants of health, and poor communication between specialty provider and rural primary care provider. The symposium will discuss RN/NP care coordination model that assists patients to manage chronic diseases to improve health outcomes in rural America.

Collaboration and Inter-Disciplinary Practice
Best practice, chronic disease, Primary care, rural

Examining and at the same time challenging APN students in enhancing their clinical leadership role

Workshop252Netty van Os, Fontys School of People and Health Studies, Master APN, TILBURG, Netherlands

Schadee ZaalMon 16:00 - 17:00

In this workshop we want to share our way of challenging and testing students in their professionalism; their vision, leadership and future ambitions in the role of a NP after two years of education. They must manifest themselves. It’s all about professional mastery and profiling and positioning oneself in healthcare. In order to pass the test, we call it a Manifesto, students have to fulfill three tasks:

1. Composing a poster which shows their vision on their role as an NP in their own practice and their personal added value. This poster often shows a metaphor amongst other things as keywords and or icons.

2. Giving a presentation to colleagues, managers, leaders etc. from their work place, explaining what the poster is showing and the meaning behind: what they stand for; how they see their role in practice; what their vision is on care delivery and person-centeredness; how they see the interdisciplinary collaboration in their workplace; what their ambitions for the future are,….e.g.

3. Writing a reflective paper which underpins the poster and goes deeper than the presentation. They have describe their vision on good care for their own patient category; their vision on themselves being a clinical leader; how they want to play this role as an NP; some examples out their own practice (critical incidents, feedback, little stories, etc.); their preferred way of collaboration with other healthcare workers and their ambitions and planned actions for the near future after graduation.

Besides sharing this best practice, we would like to explore and discuss during this workshop what student APN’s need more to get prepared for picking up the challenge of becoming leaders and innovators in healthcare. Do they need more knowledge about finances or training in writing business cases, e.g.?

Leadership
Best practice, professional mastery, vision

CANCELLED: Bridging the gap in pain assessment. 'Imagine you are in pain and unable to express it'.

Workshop444Juanita Cheuk-ALam, Erasmus MC, Anesthesiology, Netherlands

Hudig ZaalMon 16:00 - 17:00

Title

Bridging the gap in pain assessment of geriatric patients.

Subtitle

Imagine you are in pain and unable to express it

Introduction and aim

As a NP, part of the role is educating healthcare staff to be aware of adequate pain assessment in geriatric patients. This is essential to deliver effective pain management. Pain is detrimental to the human body. Especially the elderly are at increased risk of discomfort, loss of function, delirium and problematic behavior. The pain perception, expression and behavior can change due to neuropathological modulation in the brain of the frail elderly. This increases the risk for inadequate pain treatment.

This workshop is designed to assist NPs to identify the subtle and obscure signs of pain in the elderly populations, especially those cognitive impaired and/or speech limited. A validated pain observation tool and assessment skills will be discussed.

Method

Interactive discussions

Observational skill training

Conclusion

A training in observational pain assessment for the geriatric population has been proven effective in reducing the risk of inadequate pain treatment.

Summary

NPs who work in geriatric population can improve pain management by educating their colleagues to recognize the less obvious signs of pain in these patients. Especially in those patients who are non-communitive and cognitive impaired.

Education
Best practice, Elderly care, geriatric patients, pain assessment, pain observation tool

A snapshot of clinical educational experiences of advanced nurses worldwide

Oral Presentation109Michelle Beauchesne, Northeastern University, School of Nursing, BOSTON, United States of America

Mees ZaalMon 16:00 - 17:00

Introduction

Apprenticeship experience remained the hallmark of clinical practice in nursing when training not education was the rule well into the 20th century. With the closing of the Nightingale Schools in 1966, Norman noted changing times and trends in health and social care warranted new directions for nursing clinical education. One significant change was the emergence of the nurse practitioner role in the United States. Sixty years later we still struggle to meet the challenge of educating advanced practice nurses (APNs) due to an exponential growth of APN roles worldwide; concurrent with increased demands for expert nursing care for diverse complex populations.< A lack of clarity and consistency in nursing education further contributes to these challenges. This paper describes the diversity of clinical experiences required for APN education in select countries worldwide today. Objectives

Describe a brief historical overview of nursing education clinical experiences.

Examine the current differences and similarities of required APN clinical experiences globally.

Explore factors that influence the structure of clinical experiences globally.

Methodology/Process

Using a survey technique with a convenience sampling of APN educators from 10 countries, we examined the issues in clinical education that encompass the knowledge, skills and competencies needed beyond the basic traditional nursing education for advanced practice. A previous paper reported those overall results. This paper focuses on a secondary analysis of the actual required clinical experiences within each educational program examined.

Results/Outcomes

Exemplars from select countries (Australia, Canada, France, Israel, New Zealand, Saudi Arabia, South Africa, Spain, United Kingdom and the United States) describe the required clinical experiences. Variables examined: number of hours, types of experiences, variety of settings, criteria for supervision/mentorship, and the role of faculty and employers.

Conclusion

Sharing lessons learned and education pearls can serve to ensure quality, maintain standards, and establish best practices worldwide.

Education
Clinical Experiences, Education, Global, Research

Inter-professional education and practice

Oral Presentation21Carol Savrin, Case Western Reserve University, Nursing, CLEVELAND, United States of America

Mees ZaalMon 16:00 - 17:00

Collaboration across health professions is essential to advancing human health. We are committed to a systemic approach to collaborative healthcare education and clinical care. Through our I-LEAP (Inter-professional Learning Exchange and Practice) project, student teams gain vital experience with inter-professional care through working with underserved diverse populations. Team activities are strengthened through didactic and curricular components and assessed through tools measuring team skills, satisfaction and inter-professional competencies. I-LEAP enhances primary care processes and patient outcomes by supporting health education, care coordination, communication and evaluation.

Teams of 5 students are placed in a variety of clinical sites. Student teams consist of one each from Medicine, Advanced Practice Nursing, Dental, Social Work, and Physician’s Assistant. Clinical partners identify a gap in care due to lack of time or lack of providers. Student teams work on the issue that has been identified for a semester and report back to the partner with suggestions, successes or activities. Gaps have included complex diabetics, patients with chronic obstructive pulmonary disease with self-care deficits, and primary care patients with inadequate dental care, among others.

Prior to becoming involved in I-LEAP teams, students complete surveys that evaluate inter-professional knowledge and skills as well as team skills. Inter-professional competencies are measured at the end of the process through observation using a tool we designed based on the IPEC competencies. We have pre-post data for all surveys. Clinical partner sites are collecting data on the outcome measures that they developed for each project.

We have found that students believe they have the knowledge and skills before starting, however, the end of the project surveys indicate considerable improvement in preparation to work on an inter-professional team and more knowledge regarding roles and responsibilities of other professions. We are still awaiting patient outcome data, which should be available in about 3 months.

Collaboration and Inter-Disciplinary Practice
interdisciplinary, Primary care

Engaging APRN and MSW Students in interprofessional clinical simulation

Oral Presentation115Mary Benbenek, University of Minnesota, MINNEAPOLIS, United States of America

Mees ZaalMon 16:00 - 17:00

Background and Aim:

Interprofessional (IP) collaboration has the potential to improve patient outcomes and offer better patient-centered care. We hypothesized that a clinical simulation engaging Family Nurse Practitioner (FNP) students and Master of Social Work (MSW) students would increase self-reported IP competence (measured by the Interprofessional Collaborative Competency Attainment Scale-ICCAS) and improve perceptions of IP education (measured by the Student Perception of Interprofessional Clinical Education-Revised instrument-SPICE-R).

Design and Methods:

The clinical simulation consisted of two case vignettes using standardized patients. Student participants were doctoral level FNPs (n=15) and MSWs (n=15). The FNPs and MSWs performed dual and sequential (warm handoff) assessments. Students engaged in a pre-encounter huddle, followed by a patient assessment (team or sequential individual), post-encounter, presentation to patient, and post-encounter reflection. Students completed pretest-posttest measures (ICCAS and SPICE-R) and wrote a 2- to 3-page reflection paper. ICCAS and SPICE-R data were analyzed using Wilcoxon Signed Rank tests and reflection papers were coded thematically using a constant comparative method.

Results:

ICCAS findings indicated significant improvements from pretest to posttest for FNPs and MSW (combined) on all six scale subdomains: communication, collaboration, roles and responsibilities, collaborative patient-family-centered approach, conflict management/resolution, and team functioning (all p-values < .001). No significant differences were found on the three factors of the SPICE-R: IP team-based practice (p=. 88), roles/responsibilities (p=. 33), and patient outcomes (p=. 21). Qualitative data from reflection papers corroborated the quantitative findings. Conclusions and Implications: Clinical simulation has the potential to teach nursing and social work students about the importance of IP collaborative practice Future research is needed to clarify FNPs' and MSWs' unique and overlapping roles on interprofessional teams and explore patients' perceptions of dual versus sequential assessments. Funding source: U. S. Department of Health and Human Services, Health Resources and Services Administration, G02HP27955

Collaboration and Inter-Disciplinary Practice
Interprofessional Collaboration, Primary care, Research, Simulation

What does the NP mean to you? A patient oriented qualitative study in oncological/palliative care

Oral Presentation194Loes van Dusseldorp, Radboudumc, Research unit Anesthesiology, Pain and Palliative Medicine, NIJMEGEN, Netherlands

Ruys ZaalMon 16:00 - 17:00

Care provided by NPs shows a high patient satisfaction, which is related to e.g. continuity, and information and advice on coping with the disease. Research shows that health care provided by NPs equals the quality of care provided by physicians and some studies even suggest that patients are more satisfied in comparison with physicians. Because patients’ views have only been examined quantitatively, underlying experiences and meanings remain unclear. Therefore, we aim to explore the meaning patients put on their experiences with the NP in oncological- or palliative care.

A qualitative design from a phenomenological perspective was used. A purposive sample of patients receiving oncological- or palliative care by a NP was recruited in 3 Dutch hospitals. Colaizzi’s seven step method and the Metaphor Identification Procedure (MIP) were used to analyse the data.

In 2017, 16 in-depth interviews were held. Respondents were on average 63,9 years and 53% were female. Six fundamental themes emerged from the data; the being of the NP (as human being & as professional), the performance of the NP role (performing care & cure), organising patient care, and the impact on patient’s wellbeing. The MIP analysis revealed 6 different metaphors representing patients’ symbolic descriptions of their experiences and attached meaning: Travel metaphor (NP is beacon, lifebuoy); War metaphor (NP is brother in crime); Chain metaphor (NP is checkpoint, intermediary); Trust metaphor (NP feels like warm nest, one feels kept on a leash); Coach metaphor (NP is push in the right direction, helps to pick up the thread); Technical metaphor (NP is like an overhaul).

Patients experience the NP as reliable, helpful and empathic. They feel empowered, at peace and being in control by support, guidance and personal attention to one’s disease and quality life. NPs providing integrated care at expert level, make patients feel safe and embraced.

Research
Nurse Practitioner, Oncological- and palliative care, Patient experiences, Research

The role of nurse practitioner on the phase I unit in oncology

Oral Presentation185Diane van der Biessen, Erasmus MC Cancer Institute, ROTTERDAM, Netherlands

Ruys ZaalMon 16:00 - 17:00

Introduction

The incidence of cancer will continue to increase due to the aging population. When patients with cancer develop metastases, most of them will die of the disease. Therefore, there is an ongoing need for new and/or better treatments. Phase-I clinical trials are the first step in this development. Over the last 10 years nurse practitioners (NPs) play an increasing role in patients’ medical and nursing care at the phase-I unit of the Medical Oncology Department, at the Erasmus MC Cancer Institute.

Brief description

NPs competences are defined with the CanMEDS-system. The NPs fulfil the role of both clinical expert/communicator. They inform patients about the trial goals and procedures, they discuss and obtain informed consent, assess symptoms of the disease and side effects of the experimental drug(s), and evaluate lab findings and additional examinations, performed according to trial protocol. At a daily basis, patients are discussed with the principle investigators, usually a medical oncologist, in order to ensure the patients’ safety on trial. NPs organize the care according phase-I study protocol with both patient and collaborating disciplines. As social advocate/clinical expert they support patients deliberating trial participation, give psycho-social support when needed, perform follow-up, refer patients to other specialists if necessary, have contact with the first line caregivers and have a role in quality. Furthermore, they educate doctors and (research/oncology) nurses, give lectures to both public and professionals, and perform research into patients perspectives.

Summary

The NPs work as professionals in collaboration with other health-care providers to provide safe, high-quality health-care services to patients with cancer participating in clinical trials. They are keyplayers at the phase-I unit and a stable factor for the patient in this uncertain stage of cancer.

Conclusion

NPs at the phase-I unit are able to provide protocoled medical care according to the CanMEDS competences.

Changing healthcare and the role of the NP/APN
Best practice, Oncology, Phase I unit

What do healthcare professionals say about improving patient self-management?

Oral Presentation108Barbara Sassen, University of Applied Sciences Utrecht, HealthCare, UTRECHT, Netherlands

Ruys ZaalMon 16:00 - 17:00

Background:

In healthcare, the focus is on optimizing patient self-management. Patients should manage their own health with the support of healthcare professionals. In patient-centered care, patients and professionals should work together optimizing self-management to achieve intended patient outcomes.

Objective:

The objective was to assess professionals’ intention and encouraging behavior toward patient self-management.

Methods:

In a longitudinal design (T1 September 2017, T2 planned June 2018), healthcare professionals (N = 120, aged 25-60 years, education level bachelor's degree, working in healthcare and doing a Master-degree to become Nurse Practitioners) completed online surveys measuring social-cognitive determinants of professionals' intention and corresponding behavior of actually encouraging patient self-management.

Results:

At time 1, social-cognitive determinants accounted for 40% (p < .001) of the variance in professionals' intention to encourage patient self-management. Important correlates of intention were attitude (ß = .443, p < .001), subjective norms (ß = .201, p < .001) and perceived behavioral control (ß = .137, p < .01). With respect to the self-reported behavior of encouraging patients, social-cognitive determinants accounted for 29% (p < .001) of the variance. Intentions (ß = .311 p < .001), and barriers (ß = -.239 p < .001) were significant correlates of professionals' behavior of encouraging patients to engage in self-management. Time and organizational constraints were important barriers. The congruence between healthcare professionals' intention to encourage patients and the self-reported behavior of encouraging patients, was 39.7%. CONCLUSIONS:

In improving patient self-management, healthcare professionals' intention to encourage patients and subsequent behavior of encouraging patients is important for the improvement of patient self-management. We found that the intentions and self-reported behavior of healthcare professionals working together with patients can be predicted by social-cognitive determinants thus implying that efforts to change and strengthen the intention-behavior relationship of healthcare professionals may have beneficial effects for the self-management of patients.

Changing healthcare and the role of the NP/APN
Prevention and public health, Research, self-management

Optimizing osteoporosis care within a family practice through participatory action research

Oral Presentation393Carolien van Aalst, Medical Centre Middenpeel, ODILIAPEEL, Netherlands

Van Beuningen ZaalMon 16:00 - 17:00

Introduction

One of the CanMeds roles of the nurse practitioner is knowledge and science. Nurse practitioners fulfil a leading role in innovation in nursing and healthcare, underpinned by research and implementation of research results.

Design and methods

In a Dutch family practice with a 3.65 times higher prevalence of osteoporosis compared to the national average, participatory action research was used to optimize osteoporosis care through multidisciplinary collaboration, with special attention being paid to the role of the nurse practitioner as she is operating on the area of both care and cure.

Participative action research was chosen because it offers insight into how to reach the research objectives and the possibility to practice the required interventions. An action research group was formed with as stakeholders the general practitioner, a general practice nurse, the physiotherapist and a dietician all from the reference area of the family practice. The nurse practitioner had both the role of facilitator and stakeholder within this research.

Research findings

Participatory action research proved to be a suitable research method to reach the common goal with the unique possibility to set up interventions in a research context with as end result the osteoporosis consultation held by the nurse practitioner as an umbrella entity from which the multidisciplinary treatment is started, evaluated and adapted to the individual osteoporosis patient.

In the action research group, the intensive cooperation around the subject has led to a greater awareness of the clinical picture, the own actions around the subject and the added value of the other disciplines. All stakeholders came to the conclusion that osteoporosis care can be optimized within the family practice only through intensive multidisciplinary collaboration.

Conclusion

Participatory action research offers many possibilities for the nurse practitioner to develop within the CanMeds roles, in which she has a clear added value.

Changing healthcare and the role of the NP/APN
multidisciplinary collaboration, participatory action research, Primary care, Research

A rheumatology patientpanel: the patient is the expert, we are the specialist

Oral Presentation205Hanneke Voorneveld-Nieuwenhuis, Maasstad Hospital, Rheumatology, ROTTERDAM, Netherlands

Van Beuningen ZaalMon 16:00 - 17:00

Background: The patient perspective can improve the care and specific needs of the patient to the delivered care. Our Rheumatology department introduced the Value Based Health Care principle in order to optimize the current healthcare system. We thought to measure the value for patients we should let them participate and asked them about what is of value for them and what are there goals.

Objectives: For this reason we aimed to create a patient panel of rheumatology patients that are well informed and prepared to cooperate and participate in research, and co-design novel healthcare strategies.

Methods: Staff members were asked to nominate patients that are expected to actively participate in the panel. Patients were verbally approached and asked to participate. After mutual agreement a contract was signed were discretion was warranted, the capacity to handle confidential information was assessed and equality between members of the panel and staff was ensured.

Results: The enrolment period lasted for six months. Thereafter, meetings were organized were discussion were held on various themes such as goals and value for patients. Additionally, a focus group of rheumatoid arthritis patients was assembled to evaluate a PROMs measurement tool. Currently, our panel consists of 60 patients with all kinds of rheumatic diseases.

Our panel has been asked to participate in other (hospital-wide) programmes including the development and evaluation of a patientportal. We organize about three meetings for the whole panel every year and focus group meetings to discuss specific subjects.

Conclusions: Panel members are very open and enthusiastic. Deployment of patient participation for co-creating innovations alongside research is an asset these days to connect changes to patients perception. In real live involving patient as an expert is not an effortless action for both patients and the expert care takers, it leads to satisfaction and an effective treatment.

Patient participation
Best practice, patient participation, rheumatology, value based health care

Measuring patient and family views of processes in teams and team effectiveness

Oral Presentation206Kelley Kilpatrick, Université de Montreal, Faculty of Nursing, Canada

Van Beuningen ZaalMon 16:00 - 17:00

Introduction: Patients and families reported that the addition of nurse practitioners (NPs) to healthcare teams improved team processes including communication, decision-making, cohesion, care coordination, problem-solving, and a focus on patient and family needs (1-4). Validated instruments are needed to examine team processes from the patient/family perspective (5). The presentation will outline key findings of the validation of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire.

Methods: A cross-sectional survey was conducted. Data were collected from May to October 2016. Participants: Patients/families followed by acute or primary care teams with and without NPs were recruited in waiting rooms and using snowball technique. No response rate could be calculated. Instrument: The questionnaire included 41 items to describe the healthcare team; patient sociodemographic characteristics; team processes; and care outcomes. Analysis: We examined face, content and construct validity using known group comparisons. Tool performance was assessed using Spearman’s item-total correlations and Cronbach alpha.

Results: The questionnaire took 10 to 15 minutes to complete. Participants (n=320) reported that the questionnaire was easy to understand. Reliability indices (Cronbach alpha) for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p<0.001). Differences were noted between clinical specialties, patient education, length of follow-up, and reason of consultation. No differences were noted between French and English language respondents. Contributions: The study produced a valid and reliable instrument available in French and in English. The questionnaire provides patient-level measures of team processes that can be aggregated to the team, organizational or system level. The questionnaire has broad applications because it captures the views of patients/families in acute and primary care teams and as they transition through the healthcare system. Further testing of the questionnaire is needed with patients and families who are hospitalized, or receiving care from teams in rural areas.

Collaboration and Inter-Disciplinary Practice
Patient and family perspective, Questionnaire, Research, Team processes

The advanced practice nurse role: what is one Brazilian university’s understanding and readiness?

Oral Presentation519Andrea Sonenberg, Pace University/College of Health Professions, Graduate, PLEASANTVILLE, United States of America

Van Cappellen ZaalMon 16:00 - 17:00

Globally, disparities persist among health access and health outcomes. Nurses make up 80% of the world’s health care workforce. They are practicing under varying titles and at varying levels in different countries. In some countries, nurses are practicing at advanced levels, regardless of their formal education or license. The WHO recommends that advanced level nurses be at the forefront of health delivery systems, design, delivery, and oversight of care. Some nursing stakeholders, including several in Latin America, are indicating interest and readiness to introduce the advanced practice nurse (APN) role. The purpose of this presentation is to describe a process undertaken to promote the introduction of the APN role in Northeast, Brazil.

The process began with an invitation extended to Dr. Sonenberg to accept a visiting scholar position to introduce the APN role in the Graduate Program in Nursing at the Federal University, in Natal, Brazil. Dr Sonenberg ministered an intensive course to graduate students and professional nurses on the role of the APN. The course slides were in Portuguese. The content was presented in English by Dr. Sonenberg, with translation by Dr. Cruz Enders, faculty member. A pre- and post- survey was administered to the attendees. Thematic content analysis was used to analyze the data. Professor Sonenberg also presented the topic to professional, organizational, and governmental audiences at the University Hospital in Natal, and the Maternity Hospital located in a rural community, two hours away. The survey findings will be presented, as well as observational data of the process.

In conclusion, introducing a new professional role to an existing health care system requires cultural consideration. Sensitivity to country context and readiness are prerequisites to the discussion. Local collaborations are essential to understanding and readiness. Without engaging the audience in the conversation, progress to system change may not occur.

International developments and collaboration
Best practice, Health care access, Latin America, Primary care

Nurses in advanced roles in Finnish health care services - the views of the shop stewards

Oral Presentation471Mervi Flinkman, The Union of Health and Social Care Professionals, Branch of Societal Relations and Development, HELSINKI, Finland

Van Cappellen ZaalMon 16:00 - 17:00

Introduction: Finland is among the countries that have the longest experience in integrating advanced practice roles (NP/APNs) within the health care system. APN roles were started to be introduced from the year 2003. Legislation concerning registered nurses’ (RNs) limited right to prescribe medication came into force on 1.1.2011.

Objectives: The Union of Health and Social Care Professionals, Tehy, in collaboration with the Finnish Nurses Association, participated in many ways to the development of the RNs advanced practice roles in Finland. Tehy has done active collaboration with the different ministries, regulatory and supervisory authorities, universities and health care organizations when the legislation, regulations, recommendations and new curriculums for the RNs have been prepared. Tehy’s shop stewards play an important role when these advanced roles are implemented in the clinical practice.

Method: A cross-sectional survey study was undertaken in June 2017. The survey was sent to 239 shop stewards working in the municipal sector. Total of 42 shop stewards filled a survey questionnaire with open ended-questions, response rate was 18. Survey questionnaire was developed for this purpose and it contained 36 items. Frequency analyses were undertaken to describe the quantitative data. Content analysis was used to analyze the qualitative data.

Outcomes: Job descriptions and titles of the RNs working in advanced practice roles vary considerably between different organizations in primary care and in specialized care. RNs had received further training, but the length varied greatly. The RNs had received moderate wage increases when the demand of their job had risen.

Conclusion: The authorization, up-to-date regulation and commonly defined titles concerning the RNs advanced practice roles are needed. This is vital when Finland is preparing for the major reform of social and health services taking place in year 2020. Cooperation between many stakeholders must continue in order to succeed in this reform.

Changing healthcare and the role of the NP/APN
implementation

Clinical nursing leadership in France: a concept to develop urgently

Oral Presentation504Christophe Debout, IFITS, France

Van Cappellen ZaalMon 16:00 - 17:00

Background

Complexity and change are two central concepts in contemporary healthcare systems. Literature stress the importance of promoting nursing clinical leadership to attain positive health outcomes. Many countries throughout the world develop competencies in leadership in preregistration nursing education. Moreover, nursing leadership is a central role for advanced practice nurses.

Aim: Identify the place of leadership in the French nursing context

Methods

Documents analysis method was used to explore contemporary policies, curricula in nursing in France.

Results

No appropriate translation seems available for the word leadership in French.

The word “leadership” is not included in French policies and curricula related to nursing even in the nurse management programme. The characteristics of concept are strongly embedded in the concept of management in France. In France nurse’s social representations consider that only nurse managers can exert leadership. No literature or reference books are available in French related to nursing leadership.

Conclusion

Nursing leadership needs urgently to be developed in France. Considering the planned introduction of NP in France, this role need to be part of the definition of APN in France. Future NP need to get competencies they need to adequately exert clinical leadership in their practice.

Leadership
French context, Nursing leadership, Research, Role development

Bringing a successful post-masters DNP program internationally

Oral Presentation460Kimberly McIltrot, Johns Hopkins School of Nursing, BALTIMORE, United States of America

Van Weelde ZaalMon 16:00 - 17:00

In the United States (US), the Doctor of Nursing Practice (DNP) is now the recommended terminal degree for all advanced practice nurses (APNs), including the roles of nurse practitioner, clinical nurse specialist, nurse midwife and nurse anesthetist. In addition, many universities are developing post-Master’s DNP programs to provide this much needed organizational and systems level content to current APNs and nurse executives.

This presentation will describe the development and implementation of an Executive-style Post-Master’s DNP Program from Johns Hopkins School of Nursing to the Kingdom of Saudi Arabia (KSA). Many of the participants were active in clinical nurse specialist roles and the program saw the trialing of the first primary care nurse practitioner. Program implementation was enhanced by integrating post-master’s students enrolled domestically with the cohort of students in Saudi Arabia, as well as a close alliance with their organizational mentors at Johns Hopkins Aramco Healthcare (JHAH), to provide on-the-ground support during the conduct of their projects. With the success and graduation of 13 students, with no attrition, discussion now focuses on moving from a pilot to future program implementation in KSA in conjunction with JHAH through accreditation and formalizing local partnerships.

Education
Doctor of Nursing Practice, Education

Internationalization in the MANP curriculum: creating globally aware Dutch NP students

Oral Presentation371Lillian Maas, Rotterdam University of Applied Sciences, Institute of Healthcare, Netherlands; Koen van der Meer, Rotterdam University of Applied Sciences

Van Weelde ZaalMon 16:00 - 17:00

Introduction and Aim:

Incorporating internationalization as a tool to increase global awareness and improvement of professional English skills. Many students work in academic settings that participate in international collaboration and research with other countries and English is the language used to communicate. Internationalization is also a significant element for accreditation for universities in the Netherlands.

Methods:

Components of internationalization are incorporated quarterly in the two-year curriculum including an international experience in their second year. To measure the impact of internationalization in the curriculum, a validated questionnaire titled, “Internationalization in the MANP Curriculum” was administered as a pre-test during the first year and then as a post-test in the second year following their international experience. In addition, students completed a self-reflection following their international experience. Both the questionnaire and self-reflection report were analyzed.

Summary:

Preliminary results reveal that Internationalization in the MANP curriculum has a positive impact on students global awareness and professional English skill. Results will be outlined in detail during the presentation.

Conclusion:

Incorporating internationalization with the MANP curriculum is essential to create Dutch nurses to have greater confidence not only in their English speaking abilities but in their ability to analyze international research publications and to participate in international research and collaboration.

International developments and collaboration
Global Awareness, Internationalization, Research

Visual analysis of the direct comprehensive care domains of the NP/APN: a global comparative study

Oral Presentation414Pedro Sastre-Fullana, ICN NP/APN Research Subgroup, PALMA, Spain

Van Weelde ZaalMon 16:00 - 17:00

Introduction/ Purpose

Comparative data and emerging themes from the ICN NP/APNN Research Sub-group’s (RSG) 2014 – 2017 mapping of the NP/APN competencies from nineteen respondent countries with the Strong Model and the ICN Advanced Practice Nursing Competencies suggested the need for more comprehensive analyses using concept mapping.

Methods

Analysis of the inter-related the concepts, categories and items of the practice domains of RSG 150 page Comparative Mapping publication was undertaken using Visual Analytics (Exploratory Data Analysis) techniques.

Findings/ Discussion

The domain specific analyses suggested that Direct Comprehensive Care was clustered within 5 core elements: Care, Knowledge, Family, Patient, and Client; Education was clustered around Health Consumer, Participant, Practice, Community, Healthcare, Preceptor and Knowledge; Research clusters included Evidence, Practice and Research, Outcome and New Knowledge; and, Publication and Professional Leadership incorporated Leadership, Evaluation, Professional Context and Critique of Healthcare Policy.

Conclusion

The country specific competency domains of both NPs and APN’s are complex. Wider application of the findings from this study are limited with respect to the lack of accessibility and/or availability of formal documentation relating to NP/APN competencies from a number of countries. Further contemporary data collection and analysis is recommended.

Changing healthcare and the role of the NP/APN
NP/APN Care Domains, Research, Visual Mapping

Implementation of the engagement model

Oral Presentation575Jan Sitvast, University of Applied Sciences Utrecht, IVS MANP, UTRECHT, Netherlands

Van der Vorm ZaalMon 16:00 - 17:00

We will report on how the Engagement Model has been implemented on 9 acute wards of a mental health care hospital and how this contributed to a reduction of rates of seclusion and restraint.

We (nurses, nurse practitioners and nursing researcher working in a mental health care institute in the Netherlands) developed a vision on care that departs from the conviction that strengthening client’s resilience must play a central role in treatment and support. At the same time we acknowledged that the use of seclusion and restraint may be considered at odds with this vision. We therefore strived for minimizing seclusion and restraint. Both agendas are closely interconnected where strengthening resilience precludes the use of seclusion and restraint. The Mental Health Organization recognized in the resilience of clients an important power for recovery. The discussion focused on how to facilitate this. In the Engagement model an approach was found that matches best the strengthening of resilience, thus also contributing to the reduction of rates of seclusion and restraint. The Engagement model teaches caregivers how to engage in contact with clients in such a way that patients experience warmth, trust and hospitality. This furthers an active involvement between clients, family and caregivers. We will report on the research that has been done in the implementation and results of the Engagement Model between 2010 and 2017. The role of expert nurses in the implementation process will be described.

Innovation
, Mental health, Research, therapeutic alliance

The contribution of Italian nursing doctoral schools to the development of nursing evidence

Oral Presentation229Annamaria Bagnasco, University of Genoa, Italy

Van der Vorm ZaalMon 16:00 - 17:00

Introduction
Many institutions around the world value nursing research and understand the importance of developing of doctoral schools to prepare future generations of nurse researchers. These nurse researchers can significantly improve the quality of care. In Italy, PhD Schools of Nursing play a crucial role by contributing to nursing evidence, and advancing the quality of care by facilitating the implementation of evidence-based nursing, especially with today’s rapid technological and scientific development.

Aim
To analyse how nursing doctoral schools have contributed to the development of evidence between their establishment in 2006 and 2015.

Design
An exploratory descriptive survey.

Methods
An exploratory descriptive survey was conducted in 2016 to analyse the papers published in peer-reviewed journals by the four Italian PhD Schools of Nursing between 2006 and 2015. Additional information regarding the papers was retrieved from Web of Science.

Results
We identified 701 scientific papers. The number of papers has increased from 12 in 2006 to 110 in 2015. The majority are published in 29 journals, of which 15 have an impact factor ranging between 0.236-3.755. These results show the increasingly significant contribution of nursing doctoral programs to the production of evidence, which can be used to improve the quality of nursing and inform health policies. Nursing doctoral schools deserve a greater recognition, especially by Italian funding agencies and political institutions.

Conclusions
This study is of key importance to raise major awareness in healthcare policy makers and commissioners of the instrumental role played by PhD Schools in ensuring advanced nursing practice and better patient outcomes.

Education
Doctoral nursing educations, nursing scholarship, patient outcomes, Research

Do they care? Entrustable professional activities for nurse practitioners

Oral Presentation590Jeroen Peters, HAN University Applied Sciences, Master Advanced Nursing Practice, NIJMEGEN, Netherlands

Van der Vorm ZaalMon 16:00 - 17:00

Introduction

Entrustable professional activities (EPA’s) are professional tasks that could be entrusted to students without direct supervision. A list of such activities for nurse practitioner (NP) trainees was developed in the Netherlands in 2011 and grouped according to the CanMEDs roles. This study investigated whether these EPA’s cover the professional activities of NP’s.

Methods

In 2013 and 2016 former NP-students of the HAN University of Applied Sciences, Nijmegen, the Netherlands, were asked to participate in a questionnaire study. Questions focused on the time they spend on each EPA (never/yearly/monthly/weekly/daily) and on background characteristics.

Results

A total of 130 former students, currently working as NP, responded. Mean age was 44.5 years (SD 8.2) and mean years as NP was 3.8 years (SD 2.6). Most were female (82%), working in general health care (74%), and working 30-40 hours a week (76%). Activities most often performed (daily/weekly) concerned their role as a clinician (e.g., advise patients 97%, monitor patients’ health parameters 88%, signal threats to patients’ health 87%, take anamneses 86%) and as a communicator (e.g., develop relationships with patients 94%, discuss information with patients 95%). Activities least often performed (yearly/never) concerned their role as a clinician (e.g., certain privileged procedures 1%, certain medical-technical procedures 1%), as a leader (e.g., certain organizational tasks 3%, managing an innovation project 17%), as a scholar (e.g., publish 2% / present 10% / conduct 18% research), and as a professional (e.g., visit international conferences 8%, engage in international professional associations 9%).

Conclusion

NP’s spend most of their time on individual patient care, such as on informing, monitoring and counseling patients. They are much less engaged in activities as a leader, scholar, or professional. It is to be discussed whether NP’s should take these roles more often, and if, how this can be arranged.

Education
Clinical activities, Education, Leadership, Research

Delphi study of APNs' EBP competencies indicates consensus among EBP nurse experts in Finland

Oral Presentation390Hannele Saunders, University of Eastern Finland, Finland

Willem Burger ZaalMon 16:00 - 17:00

Aims: To establish consensus over the essential EBP competencies for practicing registered professional nurses and practicing APNs through a national Delphi study of EBP experts in Finland; to internationally validate and endorse the EBP competencies developed by Melnyk et al. (2014).

Background: Systematic implementation of EBP is essential to effectively improving the quality and consistency of care as well as patient outcomes. However, previous studies have shown that nurses do not consistently use evidence in practice. EBP competencies are essential in advancing the systematic implementation of EBP among registered professional nurses and APNs in their daily practice.

Design: A national Delphi study of Finnish nurse experts in EBP

Methods: A national Delphi panel of Finnish EBP experts in nursing was conducted at the end of 2017 to establish consensus and to internationally validate and endorse the essential EBP competencies for practicing registered professional nurses and practicing APNs developed by Melnyk et al. (2014). The electronic Delphi panel consisted of Finnish practicing registered nurses (RNs), practicing APNs, nurse leaders, and nurse teachers with expertise in EBP. The Argument Delphi -method, a version of Policy Delphi, was used to establish consensus and highlight panelists’ variety of views on the essential EBP competencies.

Results: Consensus was established in multiple Delphi rounds on the essential EBP competencies developed by Melnyk et al. (2014), with minor modifications. All EBP nurse expert groups on the Delphi panel viewed the EBP competencies as important in supporting the systematic implementation of EBP among Finnish RNs and APNs at Finnish clinical practice settings.

Conclusions: The national Delphi panel of Finnish EBP nurse experts internationally validated and endorsed the essential EBP competencies for practicing registered professional nurses and practicing APNs developed by Melnyk et al. (2014) as applicable for use in Finnish healthcare delivery settings.

Education
EBP competencies, Research

Development of diagnostic reasoning skills in a Dutch advanced nurse practitioner education program

Oral Presentation591Gabriel Roodbol, HAN University of Aplied sciences, Master Advanded Nursing Practice, NIJMEGEN, Netherlands

Willem Burger ZaalMon 16:00 - 17:00

Development of diagnostic reasoning skills in a Dutch advanced nurse practitioner education program

G.J.M. Roodbol, MScN, RN, E.R. Bossema, PhD, J.W.B. Peters, PhD

Introduction

Diagnostic reasoning is the necessary thinking process for making adequate decisions in clinical practice. A major part of our advanced nurse practitioner (ANP) education program is focused on improving this skill. For further improvement, several programmatic changes were carefully planned and applied. This study investigated whether these changes improved the diagnostic reasoning skills of our students.

Method

Students who in 2013 or 2014 started the two-year dual ANP education program at the HAN University of Applied Sciences in Nijmegen, the Netherlands, were asked to complete the Diagnostic Thinking Inventory (DTI) at the end of every semester. The DTI measures 'flexibility in thinking’ and 'structure of memory'. Repeated measures ANOVA’s were applied to examine whether ANP-students improved during the education program and one-way ANOVA’s to examine whether ANP-students differed from fourth-year medical students at the end of the education program.

(Preliminary) results

ANP-students (N=49) improved in ‘flexibility in thinking’ and ‘structure of memory’ during the education program (p=0.001). However, the two groups did not differ from each other (p=0.23 and p=0.61, respectively), despite the fact that more attention was paid to diagnostic reasoning in the second year of the education program of the 2014 cohort. Compared to medical students, ANP-students scored significantly lower at the end of the education program (p=0.01).

Discussion

ANP-students’ flexibility in thinking and structure of memory in diagnostic reasoning is less well than of medical students. More attention to diagnostic reasoning in the education program does not improve skills. We await the results of the 2015 and 2016 cohorts, for whom the clinical reasoning cycle was implemented.

Education
Diagnostic reasoning, Research

Assessing competency, belief in evidence-based practice among nursing faculty: a national study

Oral Presentation533Cindy Zellefrow, The Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare, The Ohio State University College of Nursing, COLUMBUS, United States of America

Willem Burger ZaalMon 16:00 - 17:00

Background

Nurse Practitioners (NPs) and Advanced Practice Nurses (APNs) are poised to be clinical and professional leaders who work to transform healthcare in order improve outcomes for all (1). In order to adequately prepare them for this role, nursing academicians are required to integrate EBP into nursing programs. However, in order to do so, they, too, must be competent in evidence-based practice, for they cannot teach what they themselves do not know.

Aim

This study sought to determine the current state of evidence-based practice competencies, knowledge, beliefs, and EBP integration amongst nursing faculty across the United States, as it has not been studied in nursing academicians on a national level.

Research method

A descriptive correlational study was conducted with a sample of 3700 nurse faculty from academic organizations across the United States. Data was collected using Melnyk et al (2008) tools on EBP competencies, knowledge, beliefs, teaching and integrating EBP into nursing curricula. Barriers and facilitators of EBP integration in to the curriculum was also collected.

Results

This oral presentation discusses the relationships between nurse faculty’s knowledge and beliefs about the benefits of EBP and the need to integrate it into academic curricula. It highlights the main barriers and facilitators for EBP in the United States. It also reports the knowledge gap in EBP teaching strategies.

Conclusion:

Nursing faculty need to be proficient in knowledge of EBP as they are key personnel’s involved in the development of future APNs and NPs.

Research
EBP competency, Nursing faculty, Research

Pain management and opioids crisis start the battle in the ED/Observation unit

Oral Presentation445Li Gao, University of Michigan Health System, United States of America

Zeelenberg ZaalMon 16:00 - 17:00

In the United States of America, illicit Drug use and narcotic abuse has been a long standing problem. Overdose and related death has been rising. Opioids were involved in 33,091 deaths in the United States in 2015, and opioid overdoses have quadrupled since 1999. Deaths from opioid overdoses have nearly surpassed deaths from motor vehicle accident, and deaths from heroin have exceeded those from gun violence per Center of Disease Control statistics. President Trump of united states announced narcotic crisis a public health national emergency in August 2017. This is the new war the whole nation are facing, especially the health care providers.

In our academic teaching hospitals, especially emergency department and Observation/short stay unit, we have a significant population of the patients present with various kind and level of pain, requiring immediate attention and pain relief. How to fight the epidemic of narcotic abuse yet provide patients with effective pain management, as well as recognize drug seeking behavior is challenging. Protocols for acute and chronic pain management have been developed and implemented with individualized approach and showed success in managing the pain and reduced narcotic/opioids prescribing. The health care providers, including nurse practitioners, who having narcotic prescribing authorities, were considered as one of the contributors to the opioids crisis. Now we can and are playing an important role in flighting the battle of opioids crisis, start right in the ED/observation unit.

Evidence based clinical practice/scientific research
Best practice, Emergency care, pain management

Perspectives on the added value of nurse practitioners in the outpatient clinic in The Netherlands

Oral Presentation327Enzio Boeijen, HAN University of Applied Sciences, Faculty of Health and Social Studies, NIJMEGEN, Netherlands

Zeelenberg ZaalMon 16:00 - 17:00

Introduction

Many Dutch NPs work at outpatient clinics, together with physicians and specialised nurses (SNs). Among SNs there is discussion about the added value of NPs. They believe that both professions do not differ in patientcare and that they do the same things. For positioning and educational purposes of the NP, it is crucial to gain insight in the added value of NPs in relation to SNs.

Methods

An explorative qualitative study was performed from March to June 2017. Data were collected through twelve semi-structured interviews with purposefully sampled NPs; all had a background as SN and worked several years as NP. The main study focus was the NP’s perspectives on the added competences of the NP in relation to the SN. Thematic analysis was used for data-analysis. The CanMEDs competences, as described in the nursing professional profiles, were used to compare the NPs and SNs practice.

Results

Three main themes were derived from the data and related to the CanMEDS competences: 1) leadership was the most distinctive competence regarding the added value of the NP in the outpatient clinic. For instance, NPs took more responsibility for tasks outside direct patient care in comparison with their previous position as SN. Such as organising the care chain or representing the nursing discipline in the outpatient clinic. 2) Integration of care and cure, and performing on the expert level of nursing was the most mentioned added value, and 3) NPs competence in Knowledge and Science.

Conclusion

Driven by the NPs’ competency in nursing leadership, the added value of NPs in relation to SNs is evident in integrating care and cure, acting as an expert in nursing and knowledge in science. NPs and SNs in a team must discuss the added value of both professions and how they can strengthen each other.

Collaboration and Inter-Disciplinary Practice
Nurse Practitioners, Nurse Specialists, Research

A nurse practitioner modeled patient-centered approach to chronic pain management in primary care

Oral Presentation11Glenmore Hendricks, Riverside Medical Clinic, United States of America

Zeelenberg ZaalMon 16:00 - 17:00

Introduction and aim

In the United States, it is estimated that chronic pain afflicts 100 million people and costs $650 million in treatment and lost productivity annually. Over the last 10 years, the use of long-term opioids to treat chronic pain has increased exponentially despite little clinical evidence to show their efficacy. Correspondingly, the rates of abuse, diversion, and even death have increased. In fact, the Centers for Disease Control (CDC) estimates that, in 2014, 62 deaths per day occurred because of prescription opioids. Chronic noncancer pain (CNCP) is pain lasting greater than three months, and have failed nonopioid or short-term opioid therapy. This presentation aims to discuss the effective use of nurse practitioners (NPs) in primary care to manage patients with CNCP and challenges they encounter. Principally, this will discuss current strategies undertaken in a NP-led pain management clinic.

Method Despite current data showing the number of opioids prescribed by clinicians has not decreased significantly, in the United States, two-thirds of Americans see NPs for their primary care needs. Hence, they manage many patients with CNCP who are on long-term opioid therapy. The recent expansion of scope-of-practice laws in many areas around the country or even states with the least restrictive collaborative statutes allow NPs to lead practices that focus on chronic pain management. This includes a comprehensive, interdisciplinary, and collaborative approach to delivering patient-centered care, augmented by NPs’ ability to prescribe both pharmacological and non-pharmacological therapy that will improve patients’ functionality.

Summary

When allowed to practice to the full extent of their education and training, NPs are sufficiently competent to deliver comprehensive evidence-based, patient-centered care to patients living with CNCP.

Conclusion Finally, as healthcare providers, the role of NPs has become even more critical in finding solutions to the opioid conundrum that exists in primary care.

Changing healthcare and the role of the NP/APN
Advance Practice, Best practice, Chronic Pain, Opioid Therapy, Primary care

Tuesday 28th Aug 2018

10:00 - 11:00 Parallel Sessions Round 5

Poster & Pitch

Enhancing palliative / end-of-life education for NPs/APNs

Poster & Pitch502Andrea Renwanz Boyle, Dominican University of California, Nursing, MILL VALLEY, United States of America

Arcadis Zaal corner ATue 10:00 - 11:00

Introduction: Nurse Practitioners (NPs) and Advanced Practice Nurses (APNs) across multiple specialties routinely deal with end-of-life issues for patients and their family members and friends. Health care providers are also participants in personal, family, and local communities within an interconnected, complex global culture and society.

The purpose of this poster is to describe an interdisciplinary approach to palliative/end-of-life care education in two paired courses currently developed and taught by an NP and Creative Writing Professor at a small liberal arts university in the USA. The courses explore end-of-life issues in old age, midlife, adolescence, and newborns.

Program Description: Examples of educational strategies to teach APNs palliative care/end-of-life care are described as presented in two paired courses. In the first course, literature and writing as healing arts or 'narrative medicine,' form a lens for exploration of life-and-death challenges, and serve to bridge gaps in understanding among APNs, patients, and families. Poetry, novels, essays, and memoirs are discussed as prompts for students to engage in guided creative writing and journal reflections that enhance student understanding of the complexities of end-of-life issues.

In the second course, case studies and case questions are presented to define palliative care, end of life care and quality of life issues. Physical, psychological, sociocultural, spiritual, religious, and ethical aspects of death and dying are described. Discussions are centered on individuals and families dealing with chronic, life-threatening illness or injuries, and terminal illnesses. Palliative care and quality of life issues are also explored for members of vulnerable, underserved, or under-resourced populations.

Summary/Conclusion: Educating NPs/APNs about aspects of palliative/end-of-life care is of global relevance. Use of literature, writing, case studies, and case questions as implemented by the authors can serve to enhance NP/APN education and practice worldwide.

Education
Education, End-of-Life Care

CANCELLED: Content validation of the SPEED instrument for measuring educational climate in ANP program

Poster & Pitch545Riet Janssen, Fontys, MANP, TILBURG, Netherlands

Arcadis Zaal corner ATue 10:00 - 11:00

- Introduction statement indicating purpose of presentation

MANP programs in the Netherlands train nurses to become nurse practitioner (NP). The program has a strong focus on learning in practice. Since 2009 the NP-profession and the course have been leg

Education
Educational climate, MANP, Research, SPEED

Integration of Lonergan’s functional specialties in an advanced practice health promotion course

Poster & Pitch150Mary Ellen Roberts, Seton Hall University, Graduate Department-College of Nursing, SOUTH ORANGE, United States of America

Arcadis Zaal corner ATue 10:00 - 11:00

Knowing as a process is what advanced practice nursing looks at when caring for and assessing patients. In Lonergan’s Generalized Empirical Method (GEM) the Functional specialties are a way of looking at advanced practice nursing. In Lonergan, as in nursing, it is NOT simply “taking a look at what’s there” or reporting how or what I feel about something but a 4-fold process Experience, Understanding, Judging and Deciding is utilized in the nursing process.

All of the 7 functional specialties can be utilized and are interchangeable.

This presentation will focus on the functional specialties in relation to the practice of nursing. We will look at the implantation of the General Empirical Method in an advanced practice Health Promotion course. Namely the integration of a reflective journal on spirituality, how it affects show we care for patients and the importance of spiritual care in caring for our patients. We will explore how Lonergan’s GEM utilizing the functional specialties can be a framework for the nursing profession.

Ethics and Moral Dilemmas
Advanced Practice, Lonergan, Nursing

The effects of a video-based education on women with breast cancer in Singapore

Poster & Pitch129Mabel May Leng Tan, National Cancer Centre Singapore, Department of Nursing, Singapore

Arcadis Zaal corner ATue 10:00 - 11:00

Purpose:

The purpose of this study was to evaluate the impact of an educational video among women who were newly diagnosed with breast cancer on knowledge, anxiety and satisfaction with their surgical decision.

Methods:

A pre-post-test design was used to compare outcomes of women who received standard of care that included breast care nurse counselling sessions and written materials to women who received standard of care plus a supplement educational video. Knowledge and anxiety scores were collected at baseline and two weeks post-operatively. Satisfaction with decision (SWD) on the nature of surgery was gathered two weeks after surgery.

Results:

Sixty-two subjects were recruited in a Singapore tertiary cancer center with a cohort of 32 women in the non-video group and 30 women in the video group. There was a statistically significant interaction effect of group and time (P = .008), wherein knowledge increased for both groups, although the increase was steeper for the video group. Both groups had significantly lower anxiety at post-implementation compared to pre-implementation (P<.001). There were no differences in SWD scores in both groups.

Conclusions:

Use of an additional video-based education significantly increased breast cancer knowledge levels among women in the educational video group. The nurses and healthcare professionals should focus on identifying individual’s informational needs on their surgical options to provide personalize care and transfers the necessary knowledge in empowering woman’s decision-making process on her nature of breast surgery.

Education
breast cancer, educational video, knowledge, Research, Women's health

An intervention based in education and cognitive strategies to reduce burnout in nurse anesthetists

Poster & Pitch92Brian Vells, Penn State Hershey Medical Center, Anesthesiology, HERSHEY, United States of America

Arcadis Zaal corner ATue 10:00 - 11:00

Recent literature and research provide rising evidence that burnout is a growing trend among healthcare providers in the United States and has been steadily rising over the last decade (Shanafelt, et al., 2015). The practice of anesthesia requires constant vigilance and emergent intervention; especially when caring for critically ill patients. Burnout can greatly affect a provider’s clinical performance, ability for compassion, and personal life (Weidlich and Ugarriza, 2015). In the provider, burnout can erode professionalism, influence quality, increase medical errors and promote early retirement (Shanafelt, et al., 2015). Burnout has been shown to lead to personal and family difficulties as well (Panagioti, M., Efharis, P., Bower, P., Lewith, G., Kontopantellis, E., Chew-Graham, C. Shoba, D., 2017) Turnover and absenteeism can result in a vicious cycle that induces more burnout among remaining providers and eventually more turnover (Meeusen, V., Van Dam, K., Brown-Mahoney, C., Van Zurdert, A., Knape, H, 2011). There is evidence to support that educational interventions that teach coping skills can help to reduce burnout amongst providers and nurses (Flarity, Gentry, Mesnikoff, 2013).

A proposed plan to increase awareness and knowledge regarding burnout amongst CRNAs at a level 1 trauma center through an educational program. The educational program will provide information that will help staff identify signs and symptoms of burnout and also provide some strategies to help the provider identify strategies to reduce burnout. A pretest format using the Maslach Burnout Inventory will provide baseline burnout levels. Post intervention burnout levels will be measured using the Maslach Burnout inventory one month and three months after the intervention. The project will be completed by June 2018 with data for poster presentation. It is hoped that successful interventions to reduce burnout will be measured to diminish provider burnout.

Innovation
Best practice, Burnout, Resilience, Stress

Evaluating the use of reflective analysis and peer review in a doctor of nursing practice program

Poster & Pitch29Michelle Beauchesne, Northeastern University, School of Nursing, BOSTON, United States of America

Arcadis Zaal corner ATue 10:00 - 11:00

Introduction The American Association of Colleges of Nursing (AACN) asserts that nursing requires both practice experts and nurse scientists to achieve quality patient care outcomes. Graduates of Doctor of Nursing Practice (DNP) programs, which prepare nurses at the highest level of practice inquiry, need competencies in analysis and critical appraisal to determine the best practice evidence. With the proliferation of online education formats, it remains a struggle to replicate the intimate seminar format essential to engaging students in scholarly discourse.

Purpose and Goal The purposes of this study were 1) to conduct an in-depth evaluation of the introduction to reflection and peer review as a credible pedagogy used to transform an online discussion board into an interactive group dialogue; and 2) to assess its contribution to DNP students’ competency development of analysis and critical appraisal.

Methods Freire’s student centered approach to learning is used within an online hybrid delivery format. Reflective writing is a documented means to assist students to analyze and critically appraise selected issues aimed toward accomplishing specific learning outcomes. Three DNP student cohorts (n=74, 92.5%response rate)) who completed Year 1 of study participated in a 15-minute web-based survey. The survey, consisting of five open-ended questions, focused on an in-depth reflective evaluation of the students’ experience in relation to the pedagogy of reflection and peer review. Participation was not connected to grades or credits. There is no intended follow-up.

Summary The faculty project team completed content analysis of responses to identify themes until saturation. This project was determined quality improvement by the university ethical review board.

Conclusion An analysis of strengths and weaknesses from the perspective of these students assists in curricular refinement and provides data to develop and enhance future directions in competency-based online education.

Education
critical appraisal, peer review, reflective analysis, Research

NP network oncology in The Netherlands : an example of collaboration and nurse leadership!

Poster & Pitch530Sylvia Verhage, Jeroen Bosch Hospital, Oncology, DEN BOSCH, Netherlands

Arcadis Zaal corner ETue 10:00 - 11:00

Introduction In 1998 the first Master Advanced Nursing Practice (MANP) educational program started in the Netherlands. In 2017 at 9 universities the MANP program is offered and there are about 3000 registered Nurse Practioners (NP) working in different areas of healthcare. There is no differentiation in the different workfields. Because of that NP oncology were unable to identify each other. Due to the wish and need for, role development, professionalization and networking by NP working in the same field of interest, the network NP Oncology was established in 2012 and has in 2017 500 members. This network is a part of the Dutch Oncology Nursing Society and has a board and various groups with a specific task like: media & communication, research and education. The aim of the network is the exchange of knowledge and experiences in which the main goals are: excellent patient care, improving knowledge and research.

Method The network represents the interests of the NP and focuses on three pillars: 1. Positioning and profiling: this refers to the development, monitoring and implementation of the NP profession, in terms of role development, independent professional and nursing leadership. 2. Improve knowledge, by organizing conferences and masterclasses, being involved in guideline development and stimulating research. 3. Collaboration with scientific, medical professional associations and with nurse educational programs and departments. Summery Due to the new role of the NP in healthcare and the growing groups of NP in oncology over the years a network is established. The different groups of this network are responsible to implement the goals of the network into practice.

Conclusion The network has profiled itself over the last 5 years through collaboration and nursing leadership. It is important to maintain the main goals nationwide and to explore how to achieve the same goals on international level.

Leadership
Best practice, Network

Sustainability of healthcare in Rural Nepal promoted by a Doctor of Nursing Practice

Poster & Pitch565Shelley Bloom, VA Medical System, CLEARLAKE, United States of America

Arcadis Zaal corner ETue 10:00 - 11:00

The Advanced Practice Nurse with a Doctor of Nursing practice (DNP) directs and delivers cost effective, pertinent, and effective healthcare. This is facilitated by collaborating with the community leaders and clinic staff. Continuity of collaborations leads to improvement in healthcare services if the data clearly dictates a path. Analyzing demographic data at regular intervals provides information that leads to Health posts in rural Nepal to have improved medical care.

The literature shows there a hierarchy within health post systems. Other systems to bring into decision making include funding sources and directors from outside boards. The DNP with a vision of the deliverance excellent primary care can help the participants This is especially true when directing care with a short-term medical service trek.

Healthcare resources are limited and costly. To provide cost-effective relevant care it is important to know local trends. The DNP tracked pertinent health demographic data. This data showed the current trends in healthcare

To improve the health of the local population, a method to track data is important. The collection of demographic data shows trends of healthcare. The data can bring together all people under one goal and promote sustainability of the system by local villagers.

Leadership
Best practice, Doctor of Nursing Practice, Primary care, Systems Leadership

NP’s and other providers’ perceptions of a shared decision making tool: a qualitative study

Poster & Pitch344Mary Behrens, Wyoming Center for Nursing, CASPER, United States of America

Arcadis Zaal corner ETue 10:00 - 11:00

Movement is Life (MIL) is a cross-functional collaboration of community stakeholders, domain experts and healthcare providers, which seeks to eliminate racial and ethnic disparities in muscle and joint health. In essence they are a think tank, a catalyst for change, at four levels; the patient, healthcare provider, community and policy level.

According to the World Health Organization, “Osteoarthritis is already one of the ten most disabling diseases in developed countries.” #_edn1 Current estimates state that “. . . 18.0% of women aged over 60 years have symptomatic osteoarthritis; 80% of those with osteoarthritis will have limitations in movement. . . “#_edn2 In the U..S., CDC statistics show that Latinas experience a higher severity of osteoarthritis and limitations of mobility, which leads to obesity and further accelerates arthritis.

MIL thus developed an interactive patient shared decision-making (SDM) tool that could be customized to actively engage the patient. A cost model was used to create this SDM tool, with 20 unique treatment pathways. In order to ensure its efficacy, focus groups were conducted to test the tool.

A focus group comprised of nurse practitioners, physicians and physician assistants was convened to provide feedback on the SDM tool prototype. Its aim; to gain an understanding, from a provider’s perspective, about the type of information currently shared with patients and what providers believe would work or not work. It also sought their perceptions regarding how the decision-making tool, with its treatment pathways, might best be used and optimized.

Outcomes: This provider focus group shared the tool was too confusing and complex. They said Latinos they treat are present focused and the 10-year timeframe was too abstract. Also, the providers recommended the tool be simplified and be used to engage patients to plant seeds for future discussions and treatment. Conclusion: SDM tool should be simplified.

#_ednref1

Evidence based clinical practice/scientific research
Osteoarthritis, Primary care, Research, Shared decision-making

ANP development and leadership through international networking

Poster & Pitch319Daniela Lehwaldt, Dublin City University, School of Nursing and Human Sciences, Ireland

Arcadis Zaal corner ETue 10:00 - 11:00

Introduction statement indicating purpose of presentation

Networking and exchange with other Advanced Practice Nurses (APNs) is critical for the development, enhancement and evolution of Advanced Nursing Practice (ANP) (Schober 2016). This is particularly true in Germany, where ANP & APN roles and structures are at an early stage of development (Lehwaldt and Krotsetis 2017). The purpose of this poster is to demonstrate how an international network of APNs supports the development of ANP in Germany.

Brief description of pertinent research or other methods adopted

The German Network of Advanced Practice Nursing & Advanced Nursing Practice (DN APN & ANP) is a growing network of nurses interested in developing advanced nursing practice in the German speaking countries (Germany, Switzerland and Austria). Members of the international subgroup are working around the world. They possess strong links to Germany either by being native German and working abroad or by being from abroad and interested in fostering ANP in Germany. The subgroup meets regularly via online media and in person.

Summary of new unpublished data and/or other relevant information

The subgroup’s objectives include assisting each other in one’s role development and with ongoing projects, and providing DN APN & ANP with insights into global developments through scientific contributions at conferences and expert workshops. The subgroup also supports ANP role development through exchange and international placements. The network is actively promoting the development of advanced nursing in Germany at a policy level. Excellent communication skills, commitment and creativity, but also positivity and motivation are therefore important leadership qualities.

Conclusion

The poster will provide tangible examples for international exchange, leadership and collaboration to support ANP development in Germany.

Leadership
international

Leadership of nurse practitioners in a peripheral hospital in The Northern part of The Netherlands

Poster & Pitch305Ingrid Janssen-Draaijer, Ommelander Ziekenhuis, Groningen, WINSCHOTEN, Netherlands

Arcadis Zaal corner ETue 10:00 - 11:00

 

Background

The Ommelander Hospital Groningen is situated in the north of the Netherlands. This rural area is characterized by shrinking, ageing and people with a low socioeconomic status. The increase in the complex, multidisciplinary care for chronically ill and frail elderly patients requires a comprehensive integrated care and patient involvement. Task substitution and supplementation by physician assistants (PA) and nurse practitioners (NP) can contribute to this development.

Until 2014 there were a small number of NP’s and PA’s working in the hospital and their role was not well defined and underdeveloped. In the recent years, steadily NP’s and PA’s were trained to provide patient care to patients of various specialisms. At this moment 15 NP/PA’s are employed by the hospital. This development and the visitation by the Dutch Collaboration of Nursing stimulated us to found a working group, start a project and to take leadership.

Aim of the project

Developing the role of the NP and PA in collaboration with the medical specialists. The NP and PA’s, by joining their forces in a working group, can act as transformational leaders. They can contribute to develop organisational strategies to improve and provide excellent healthcare.

 

Methods and results

To achieve this aim various approaches are used:

developing a future-proof common vision on providing excellent health careelaborating interdisciplinary communication and collaboration skills;embedding of individual talents for expertise promotion, related to the CanMEDS; as evidence-based practice, finance & strategy, education, moral deliberation sessions.Conclusion and implications.

Leadership of the NP/PA’s in the Ommelander Hospital Groningen will be developed in collaboration with the physician assistants, nurses, medical specialists, management of the hospital and external partners. At first a common vision will be developed in order to gain full support. Integrating evidence-based practice will be supported by starting Journal clubs and moral deliberations.

Leadership
Leadership, Peripheral hospital

Developing leader-mentors from bedside to management by the LEAP: Leadership-Mentor Partnership

Poster & Pitch13Maria Kidner, LocumTenens/Essentia Health Care, CT surgery, CHEYENNE, United States of America

Arcadis Zaal corner ETue 10:00 - 11:00

Purpose:

LEAP2: A Leadership Mentor Partnership is to inspire curiosity to allow people to consider and think, to mentor courage to allow people to try something new in leadership, and use mentorship to help people surpass possibilities together.

Leaders set the tone and culture for an organization and have direct impacts upon the success and future of that organization. Obtaining leadership habits required knowledge, understanding and practice.

LEAP2: A Leadership Mentor Partnership is a unique 2-course educational experience. Part 1 provides knowledge with interactive skills development on the four pillars of LEAP: Leadership, Engagement, Accountability, and Professionalism combined with development of a personal strategic plan of values, vision, and mission. Part 2 focuses on advanced leadership skills with problem solving, project design, framing questions, and leading teams to have measurable outcomes.. LEAP utilizes Patricia Benner’s nursing theory, Novice to Expert through the four LEAP pillars and three domains of leadership (relationships, critical & creative thinking, technical skills/knowledge). This program mentors each person on their quest of discovery of the leader within and subsequently enhancing professional identity and importance to self, profession, community, country and globally.

Implications

Every NP needs excellent leadership skills, a strong sense of professional identity, and habits to mentor teams and solve problems. Obtaining leadership wisdom requires study, time, practice, and contemplation of self, personal values, profession, combined with a vision of the future.

Leadership
Communication, Novice-to-Expert, Value-based leadership

Concurrent Sessions

Nurse prescribing principles and developments

Clinical WorkshopCW5Elissa Ladd, Associate Professor & Director of Global Health Programs, MGH Institute of Health Professions, BOSTON, United States of America

Van Rijckevorsel ZaalTue 10:00 - 11:00

The practice and regulatory authority for nurse prescribing is rapidly expanding around the world. Nurse prescribing is developing often in response to national exigencies in relation to workforce shortages and by the need to advance health system efficiencies. Whether functioning within or outside traditional regulatory frameworks, nurses need to have knowledge of how to access and appraise the best evidence-based information on drugs.  Levels of evidence, scientific sources of information, research funding, and industry promotions will be addressed. Further discussion will include recent regulatory developments pertaining to nurse prescribers around the world.

 

Dr. Ladd received her undergraduate degree from the University of Pennsylvania, Master of Science degree from Rush University, and PhD from the University of Massachusetts. Currently, Dr. Ladd is an Associate Professor at the MGH Institute of Health Professions (MGHIHP) in Boston and is the Director of their Global Health Programs. She also holds an appointment as Adjunct Professor at Manipal University, Manipal, India. She has practiced as a Family Nurse Practitioner in a wide array of primary care settings, both in the US and globally. She was a Fulbright Fellow in India and is currently the recipient of a US State Department/Government of India grant for capacity building around interprofessional education.

Dr. Ladd’s area of research pertains to prescribing practices of primary care providers and pharmaceutical policies. She led a national survey on prescribing behaviors of nurse practitioners and recently conducted an analysis of opioid prescribing by NPs and physicians, based on scope of practice laws. Her current work is an index of global policies that support nurse prescribing. She is one of the founding members of the MGH IHP’s Center for Climate Change, Climate Justice, and Health.

Health-care Policy
prescribing

Foundations for the future: the leadership of the AANP over the decades

Symposium409Kathy Wheeler, American Association of Nurse Practitioners (AANP), VERSAILLES, United States of America

Eduard Flipse ZaalTue 10:00 - 11:00

Introduction/Purpose

The nurse practitioner (NP) role formally began in the United States in the 1960s. Numerous professional organizations at institutional, local, state and national levels, work to improve the practice climate for nurse practitioners (NPs) so that they can provide the high quality, patient centered, cost efficient care nurse practitioners are known for. One organization, the American Association of Nurse Practitioners (AANP), is “the largest and only full service national professional membership organization for nurse practitioners of all specialties” (AANP, 2017a, para 1). AANP has been instrumental in numerous, critical policy and practice issues across the United States (AANP, 2017b; AANP, 2017c). This three-part symposium will discuss the evolution of the NP role in the United States.

Description

The first presentation will discuss the historical context of the NP role in the United States and the critical policy and practice developments that occurred along the way. The second presentation will discuss the current state of NP practice and the supply of the NP workforce. The last presentation will discuss the Consensus Model (APRN Consensus Work Group, 2008), involvement of AANP in its development, what it means and how it is being implemented in the United States.

Summary/Conclusion

This three-part symposium will illuminate the critical initiatives AANP has been involved in which have been foundational to the NP role development in the United States, specifically critical policy and practice initiatives, national NP data, and the Consensus Model. Broadly reviewing and analyzing these advancements may be useful to those involved in role development around the world.

Leadership
American Association of Nurse Practitioners, Leadership, Role

Harm reduction: engaging people who inject drugs in setting and achieving personal goals

Workshop539Kerry Nolte, University of New Hampshire, Nursing, DURHAM, United States of America

Ruys ZaalTue 10:00 - 11:00

Advanced Practice Nurses have opportunities to engage and support people who inject drugs (PWID) in setting and attaining health related goals. Approaching conversations with humility and curiosity to learn about substance use disorders and co-occuring conditions are recognized as precursors to supportive and pragmatic conversations with PWID. Accepting a person “where they are at” and respecting their goals is a successful approach that can ensure a client has true access to care. Regardless of insurance, transportation, or other barriers to care, feeling judged or condemned is a major barrier to PWID disclosing and discussing their drug use. PWID who have good rapport with their care provider are more likely to discuss their drug use, adopt provider recommendations, maintain continuity of care, and seek timely care. Each connection with a patient in any setting presents an opportunity to establish rapport, promote health, and set goals to reduce risk. Harm reduction informed practices have demonstrated success within syringe service programs (SSPs), but haven’t been widely applied across healthcare settings. Specifically, PWID who are involved in SSPs are 5 times more likely to be successful in substance use treatment and recovery, half as likely to contract HIV or Hepatitis C, and less likely to die from overdose. Goals that could be pursued range from abstinence from substances to use of safer injecting practices. Harm reduction approaches focus on reducing riskier drug use, ensuring safety of supplies, and safely disposing of syringes. Together these approaches demonstrate clear reductions in infections, cost, and accidental needlestick injuries. This session will engage attendees in collaborative learning, conversation, and case discussion to identify opportunities to engage clients in setting goals. Participants will role play a Brief Negotiated Interview, a motivational interviewing based approach used to incorporate harm reduction strategies and provide a brief intervention for PWID.

Patient participation
Addiction, Best practice, Goal Setting, Prevention and public health

The role of the NP in skin cancer care in general practice

Workshop98Maartje Spit, Huisartspraktijk Schoone, WESTERHOVEN, Netherlands

Hudig ZaalTue 10:00 - 11:00

Abstract

There is an increase in the incidence of skin cancer and this increase will continue the next years. Nurse practitioners (NP) in general practice can fulfil a prominent role in the diagnosis and treatment of skin cancer. In 2017 a guideline was introduced in the Netherlands by the Dutch GP's society. Currently this guideline is implemented to improve skin cancer policy in primary care. The goal of the workshop is to show NP's in Europe how skin cancer care in general practice can be addressed. This is done by showing diagnostic and therapeutic options by means of naked eye examination, dermoscopy of suspected skin lesions, cryotherapy, biopsy and topical treatment with chemotherapy (fluorouracil cream). Besides these aspect's the NP plays an important role in education, collaboration and management. This workshop is meant for NP's who consider to develop (more) skills in dermato oncology in general practice.

Learning objectives

The NP knows which treatment options can be applied in general practice and how to apply these treatments.

The NP learns how to perform a diagnostic punch biopsy in a suspected skin lesion.

The NP knows the indication and mechanism of action of topical chemotherapy.

The NP gains insight in the different CANMED roles that can be applied in skin cancer care.

Changing healthcare and the role of the NP/APN
dermato oncology, Primary care, skin cancer

Designing objective structured clinical exams (OSCE) for assessing APN clinical competency

Workshop121Gail Johnson, University of Washington School of Nursing, Department of Psychosocial and Community Health, SEATTLE, WA, United States of America

Schadee ZaalTue 10:00 - 11:00

The Objective Structured Clinical Exam (OSCE) has been widely recognized as a valuable assessment tool in evaluating clinical competencies. As a standardized performance based tool, it helps to assure safe practice for entry-level advanced practice nursing (APN) students, prior to starting their first clinical rotation. Direct observation in clinical simulations provides many opportunities for assessment and learning. Validity and reliability of the OSCE is dependent on well-designed content, structure and implementation. The purpose of this workshop is to enable participants to design an OSCE case for assessing APN clinical competency in an interactive, hands-on format.

The OSCE can be used formatively, helping students progress in their skills related to clinical care. It has been shown to have added value for active learning from a student perspective. It can also be used in a summative way to evaluate clinical competencies at various milestones in a program or at the end of a program prior to licensure. Validity is increased with the inclusion of realistic tasks and the assessment of specific domains. Reliability is increased with standardized scoring rubrics and trained examiners.

The workshop will take participants through the steps of designing an OSCE for learning and evaluation of clinical competence. These steps include defining the purpose of the exam, developing candidate instructions, examiner instructions and scoring instruments, case related content and information for the standardized patient and trainer.

Best practices will be emphasized, including a focus on clinical practice directly related to the delivery of safe patient-centered care, evaluation with a standardized checklist to enhance rigor and reliability, and mastery of desired knowledge and skill.

Education
APN education, Best practice, clinical practice, OSCE, Primary care

Empowering Nurse Practitioners for Business Ownership: Creating Change, Advancing Healthcare

Oral Presentation618Jean Aertker, Gail Sadler, Tampa Occupational Health and Wellness, TAMPA, United States of America

Jurriaanse ZaalTue 10:00 - 11:00

Since launching the first and only free NP business support group in 2010, the Association of Nurse Practitioners in Business (ANPB) has assisted thousands of NPs to explore the unconventional path into advanced practice business ownership. The impetus for the start-up was to help organize an efficient way to answer all the impromptu phone calls and inquiries from novice to expert NPs looking for a new career path and respond to established practice inquires as well. The organization began to build stakeholders early on from the growing pool of successful NP business owners around the nation who were willing to mentor, guide and refer when appropriate. The goal was simply to promote and support Nurse Practitioners in business by building relationships and links to keep connected by primarily by social mentorship focusing on all things related to their NP business. Education topics provided range from how to start up a business, to creating a sustainable business and developing a transitional plan to retire “in-practice” but not from NP practice! Examples of a variety of unique and creative NP practice models will be featured in short video segment interviews showcasing NP business owners who made the leap to independence. The presenters for this oral presentation are the founder and senior founding board member who maintain the website and provide the creativity for building the association of NP business owners who support one another. This presentation is an update to the first ANPB presentation to ICN London in 2012 and both are successful business owners with over 46 combined years of business acumen. ¬¬¬¬The success we measure is when we are able to assist a fellow NP meet their entrepreneurial goals and connect with our growing and extensive network of colleagues sharing resources to help the NP navigate their journey to success.

Innovation
Business Ownership,

Successful leadership and advocacy to optimize advanced practice nursing roles

Oral Presentation405Josette Roussel, Canadian Nurses Association, Policy Advocacy and Strategy, OTTAWA, Canada

Jurriaanse ZaalTue 10:00 - 11:00

Nurse practitioners (NPs) are providing high-quality care and increasing access to health care for many Canadians. The nearly 5,000 NPs in Canada are working in multidisciplinary care teams and providing primary care for over 3,000,000 Canadians.

Since the introduction of NPs, many provincial, territorial and federal laws have gradually been modernized to recognize and list NPs as professionals eligible to provide a range of health services. These successes have allowed NPs to officially sign off on a range of legal and administrative documents which verify that they have examined or treated a patient and assessed a patient’s eligibility for a federal program. Despite progress, numerous federal laws still require updating. Without these changes, barriers in access to care persist for many Canadians.

This presentation will explore Canadian Nurses Association (CNA) leadership and advocacy efforts to remove existing federal legislative and policy barriers to reflect the full abilities and potential of NPs.

CNA’s advocacy efforts have succeeded in comprehensively addressing federal barriers to NP practice. Recent accomplishments include a high-level of awareness among federal politicians and policy-makers as well as changes to laws and policies. NPs are now recognized as health-care professionals authorized to sign claim forms for federally administered program benefits such as the Disability Tax Credit Certificate, employment insurance and the Canada Pension Plan. CNA leadership and stakeholder collaboration have been essential to achieving this level of progress. For our health-care system to be truly accessible for all Canadians, health-care professionals must be permitted to treat patients to the full extent of their qualifications. Removing these barriers reduces health-care costs by eliminating the duplication of services and improving patient-centred approaches and access to care.

Leadership
advocacy, Best practice

The need for collaboration and clinical leadership in mental health care

Oral Presentation479Riet van Dommelen, University of applied sciences Utrecht, UTRECHT, Netherlands

Jurriaanse ZaalTue 10:00 - 11:00

Tackling the challenge of maintaining a healthcare system with good care and affordable costs we will need more shared decisions making, co-creation, and selfmanagement. These will be important concepts of the next decade within the healthcare system. To obtain this, collaboration is necessary, between the healthcare professional and the patient, between the healthcare professional and the family and informal networks around the patient, between healthcare professionals with various backgrounds, and between institutes. Nurse practitioners, advanced nurses are the linking pin between afore mentioned themes. They not only have the necessary liaison skills, but the have the skills to take the lead.

In this session I will report on the achievements of the implementation of the nurse practitioners in the Dutch healthcare system and describe the good progress that has been made in terms of role-development and positioning of the nurse practictioner in relation to the issues mentioned above. I will focus on mental health care and discuss what contribution the nurse practitioners can have in primary care and community care where we face the challenge to connect the health services with the social domain. It is not only the case in the Netherlands but also elsewhere in the world.

Leadership
clinical leadership, Mental health

Findings from the third Australian nurse practitioners national prescribing survey

Oral Presentation110Andrew Cashin, Southern Cross University, East Ballina, Thomas Buckley, University of Sydney, Nursing, Jacqui Fong, Univerity of Sydney, Julianne Bryce, Australian Nursing and Midwifery Federation, Melbourne, Australia

Mees ZaalTue 10:00 - 11:00

All Australian Nurse Practitioners are authorised to prescribe medications and prescribing behaviour is incorporated in the national standards for practice (Cashin et al 2015). This presentation presents findings from the 2017 Australian Nurse Practitioner prescribing survey. An online survey was conducted open to all Australian Nurse Practitioners who prescribe medications as part of their role. The findings of what are the most frequently prescribed medications, models of prescribing, elements of prescriber confidence and influences on prescriber behaviour are presented. This study builds on the findings of surveys conducted in 2007 and 2010 (Cashin et al 2009; Buckley et al, 2013). It is concluded that Nurse Practitioner prescribing behaviour continues to evolve in Australia and that Nurse Practitioners are promoting access to medications for the Australian population through their quality use of medicines.

Research
medicines, prescribing, prescribing confidence, Research

The evolutionary stages of prescriptive authority: empirical and normative considerations

Oral Presentation93Tracy Klein, Washington State University, College of Nursing, VANCOUVER, United States of America

Mees ZaalTue 10:00 - 11:00

This presentation traces a timeline of the historical evolution of prescriptive authority and its implementation in the US to illustrate empirical and normative assumptions that may impact the goal of plenary authority. Its purpose is to share knowledge with countries where this authority is emerging.

Methods will include presentation and discussion of the author’s own research, regulatory experience and publications regarding prescribing competencies and preparation for prescribing transition and implementation of legislative changes (Klein & Kaplan, 2010; Klein, 2011; Klein 2012; Klein 2015; Klein et al 2016; Wainwright et al 2016; Panther et al 2017) as well as presentation and discussion of an evolutionary timeline to plenary authority with exemplars of common points of conflict and potential resolution. The presenter's experience includes the regulatory development of state, US national, and international (Canadian) prescriptive authority for nurse practitioners, as well as clinical nurse specialists.

Examples of transitional issues include whether the transition is restrictive, limiting or full, and the existing role of the registered nurse in contrast to the advanced practice nurse. Complicating issues in the development and evolution of prescriptive authority include the impact of ethical issues related to the assumption of the role such as decision-making and authority regarding pain management, substance used disorder, mental health disorders, and cannabis as well as relational issues such as the provision of medications for family, friends, or colleagues.

The presenter will use discussion, case analysis, exemplars and visual tools to describe, analyze and present useful areas of policy development related to prescribing and prescriptive authority to engage the audience in potential application to their own context.

Health-care Policy
Advanced Practice Nurses, Health Policy, Prescriptive Authority, Primary care

Improving medication management on CKD patients stage 4-5

Oral Presentation6Maaike Hengst, Catharina Ziekenhuis Eindhoven, Nephrology, EINDHOVEN, Netherlands

Mees ZaalTue 10:00 - 11:00

The project was funded by the Dutch Kidney Foundation in 2012

Patients with chronic kidney disease stage 4 or 5 (CKD 4-5) have an increased risk of hospitalisation due to adverse effects of the prescribed medication or interaction of medication due to polypharmacy (1). In the Catharina Hospital we developed the self-assessment medication tool.

As every person has his own abilities and barriers regarding self-care/management we aim to optimize medication management and education in the fragile CKD 4-5 patient population. Therefore we developed the BMN questionnaire for use in CKD 4-5 patients, to identify which patients are independent in managing and using their medication and, if necessary, in which patients additional care is needed to optimize their medication usage. As support we started an educational program on patient safety on medication use for hemodialysis nurses and hemodialysis patients and CKD 4-5 patients not on hemodialysis.

This tool aims to achieve a correct medication management and usage in hemodialysis and CKD 4 patient population. Secondary this tool was made to help health care professionals involved in the care of this fragile patient population defining the right amount and type of support needed by an individual patient.

With validation and education of health care professionals of all levels in this hospital, we created a more safe medication environment for the fragile CKD 4-5 patient population.

Further fine tuning of the BMN and further education of health care professionals will create awareness about the dangers of prescribed medication in CKD 4-5 patients, with regard to adverse drug events, renal damage due to high dosages, and interactions due to polypharmacy.

The developed materials are ready to be used by all Dutch dialysis centres in for now.

Innovation
Best practice, CKD patients stage 4-5, self-care/management, validation and education of health care profession

Evaluation of a compression vest for symptomatic breast/chest wall edema in breast cancer patients

Oral Presentation399Marieke Traa - van de Grootevheen, University Medical Center Utrecht, Rehabilitation, SOEST, Netherlands

Plate ZaalTue 10:00 - 11:00

BACKGROUND Breast and chest wall edema is a complication of breast cancer treatment, resulting in pain and physical impairment, impacting quality-of-life. Current therapy consists of lymph drainage and taping. We examined the effect of a compression vest in breast cancer patients with breast/chest wall edema on pain, degree of breast edema, health related quality-of- life (HrQOL) and experiences of wearing the vest.

METHODS This mixed-method study was conducted in the UMC Utrecht including breast cancer patients with symptomatic breast/chest wall edema. Patients were instructed to wear a compression vest (Thuasne®), underwent physical examination and filled in questionnaires at baseline, 1, 3 and 6 months. Breast edema degree was scored. HrQOL was assessed and differences in pain and swelling were tested using Wilcoxon signed rank-test. Twelve patients were qualitatively interviewed twice (1 and 3 months) about their experiences of wearing the vest.

RESULTS Twenty-five patients were enrolled. At baseline 37% (n=9) reported mild pain, 64% (n=15) of the patients reported moderate to severe pain breast/chest wall pain, which was significant lower at two weeks (36%, n=8). At 1 month moderate/severe pain was reported by 28% (n=7). Prevalence of patient-reported breast/chest swelling reduced: 48% at baseline, to 27% at 2 weeks and 28% at 1 month and increased at 3 months to 32%. A decrease in swelling was reported by eleven patients at one month compared to baseline. Physician reported edema was comparable at baseline, month 1 and 3. HrQOL was similar at all time-points. Facilitators and barriers were within physical, emotional, cosmetic, self-management and motivational domains.

CONCLUSION A compression vest in breast cancer patients with symptomatic breast/chest wall edema can be effective, reducing patient reported breast/chest wall swelling and pain within one month. Patients appreciate tailored vests, possibilities for different models and colors, which affects using it.

Evidence based clinical practice/scientific research
breast cancer, edema, Research, selfmanagement

Intravenous immunoglobulin therapy for small fiber neuropathy: a RCT on efficacy and safety

Oral Presentation95Margot Geerts, Maastricht University Medical Center, Neurology, MAASTRICHT, Netherlands

Plate ZaalTue 10:00 - 11:00

Introduction:

The purpose of this presentation is to show the possible role of a Nurse Practitioner (NP) in clinical research. With an NP with 8 years’ experience in neuropathic pain treatment, the nurse-led study intravenous immunoglobulin therapy (IVIg) in patients with SFN (IVIG-SFN study) was performed.

Description:

Neuropathic pain has major consequences for the patient’s functioning and quality of life (Qol), with restriction in daily and social activities, depression, sleep disturbances, and anxiety. SFN is the most common cause of neuropathic pain in peripheral neuropathies. Treatment of neuropathic pain can be a clinical challenge given the limited efficacy of current pharmacotherapy. In a substantial number of patients (24-93%) but no underlying cause of SFN can be identified, known as idiopathic SFN (I-SFN). Treatment IVIg has proven to be efficacious in other immune-mediated neuropathies.

Summary:

A RCT in 60 patients with I-SFN was performed. Patients were randomized to start with IVIg or placebo. Pain medication was only allowed in stable dosages for at least 30 days prior to randomization. Treatment success was = 1-point improvement on the PI-NRS during 12 weeks treatment compared to baseline. Secondary endpoints were autonomic symptoms, sleep interference, and Qol. Patients achieved study medication in 4 courses of treatment with 3 weeks apart. Patients filled in a pain diary twice weekly. A set of validated questionnaires on autonomic symptoms, sleep interference, and Qol were filled in at multiple study visits. All patients were followed up during 3 months after end of treatment.

Conclusion:

This is the first RCT with IVIg in patients with I-SFN. Positive findings will result in a new treatment option for I-SFN and support an immunological role in this condition. More clinical research led by advanced NPs is needed to support high-quality and safe treatment with neuropathic pain medication in chronic pain management.

Research
intravenous immunoglobulin therapy, randomized placebo controlled study, Research, small fiber neuropathy

Steps towards a fully integrated electronic blood transfusion system: role of the APN hemovigilance

Oral Presentation192Els Costermans, University Hospitals Leuven (Belgium), Haemovigilance, LEUVEN, Belgium

Plate ZaalTue 10:00 - 11:00

Introduction

The role of the APN Hemovigilance at the University Hospitals of Leuven is to optimise blood transfusion safety for patients and to rationalise the use of blood components. We noticed problems as the prescription and scanning of blood components were not integrated in the Electronic Medication Prescription (EMP) unlike all other medication. This resulted in additional administrative work for doctors and nurses. The APN made efforts to optimize the electronical prescription and administration of blood transfusion.

Description

After exploring literature and legislation on blood transfusion, the APN developed templates for the electronic prescription of blood components in cooperation with doctors and ICT. This resulted in an new versio of the EMP and nurses were now able to scan the administration of blood in the EMP.

The APN operated as leader for this project, building bridges between the medical staff, nurses and ICT.

After a test period the innovations were implemented on a pilot ward. Doctors and nurses were invited for active participation and received the necessary support from the APN. Finally the entire hospital implemented the new procedure.

Medical staff was informed by e-mail and by an instruction movie. Nurses were guided through multiple education sessions, instruction posters and movies.

Summary

As a result of linking the blood component administration to the EMP, we noticed a better scanning of blood components by nurses. The medical staff found the templates easy to use. Although it initially looked as a small improvement, it meant a substantial gain in time for the APN, who performs corrective actions. It also resulted in improved patient safety and a better invoicing of blood components.

Conclusion

Although it took time to develop this electronical system, the implementation went smoothly thanks to the planning and support by the APN, stimulating the participation of nurses, doctors and ICT.

Innovation
Best practice, blood transfusion, Critical/ acute care, hemovigilance, implementation project

Implementation barriers and facilitators of clinical nurse specialist/specialized nurses in oncology

Oral Presentation174Ann van Hecke, Ghent University, University Centre for Nursing and Midwifery, GHENT, Belgium

Van Beuningen ZaalTue 10:00 - 11:00

IntroductionAdvanced practice nursing roles are increasingly implemented internationally due to growing evidence about their contribution to health care. However, frameworks show that role implementation is complex. The identification of barriers and facilitators is a vital step in the implementation process. The purpose of this study is an in-depth exploration of barriers and facilitators for role implementation as experienced by clinical nurse specialists (CNSs) and specialized nurses (SNs) in oncology.

Method15 semi-structured individual interviews were conducted with CNSs and SNs in Flanders (Belgium). Participants from various oncology sub-specialties in university and peripheral hospitals were included through purposive sampling (December 2016-July 2017). Interviews were analysed using the constant comparative method based on a grounded theory approach.

Summary of resultsFindings revealed that CNSs and SNs experienced role implementation as a lonely and lengthy pursuit. They looked for partners in doctors, middle managers, head nurses, and ward nurses as catalysts for role implementation. Participants also looked for acknowledgement of their position and expertise from healthcare professionals and patients. The lonely pursuit was emphasized by the solitary position of CNSs and SNs in the multidisciplinary team. In addition, role confusion, a high workload and feeling financially undervalued contributed to the lonely position. Participants voiced the need for a respected and experienced coach in a similar position to guide role development and implementation. Vigilance regarding the job content and nursing focus of the role, proving the added value and increasing the visibility of the position were perceived as important strategies for role acceptance.

ConclusionThe implementation of CNS and SN roles is a lonely quest for support and acknowledgement. Results of this study could assist the development of strategies for successful CNS and SN role implementation, which could prevent CNSs and SNs from feeling powerless and alone and increase job satisfaction.

Health-care Policy
Advanced Practice Nursing, Oncology, Research

Health professionals' dealing with hope in palliative patients with cancer, an explorative study

Oral Presentation240Corine Nierop- van Baalen, Haaglanden MC, Oncology, Netherlands

Van Beuningen ZaalTue 10:00 - 11:00

Purpose: Hope is important for individuals with cancer in palliative care. Health professionals' perspective on hope affects the communication with palliative patients. The aim of this study is to explore how Dutch health professionals deal with palliative patients with cancer who hope for prolongation of life.

Method: Focus group discussions (FGD) were conducted. An interpretive description approach was used to understand the interpretation of and reaction to hopefulness in palliative patients with cancer by health professionals. Three FGD's were held, each consisting of five to ten health professionals working with palliative patients recruited in a general Dutch hospital and homecare organization.

Results: The ways in which the participating health professionals interpret hope in palliative individuals with cancer and their behaviour towards these hopeful palliative patients are shaped by their reliance on their own normative ideas. Patients' hopefulness generally violates these norms and is, therefore, considered a problem that requires intervention.

Conclusions: Hope that does not correspond with the medical facts is experienced as problematic by Dutch health professionals who therefore believe they should intervene and do something about it. Health professionals are challenged to face and address patients’ and families’ perceptions of hope, especially when those perceptions might differ from their own as professionals.

Evidence based clinical practice/scientific research
hope cancer health professionals palliative care, qualitative research, Research

Development of screening criteria for medical and nursing apps for educational purposes

Oral Presentation611Ercolie Bossema, HAN University Applied Sciences, Master Advanced Nursing Practice, NIJMEGEN, Netherlands

Van Cappellen ZaalTue 10:00 - 11:00

Introduction:

Education in the coming decade strives to make its education less place and time- dependent and also to provide students with up-to-date knowledge and skills during theoretical education and practical learning. In recent years, many medical and nursing apps have been developed. Due to the lack of unambiguous criteria and the large amount of apps, it is very difficult to select high-quality apps. The purpose of this research is to establish criteria on the basis of which teachers can assess and select medical and / or nursing apps for educational purposes

Method:

Initially, a systematic-literature-review was performed in order to identify (inter)national criteria which are currently used to assess medical-apps. These criteria have been supplemented with criteria that have been developed by care-related organizations for medical-app assessments. In the next phase we asked experts (n=21), by means of a Delphi procedure, to classify and supplement these criteria. In the second Delphi round we asked them to score the relevance of these criteria on a 1-10 scale. In the third round we reduced the number of criteria by asking the experts which of the criteria could be aggregated. In the last round we conducted focus group discussions to gain consensus.

Results:

On the basis of the literature-review, the criteria of care-related organizations, and after complementation of the experts, a list of 108 criteria was gained. After ranking of these criteria, 42 remained with a median score of 8. After aggregation and the focus group meeting, we gained a list with 19 criteria: these can be divided in Functionality (n = 6), Description of the app (n = 4), quality of content (n = 3), design (n = 2), privacy (n = 3) and potential risk of interest (n = 1).

Conclusion:

This research has yielded a list of useful criteria.

Education
app, Research

Innovation of information provision: a project for the nurse practitioner

Oral Presentation274Sylia Hofland, The University Medical Center, Centrum voor Voortplantingsgeneeskunde, GRONINGEN, Netherlands

Van Cappellen ZaalTue 10:00 - 11:00

Introduction:

During the patients fertility journey patients need reliable information about this journey. It is the responsibility of the nurse practitioner to constantly innovate and improve the communication between health professionals and patients.

Background:

In our fertility clinic patient receive their information about fertility examinations and treatments through oral information, web site and leaflets. Patient satisfaction inquiries and patient interviews showed that patients are not content with our information provision; they still had many questions about which they called us.

Summary of new unpublished data and/or other relevant information:

The nurse practitioner took the lead in innovating and improving the information provision.

First she designed a clear and basic information card for patients that described how and where the information is provided and can be found. In addition, FAQs are inventoried and the answers are being published on the web site. The answers are based on scientific research, evidence-based guidelines and protocols applicable within the fertility clinic.

She was leading this project because:

The nurse practitioner is trained to set up and evaluated health information and research.

The nurse practitioner is able to give patient-centred care and takes into account medical and nursing problems.

Because of the way the nurse practitioner is trained, she knows how to cooperate with all the members of the team.

Conclusion:

To optimise information provision for patients is a task requiring various skills central to the nurse practitioner and therefore she is the appropriate person to lead this project.

Innovation
Information provision, Innovation, Women's health

Patient centered care in the digital age

Oral Presentation561Mitra Rangarajan, Lifebridge Health, Medicine/Gastroenterology, United States of America

Van Cappellen ZaalTue 10:00 - 11:00

Purpose:

The purpose of this symposium is to provide the current research data on patient centered care in digital age. Provide a framework and tools to participants to engage patient in their healthcare and improve outcomes.

Methodology:

A literature search was conducted using PubMed, Cochrane Review, CINHAL, Ovid, WHO/Europe, and European Health for All Family Database and MeSh Database. Additional articles were extracted from open access journals, European and the Library of Congress (USA). Inclusion criteria were systematic review, meta-analysis, retrospective studies, qualitative studies, and experimental studies. Out of 24000 articles, 100 articles met the inclusion criteria. A summary table was created to rate the strength of the evidence in 100 articles. At least 70 articles were level III, IV and V, strength of evidence ranged between A and B. The other 30% of the articles were level I and II with strength of evidence ranged between A, B and C.

Summary:

Internet based technologies such as patient portals and personal health records are rapidly viewed as key to patient engagement, patient centered care and patient-provider communication. There are at least five key elements that drive patient engagement in this information age and they are: Patient education, comprehensive data, patient safety/security, transparency and round the clock access. While innovation in e-health technologies is rapidly transforming the way we deliver healthcare, communicate with patients and peers, improve digital access to various types of healthcare, connectivity barriers will inevitably create a digital divide due to connectivity barriers for low income, elderly and rural patients. Patients with low education may lack the skill to digitally engage in their healthcare.

Conclusion:

Despite these shortcomings, technology will continue to transform the way we deliver care and will become the most important tool in this 21st century to empower patients to take charge of their health.

Patient participation
Best practice, Care, Digital

Comprehensive care provided by the different specialisms of nurse practitioners in The Netherlands

Oral Presentation318Arnout Uitewaal, Council for Nurse Specialists V&VN, UTRECHT, Netherlands

Van Weelde ZaalTue 10:00 - 11:00

Aim

To compare the developments in the profession of the certified nurse specialist to those in the profession of nurse practitioners in other countries.

Content

At the start of registration in 2008, the profession was categorized into five specialisms. Even though registration in one of the specialisms has legal consequences, the registered-specialism is rarely used as a ‘title’ to describe one’s expertise. Instead, the commonly used categorization is based on the medical field (e.g. cardiology, psychiatry) in which the nurse specialist provides care. Therefore, a re-evaluation of the specialisms has been undertaken, with the outcome to reduce it to two specialisms: general healthcare and mental healthcare.

The choice for five specialisms, was motivated by developments in the Dutch healthcare system; rising costs, an aging population, a higher burden on specialized care and the subsequent need to partially transfer tasks, traditionally reserved for doctors, to other professionals. By bundling different fields, it was possible to bundle educational programs. Aim was to move away from narrow-thinking and to break down barriers between different fields, to provide more comprehensive care. This led to four somatic specialisms (preventative care, acute care, intensive care and chronic care) and a fifth specialism in mental healthcare. The clustering in specialisms was meant to provide focus for the development of nursing expertise within that category of care.

Stakeholders, especially nurse specialists themselves, prefer a new categorization into two specialisms, since this would provide them with the necessary leeway to further develop their profession, while at the same time providing sufficient demarcation (i.e. general vs. mental healthcare).

Method

First, the chairman will provide an introductory presentation on the developments in the profession of the nurse specialist. Afterwards, a discussion with the audience on the differences and/or parallels in the profession of the Nurse Practitioner in other countries.

Changing healthcare and the role of the NP/APN
Developement, Position, Role

Mentoring faculty in a newly developed advanced practice program in Hungary

Oral Presentation254Mary Steinke, TL Care Corporation, United States of America

Van Weelde ZaalTue 10:00 - 11:00

The proposed presentation will outline the development process in the ongoing mentoring between the ICN APNN practice subcommittee and faculty for the emerging advanced practice role in Hungary. The Subcommittee was approached by Hungarian advanced practice nurse advocate to help guide the education and role development for the first advanced practice nurse role in the country. The goal of the project is to facilitate the development of nurse practitioner faculty, contribute to the development of curriculum, national practice and policy drawing on the commitment and diverse multinational expertise of the committee.

There are currently no guidelines available for comprehensive multinational mentoring of advance practice nurse faculty. The subcommittee took the opportunity to provide guidance to shape the advanced practice education and practice and influence a nationally emerging role. The first phase of the project was the development of mentoring model to be tested. Outcomes related to the formal mentoring process will be assessed using pre and post-test as well as qualitatively with mentor and mentee focus groups and key stakeholder interviews. Perceptions of student competency outcomes and policy level implications will be thematically explored.

The mentoring model will be detailed and initial outcomes will be presented. The outcomes will be relevant to advance practice nurses who are interested in developing or enhancing the skills and scope of their mentoring.

Conclusion

A comprehensive mentoring model to facilitate the development of a national advance nurse practitioner role will have a significant impact in Hungary. The mentoring model may also provide assistance to other countries considering developing an advance practice role encouraging early engagement with the ICN APNN

International developments and collaboration
Best practice, faculty, mentoring, Primary care

Advanced critical care practitioner- a new role and new challenges

Oral Presentation325Gerry dr Lee, King's College London, Adult Nursing, LONDON, United Kingdom

Van Weelde ZaalTue 10:00 - 11:00

There is unprecedented demand on healthcare services with an ageing population and many patients with multiple comorbidities. With a chronic shortage of doctors in intensive care, alternative roles are being explored. In the UK, one of these is the role of the Advanced Critical Care Practitioner (ACCP). The ACCP Curriculum was developed by the Faculty of Intensive Care Medicine and is used to provide a structured programme of training. The ACCP programme consists of academic and clinical components.

The aim of this paper is to outline how the programme was developed and delivered in terms of educational and clinical components and how we addressed the clinical and academic learning needs of the ACCP trainees in a major London critical care unit using the FICM structured programme and related competencies.

The ACCP trainees have undertaken and completed the required Direct Observation of Procedural Skills, Acute Care Assessment Tool, Case-based Discussions, ICM Mini-Clinical Evaluation Exercise, Multi-Source Feedback and an Expanded Case Summary. Both trainees have had their logbooks reviewed and have demonstrated their clinical activities, patient involvement, practical procedures and critical incidents as well as a summary of all formal teaching sessions and courses attended.

This new ACCP role requires close collaboration between the clinical workplace and the university in developing this demanding advanced practice role and ensuring quality assurance mechanisms are in place, set training standards, ensure adequate supervisory requirements are in place and clear role descriptions are available.

The ACCP posiiton is a new advanced practice role in the UK that offers opportunities to fill gaps in the medical workforce, improve clinical continuity, provide mentoring and training for non-medical staff as well as offering a rewarding clinical role.

Education
Best practice, critical care, Critical/ acute care

International nurses society on addictions: addressing substance use as a global health risk

Oral Presentation398Stephen Strobbe, University of Michigan School of Nursing, Health Behavior and Biological Sciences, ANN ARBOR, United States of America

Van der Vorm ZaalTue 10:00 - 11:00

Introduction: The purpose of this presentation is to increase awareness of substance use as a worldwide health risk, and to introduce the International Nurses Society on Addictions (IntNSA) as a “global leader in addictions nursing.”

Methods: The prevalence and consequences of alcohol, tobacco, and other drug use will be presented, citing data from the World Health Organization (WHO). Opportunities for all nurses to assume more active roles, and to have a positive impact on prevention, intervention, treatment, and recovery, will be explored. IntNSA will be introduced as a non-profit, volunteer, specialty nursing organization, with roots reaching back to 1975. Its mission is to “advance excellence in nursing care for the prevention and treatment of addictions for diverse populations through advocacy, collaboration, education, research, and policy development.” Various assets, recent activities, and plans will be shared.

Summary: Coinciding with the launch of the European Region of IntNSA at the 10th ICN Nurse Practitioner / Advanced Practice Nursing Conference in Rotterdam, this specialty nursing organization is now poised to reach its full potential as a global leader in addictions nursing, by helping to create communities of nurses to address substance use in their local practices, and global regions.

Conclusion: Problematic substance use is a global health risk. Nurses around the world are ideally situated to address this challenge. The International Nurses Society on Addictions is in a position to assist in these efforts.

International developments and collaboration
Addiction, Nursing

Insomnia and substance use disorders: an evidence based clinical treatment

Oral Presentation347Koos de Koning, Brijder Verslavingszorg, Kliniek Alkmaar, HEILOO, Netherlands

Van der Vorm ZaalTue 10:00 - 11:00

Up to ninety percent of clients withdrawing from substance use suffer from insomnia. The evidence for treatment of insomnia in this population is well known, though not based on evidence based practice and not aimed at recovery. Descriptions of treatment in addiction clinics are lacking. This oral presentation highlights a treatment of insomnia which includes these elements, aimed at inpatients in addiction care.

After a thorough problem analysis (literature study and survey -n=47-) a practical study of mixed design collected descriptions of the treatment of insomnia. Five experts commented on the possible introduction of such treatment. These data resulted in a proposed treatment. Therapists and clients commented on this proposal in six interviews, four of them in a group. Qualitative analysis resulted in a treatment design.

Treatment of insomnia consists of the following steps:

- pre- and posttreatment information,

- diagnostics,

- treatment of underlying causes,

- a one group session cognitive behavioural therapy for insomnia, supported by

- recovery and the clinic’s treatment programme,

- pharmacotherapy in crisis situations, and

- referral to a sleep clinic.

The designed treatment provides clients with the best possible care for insomnia, is aimed at recovery, uses the existing treatment program and matches the situation in the clinic at no extra costs. The cost of treatment may decrease due to decreased prescriptions of drugs and lower relapse rates. Nurses and peer workers play a central role, because clients interact with them the most. The MANP can implement and evaluate the treatment, and stimulate other workers to let their clients benifit from it too.

Evidence based clinical practice/scientific research
Insomnia, Mental health, Research, Substance use disorder

Recovery-focused treatment to patients with severe mental illness and intellectual disability (ID)

Oral Presentation250Ingeborg Berger, Parnassia Groep, Mental health, ROTTERDAM, Netherlands

Van der Vorm ZaalTue 10:00 - 11:00

Introduction

The Parnassia group offers recovery-focused treatment to patients with Severe Mental Illness (SMI), in a non-clinical setting. Patients with intellectual disability (ID) are insufficiently recognized in this population. From November 2015 a Nurse Practitioner(NP)-student implemented the SCIL ‘’screening for intelligence and intellectual disability’’ to screen patients on ID. Dutch society expects people to be in charge of their own life, to take ownership of their care and to participate. Society frequently asks too much from more vulnerable people with ID with often problematic consequences. To explore the needs for support and possibilities for self-management for these patients an explorative qualitative study was performed by the NP-student. Outcomes of this study resulted in interventions to improve treatment, care and the introduction of a group program.

Brief description

After graduating the NP created and coordinated a one-year-program focused on recovery, empowerment, week-structure, social contacts and society-participation. This group program consist of visits twice a week to the group. During these visits illness-management ‘’Happy Healthy Life’’, participative drama, exercise and relax-groups, creative therapy, and individual job coaching are introduced. The program has attention for poorer understanding and mental slowness. Furthermore, it is focused on the strengths and talents of the participating patients. Supportive learning-materials, such as pictures, games and films are widely implemented to increase understanding. Some of these materials are created by the NP and colleagues.

Other relevant information

Before start all patients are interviewed about personal goals and expectations. Questionnaires are used to examine the effectiveness of the program.The program started in October 2017, and first results are expected in 2018.

Conclusion

Attention for ID combined with SMI resulted in an innovative program focused on talents, vulnerability ànd strengths, created and coordinated by a NP.

Innovation
Intellectual disability, Mental health, Recovery-focused treatment

Spiritual care practices of APNs: a multinational perspective

Oral Presentation79Beth DeKoninck, University of Saint Francis, FORT WAYNE, United States of America

Zeelenberg ZaalTue 10:00 - 11:00

The purpose of this presentation is to share the findings of a multinational survey which explored the spiritual care practices of APNs.

Spiritual care has always been at the core of nursing, however, the nursing profession moved away from this core tenet during the mid-to-late 1900s. It is only in the past twenty to thirty years that the focus has returned to spiritual care, both by the profession and governing bodies of healthcare and the nursing profession. Advanced practice nurses (APNs) have become instrumental to the healthcare systems of many countries and the role is ever-expanding globally. Thus, it is important to examine spiritual care practices of APNs to determine next steps in the provision of spiritual care for patients globally. This multinational study was a survey which examined spiritual care practices of APNs as well as barriers to spiritual care faced by APNs. The presentation will address how the project was developed, and the results, as well as, the need for research going forward.

The results of this study demonstrate that APNs need further education and support in the area of spiritual care in order to feel more confident in broaching the topic with their patients. It is only through open dialogue that the integration of spiritual care into the daily practice of APNs can be strengthened so that holistic patient care becomes a practical reality and not an academic exercise.

Changing healthcare and the role of the NP/APN
APN, Primary care, Research, spiritual care

Evaluation of spiritual care competency following an advanced practice nursing program

Oral Presentation583Caryn Scheinberg-Andrews, Henrietta Szold Hadassah School of Nursing at the Faculty of Medicine at Hebrew, Nursing, JERUSALEM, Israel

Zeelenberg ZaalTue 10:00 - 11:00

Introduction: Israel is a country with strong connection to religion. Spirituality is defined as the presence of self-transcendence, a yearning to find our place or meaning in the world, and a connection to a Higher Power. Religion, in contrast, is associated with an affiliation with a specific faith, group, and set of practices. The idea of spirituality as a dimension of care is relatively new in Israel<, and few institutions have designated non-religious providers of spiritual care1. However, some institutions are now introducing the concept of non-religious spiritual care providers based on the holistic worldview of quality of life . The undergraduate nursing curriculum at Hadassah School of Nursing presently is increasing awareness of nursing and spiritual care. Currently, the graduate program includes spiritual care in its curriculum as part of APN education. The purpose of this presentation is to show the difference in student competence in spiritual care after participating in a pilot workshop on spirituality. Methods: Descriptive survey method for students taking a workshop on spirituality. The survey is based on the “Spiritual Care Competence Scale”, forward and backward translated from English to Hebrew. The sample includes 28 Jewish, Christian, and Muslim second-year APN students taking the MA workshop on Spirituality who have completed the survey. Results: Our curriculum, which did not include spiritual care, now it is a mandatory workshop for all APN students. Conclusion: Addressing spiritual distress has become an integral part of palliative care and hospice treatment even in Israel. However, the school of nursing recognizes the educational importance of teaching spiritual care as part of the nursing process in all realms of patient care - not just palliative care. Adding this competency to the curriculum enhances the notion that APN care is holistic and contributes another dimension to the multidisciplinary approach to patient care.

Education
nursing competency, religiosity, Research, spirituality

Evaluation of Moral Case Deliberation as a workplace-based assessment in the ANP curriculum

Oral Presentation592Mariël Kanne, University of Applied Sciences Utrecht, Institute for Nursing Studies/MANP, UTRECHT, Netherlands

Zeelenberg ZaalTue 10:00 - 11:00

Advanced practice nurses are expected to be leaders in recognizing and resolving moral problems, creating ethical practice environments and promoting social justice in the larger healthcare system (1). Professional responsibility is intertwined with all competencies and includes moral responsibility. Professionalism can thus be regarded as a second-order competency which asks for ongoing critical reflection on the ethical and moral dimension of decisions and behavior (2). This is the reason why the ANP workplace-based learning program of the University of Applied Sciences in Utrecht (Netherlands) contains two assignments on ethics.

In this presentation we will present results from a research project to examine the utility of one of these assignments: the workplace-based assessment Moral Case Deliberation (MCD). The objective of this project was to improve the evidence-based level of the ANP workplace-based curriculum as a whole and especially the MCD assessment. MCD is well described in literature (3) and much research has been done on the effects of MCD in health care organizations (4), but as an assessment in the ANP program it is unique. Our goal was to improve learning outcomes of the MCD assessment by understanding factors that contribute or hamper learning effects according to students and clinical supervisors. Data were collected through focus groups. Qualitative data analysis shows that the validity of the MCD assessment is satisfactory but that reliability is less clear. Educational impact on APN role-taking aspects is high, growth of moral sensitivity as result of the assessment is assumed but not clearly mentioned. The acceptability of the assessment could be improved by setting clearer goals and feedback criteria. Cost effectiveness is strongly related to individual students, clinical supervisors and workplace conditions. More research is needed to learn how moral sensitivity and moral action of APN's can be enhanced and assessed in a formative matter.

Education
learning outcomes, Research, workplace-based curriculum

11:30 - 12:30 Parallel Sessions Round 6

Poster & Pitch

Patient factors predicting weight loss after Roux-en-Y gastric bypass

Poster & Pitch169Linda Sillén, Surgical Clinic in Norrköping, NORRKÖPING, Sweden

Arcadis Zaal corner BTue 11:30 - 12:30

Objective: Gastric bypass surgery is widely accepted for the treatment of patients with morbid obesity. It has proven efficacy in causing sustainable weight loss and resolution of comorbidities, but not lead to equal weight loss results in every patient. The purpose of this study was to identify pre-operative factors predicting weight loss following Roux-en-Y gastric bypass (RYGB) surgery.

Material and Methods: 281 patients subjected to RYGB between January 2006 and June 2012 were included. Demographic, physical and socioeconomic factors were assessed with regression analysis. Dependent variable was percent of excess weight loss (%EWL) at follow up.

Results: Follow up data at one year was available in 96%, at two years in 88%, and at three years in 65% of the patients. Mean EWL was 72.5%. The success rate (defined as =60%EWL) at 1 year was 73%, at 2 years 74% and 71% after 3 years. An earlier onset of obesity and high preoperative BMI were independently associated with unsuccessful weight loss at 1 year follow up. At 2-year follow-up, an association between unsuccessful weight loss and psychiatric disorder, diabetes, hypertension and preoperative BMI was seen. At 3-year follow up no statistically significant associations were detected.

Conclusions: RYGB provides successful weight loss for most patients. The results from this study indicates that an earlier age of onset of obesity, high preoperative BMI, psychiatric disorder, diabetes and hypertension are associated with unsuccessful weight loss.

Research
Bariatric surgery, Research

The E-nose used as a diagnostic screening tool for head and neck malignancy

Poster & Pitch237Pamela Hartgerink, Kaakchirurgie Oost-Nederland, HAAKSBERGEN, Netherlands

Arcadis Zaal corner BTue 11:30 - 12:30

Background

The golden standard to diagnose head- and neck malignancies is to perform a histopathological analysis. Results of the pathological anatomical tissue biopsy (PA) are available in a few days. The E-nose could perform an adequate diagnosis within 5 minutes, only by using breath analysis.

Goal

Validation of the E-nose in its diagnosis of malignancies in the head- and neck area.

Method

A prospective study was performed in Medisch Spectrum Twente. Patients with clinical suspicion of a head- and neck malignancy were included and underwent E-nose breath analysis in addition to the standard biopsy. The PA diagnosis was compared to the E-nose results (Malignancy: Yes/ No).

Results

A total of 82 patients were included, 45 of whom had a positive biopsy (diagnosis of carcinoma confirmed). A total of 47 patients tested positive with the E-nose, 37 of whom were true positive. Of 35 patients with a negative E-nose result, 27 were true negative. Sensitivity is 82% (37/45) and specificity is 73% (27/37).

Discussion

In this studie the E-nose is tested in a hospital population. Patients were already clinically suspected of a head- and neck malignancy, which makes PA confirmation essential. In addition to the definitive diagnosis, PA-results give information about tumor characteristics such as staging and differentiation, which are needed to determine therapy. It is not yet possible to determine these tumor characteristics using E-nose. However, E-nose is easy to apply, non-invasive and a patient-friendly screening tool with quick results.

Conclusion

The E-nose is not yet applicable to adequately diagnose malignancies in the head- and neck area in second-line healthcare. Nonetheless, research to the applicability of E-nose in first-line healthcare should still be validated. Further research will be necessary on a sufficiently large population.

Research
E-nose, Research

CANCELLED: Psychological and physical symptoms related to overestimating the cancer risk by Barrett patients

Poster & Pitch144Mirjam van der Ende, Catharina hospital, Gastro- enterology, EINDHOVE, Netherlands

Arcadis Zaal corner BTue 11:30 - 12:30

Background and Aims

Barrett Esophagus (BE) is a premalignant condition that affects patients' quality of life (QoL) and it may be psychological burden due to the threat of developing an esophageal adenocarcinoma (EAC). The aim of this study was to assess the EAC risk perceived by non- dysplastic BE patients and associate the perceived EAC risk with illness perceptions and QoL.

Methods

This cross-sectional questionnaire study included 233 BE patients aged 18-75, from a database in a tertiary referral center for BE. Based on their annual- and lifetime EAC risk estimations measured with the Magnifying Glass scale patients were divided into an overestimate- and an underestimate group. Differences between these groups were assessed on demographics, reflux symptoms, the medical Outcomes Study Short Form-36 (SF-36) and the Brief Illness Perception Questionnaire (B-IPQ).

Results

The questionnaires were completed by 68% patients of which 41% patients overestimated their annual risk and 25% overestimated their lifetime risk of developing EAC. Overestimating an EAC risk is associated with lower means in QoL on the domains: bodily pain (annual p=0.007, lifetime p=0.014), general health (annual p=0.011, lifetime p=0.014), vitality (annual p=0.030), physical functioning (lifetime p=0.028), significant worse illness perceptions (total score annual risk p=0.001, lifetime risk p=0.001) and significant more reflux symptoms.

Conclusions

Overestimating the EAC risk by BE patients is associated with decreased QoL and worse illness perceptions, which is most likely caused by reflux symptoms as well as dyspeptic symptoms. These should be adequately treated and patients may be in need of extra support and specific information about their EAC risk.

Research
Barretts’ esophagus, Non-communicable diseases, perceived cancer risk, Quality of life, Research

Postoperative pneumonia and prolonged ileus after open elective colon cancer surgery

Poster & Pitch105Annette Stenberg, Regionostergotland, Sweden

Arcadis Zaal corner BTue 11:30 - 12:30

Abstract

Colorectal cancer is one of the most common malignancies in Sweden where surgery is the main treatment modality. Surgery is sometimes associated with complications such as pneumonia and impairment in bowel motility, prolonged postoperative ileus (POI).

Purpose

This study aimed to describe incidence of pneumonia, prolonged POI and other complications after open elective colon surgery before and after the introduction of the ERAS program.

Methods

Data collection of all patients who underwent open elective colon cancer surgery in 2011 and 2014 was conducted retrospectively through a medical record audit and an audit of the ERAS register at a county hospital in the southeast region of Sweden.

Results

Fifty-six patients were included in 2011, and 71 in 2014. No differences in pneumonia and prolonged POI occurred between 2011 and 2014. Use of long-acting opioids and non-steroidal anti-inflammatory drugs (NSAID) was statistically significantly higher (p<0.001) in 2011, whereas use of Targiniq and Magnesiumoxide was statistically significantly higher (p<0.001) in 2014. No differences occurred regarding time to flatus, time to defecation and time to tolerating solid food between groups. The ERAS program was applied in all patients in 2014 and the overall mean compliance was 75.9%.

Conclusions

A comparison before and after the introduction of the ERAS program indicated no statistically significant differences regarding frequency of prolonged POI and pneumonia. Further studies within this area are needed.

Research
Colon cancer, complications, pneumonia, Prolonged postoperative ileus, Research

Unplanned readmissions after surgical care in Sweden

Poster & Pitch104Christina Ahl Jonsson, Region Ostergotland, Sweden

Arcadis Zaal corner BTue 11:30 - 12:30

Background

Hospital readmission is considered as an indicator of quality in health care. Risk factors for readmission have been suggested, but level of prediction in clinical settings has been poor. Nurse Practitioners may contribute to reduced readmission rates by improving the discharge process and home follow-up.

Aim

The aim of this study was to identify unplanned readmissions of patients initially admitted to a surgical department.

Method

The study was conducted by retrospective review of medical records of patients with unplanned readmission within 30 days after initial surgical admission during the year 2012, at a county hospital in the southeast of Sweden.

Results

A total of 219 patients out of 3079 surgical patients were readmitted unplanned during the year 2012. Diseases within the liver, pancreas and the biliary system were the most common diagnostic group. Patients that was initially acute admitted was elderly and to a greater extent cohabiting than those admitted electively. Among the readmitted patients were surgical complications common during both the initial admission period as well as the readmission. Secondary and tertiary unplanned readmissions occurred in 39 patients.

Conclusion

Unplanned readmission within 30 days after initial admission at a surgical department is frequent, especially in initially acute admitted elderly patients. Those readmitted due to complications related to the initial admission have longer length of stay and suffered to a greater extent by complications during the initial admission period.

Research
Hospitalization, Nurse, Patient readmisson, Research

Challenge of developing nursing practice models for the facilitation of critical patients’ recovery

Poster & Pitch459Misuzu Nakamura, Jichi Medical University, SHIMOTSUKE-CITY, Japan

Arcadis Zaal corner FTue 11:30 - 12:30

Objective: The present study aimed to develop models for the facilitation of critical patients’ recovery by examining component factors of nursing practice.

Methods: Focus group interviews with CNS and PreCNS were conducted to collect data: case examples of nursing care provided to facilitate patients’ recovery. The interview results were documented verbatim, and component factors related to nursing care and its facilitation were extracted and interpreted. The descriptions were summarized and classified according to their similarities.

Results: Data were collected from five groups. The mean age was 40.8 ± 5.7 years old. The male-female ratio was 6:18. The mean total period of working as nurses was 18.3 ± 6.2 years. The mean period of working as CCNS was 3.4 ± 1.7years. The mean interview time was about 55 minutes. Descriptions of nursing care provided for recovery were classified into 19 categories, including: [exerting our best efforts while placing the highest priority on life support], [initiation of risk prevention intervention from the period in which patients’ conditions are unstable], [provision of combined care to shorten the care period], [placing an importance on the well-being of patients], [understanding of the situation and nursing practice with composure], [development of relationships with patients to help them express their needs], [coordination to encourage patients to participate in treatment and care], [setting of goals and the development of plans with patients], and [interaction with patients while helping them understand the recovery process].

Discussion: Advanced and sophisticated nursing care was provided in cooperation with critical patients to maximize their abilities to recover, while carefully avoiding the risk of exacerbation for patients with an unstable condition, based on clinical judgments supported by “thought and practice”.

Research
Critical patients’ recovery, Critical/ acute care, Nursing practice models, Research

Blood pressure telemonitoring improves the control of hypertension: a clinical controlled trial

Poster & Pitch294Wenwen Meng, Chinese PLA General Hospital, BEIJING, China

Arcadis Zaal corner FTue 11:30 - 12:30

Objective To explore the effect of blood pressure telemonitoring and integrated management based on cloud platform on blood pressure compliance in outpatients with hypertension. Methods A total of 172 hypertensive patients in our hospital were selected from June to October 2016 and randomly divided into observation group (84 cases) and control group (88 cases),the observation group used the blood pressure telemonitoring and integrated management based on cloud platform to continue the management, the control group followed the routine outpatient follow-up mode.3 months later,compared the two groups the average 24h,daytime,nighttime,morning SBP,DBP; 24h,daytime,nighttime,morning blood pressure compliance rate.Results After 3 months,the average SBP, DBP of 24h,daytime,nighttime,morning in the observation group were significantly decreased,compared with the control group the difference was statistically significant (P<0.05).In the observation group after intervention, the 24h, daytime, nighttime,morning blood pressure compliance were 72.7%, 82.1%, 59.5%, 54.8%,the control group were 31.8%, 38.6%, 20.5%, 19.3%,the difference was statistically significant between two groups(P <0.05). Conclusion Compared to the traditional outpatient follow-up mode, blood pressure telemonitoring and integrated management guides patients to control blood pressure significantly,it is worth further use.

Innovation
Best practice, Blood pressure compliance rate, Blood pressure telemonitoring, Non-communicable diseases

Screen to screen contact for the guidance of patients and caregivers at home by nurse practitioners

Poster & Pitch372Hanny Overbeek, St Antonius Hospital, Hematology, NIEUWEGEIN, Netherlands

Arcadis Zaal corner FTue 11:30 - 12:30

Introduction

For a selected group of patients it’s possible to spend the neutropenic phase after autologous stem cell transplantation at home instead of in the hospital guided by a team of nurse practitioners. Crucial in this process is a 24 hour available caregiver. Caregivers experience this as a heavy responsibility and difficult task, accompanied by many uncertainties. We set up a system of ambulatory care in which patients have a hospital check three times a week supplemented with screen to screen contact via remote video technology. Because this is an innovative intervention, a feasibility study took place to evaluate the use of remote video technology in the ambulatory setting.

Methods

26 patients and their caregivers were recruited from July 2015 till August 2017. Patients were provided with a tablet and software. Twice a week the team set up a video call with patient and caregiver. Patients, caregivers and nurse practitioners outcomes were measured using semi-structured questionnaires.

Results

Ninety percent of the patients and caregivers thought screen to screen contact had helped them feel more confident and safe in the ambulatory setting. There were eight failed attempts to get in contact with patient and caregiver. After switching to a new provider, setting up the calls went smoothly in all cases. The image quality was fairly good, but not good enough to evaluate oral mucositis. Nurse practitioners perceived great value to screen to screen contact for carrying out clinical eye assessment of patients, and its capability for clinical observation and empowerment of both patient and caregiver.

 

Conclusion

 

The majority of patients and caregivers showed high satisfaction with the use of screen to screen contact. The key advantage of this contact, as seen by the nurse practitioners, were enhancement of increasing patient’s and caregiver’s confidence while staying at home during the neutropenic phase.

Innovation
Critical/ acute care, patients and caregivers, screen to screen contact

Threshold inspiratory muscle training improves dyspnea and sleep quality in heart failure patients

Poster & Pitch287Ai-Fu Chiou, National Yang Ming University, Taiwan

Arcadis Zaal corner FTue 11:30 - 12:30

Background: Dyspnea is the most common symptom worsening with progress of heart failure and influences patients' sleep quality, resulting in poor quality of life. Threshold inspiratory muscle training was found to improve strength of inspiratory muscle in heart failure (HF) patients. However, few studies have investigated the effects of threshold inspiratory muscle training on dyspnea and sleep quality in HF patients.

Aim: To investigate the effects of threshold inspiratory muscle training on dyspnea and sleep quality in HF patients.

Methods: This randomized controlled trial recruited 29 HF patients (NYHA II-III, LVEF = 45%) with inspiratory muscle weakness (MIP < 70%, predicted) and randomly assigned to the intervention group (n = 15) or control group (n = 14). Patients in the intervention group received the threshold inspiratory muscle training with 30% of maximal inspiratory pressure, 30-minutes per day for 12 weeks. Patients in the control group received usual medical care and had no any intervention. Dyspnea and sleep quality were measured with the modified Borg scale and Pittsburgh Sleep Quality Index at baseline, 4 weeks, 8 weeks, and 12 weeks after intervention.

Results: About 79.3% HF patients experienced mild to moderate dyspnea and 72.4% HF patients have poor sleep quality. After threshold inspiratory muscle training, the intervention group has significantly improved on dyspnea (F = 4.67, p < .05) and sleep quality (F = 3.76, p < .05). The control group showed no significant differences on dyspnea and sleep quality. Generalized estimating equation showed that the improvements of dyspnea (B = -0.16, p = .662) and sleep quality (B = -2.95, p < .001) in the intervention group after 12-week threshold inspiratory muscle training are significantly greater than control group.

Conclusion: Threshold inspiratory muscle training is a safe and effective method to improve dyspnea and sleep quality in HF patients.

Research
Critical/ acute care, dyspnea and sleep quality, heart failure, Research, threshold inspiratory muscle training

Assessment of post-operative pain management among acutely and electively admitted patients

Poster & Pitch76Mahnaz Magidy, Akademiska Hospital, Surgery, UPPSALA, Sweden

Arcadis Zaal corner FTue 11:30 - 12:30

Abstract

Rationale, aims and objectives

Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery.

Methods

A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital’s surgical department were included. Data collection was performed at hospital discharge.

Results

In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted.

Conclusions

There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.

Research
Critical/ acute care, pain, post-operative, quality indicator, surgery

The constraints and challenges facing emergency nurses in epidemic events: a qualitative study

Poster & Pitch63Stanley Kam Ki Lam, Tung Wah College, HONG KONG, Hongkong

Arcadis Zaal corner FTue 11:30 - 12:30

Introduction

Emergency nurses are engaged in the context of the management of epidemic events which unfold along with the evolving disease situations. In such a context, it is important to preface the emergency nurses’ experience and perception regarding their encounter with the tasks associated with epidemic management that constituted the emergency nurses’ action, interaction, and strategies.

Purpose

The present study aimed to explore the nature and events of how emergency nurses characterized the tasks encountered at work in the management of epidemic events.

Methods

A qualitative descriptive design was used in the present study to explore the experiences and perceptions of emergency nurses. Participants were purposively recruited from 10 emergency departments in Hong Kong. Semi-structured, face-to-face, individual interviews were conducted with 27 emergency nurses. The audio-recorded interviews were transcribed verbatim and interpreted with a thematic analysis approach.

Results

Four intertwined themes emerged from the analysis: fraught with resource constraints, fraught with threats of infection, fraught with ubiquitous changes, and fraught with lingering uncertainties. These themes collectively portrayed the circumstances facing emergency nurses which were fraught with constraint and challenges that associated with the risk for infection, shortage of resource, changes in the workplace, and uncertainty surrounded the situations.

Conclusion

The instabilities and vulnerabilities within the circumstances in which emergency nurses were situated in during epidemic events were delineated in this study. These impediments in the everyday practices of emergency care delivery are the fundamental sources that constitute the tasks and issues facing emergency nurses and compel them in the engagement of epidemic management. The findings shed light on the importance of hospitals and emergency departments to address both technical problems and adaptive challenges facing emergency nurses amid epidemic events.

Research
Emergency care, emergency nurses, epidemic, outbreak, Research

Concurrent Sessions

True leadership, be a leader

SpecialSpecialMark Venekamp, the Netherlands

Jurriaanse ZaalTue 11:30 - 12:30

Mark is an experienced senior executive with more than 20 years of (international) experience at tactical, strategic, operational as well as at transformation and crisis management level. As a leader, he has a track record in building and creating commercial growth, cultural change and creating operational excellence or customer intimacy within small, medium and large profit and non-profit organizations and healthcare.

Mark is a visionary leader and trainer with a 'hands-on' approach. He is a decisive and 'culture conscious' human executive and an excellent leader, communicator and team player. He thinks 'out of the box' and is creative, adaptive and persevering.
Since he began his career, he has worked with Purposeful leadership and BRAIN leadership as well as organizational and change processes in combination with group dynamics, individual coaching and effective learning processes. It is his passion to challenge and release the hidden talents and potential within organizations, teams and individuals, so that the results in all areas will continue to improve. Works from top management to deep within the organization at operational level.

Energetic integrator with clear and direct presentation with focus on the interaction between environment, organization and individual.
Mark Venekamp will take you to a next level of (euro) leadership which always start with yourself. Our world needs movement starters more then ever. Nurse practitioners could be the ones to lead this movement, make it /healthcare more compassionate and even joyful again, while feeling safe at work and stay fulfilled. Purposeful leadership, empower yourself and make your mark to the world.
He will show you mind power and easy to use elements that will help you being a true leader.
Use your brain at work, learn about her functions, her limitations and capacities. Mark will be a guide so you can guide yourself directly after the workshop and grow.

If you have no interest in being creative, more effective, peaceful in the heart and to grow happiness then this workshop may not be for you, for everyone else it could be a life changing experience.

Leadership

Errorless learning; an intervention for patients with Korsakoff’s syndrome to learn skills

Workshop123Mathilde Bos, HU, MANP, UTRECHT, Netherlands

Ruys ZaalTue 11:30 - 12:30

Errorless learning; an intervention for patients with Korsakoff’s syndrome to learn new skills.

Can patients with Korsakoff’s syndrome learn new skills? The answer is yes. Though patients suffering from Korsokoff’s syndrome can hardly recall any new information they receive, they can, in fact, learn new skills. These new skills such as making coffee with an unfamiliar coffee machine or brushing their teeth with an electric toothbrush can support more independent living and/or the adoption of healthier lifestyles.

The intervention to learn these new skills is called ‘errorless (re)learning’. The caregiver chooses a skill; if possible in conjunction with the patient. After this the caregiver describes the skill in small, clear steps. These steps must feel ‘organic’ for the patient. After that, they can start to practice together by exactly following the described steps. During this learning process no mistakes are allowed because, when the patient makes a mistake in one of the steps taken, the mistake is also learned. Errorless (re)learning an activity or skill is what we want to offer the patient.

Training in the new skill can be done by doing it step by step together and/ or by giving the step by step instructions to the patient only verbally while the patient is practising the skill. Though the patient will forget that he practised, he will probably, after a few weeks of training, master the skill.

This workshop aims to familiarise participants with this type of training for patients with Korsakoff’s syndrome. Some background information will be given in the workshop and we will complete some simple exercises.

Evidence based clinical practice/scientific research
Best practice, errorrless learning, Korsakoff's syndrom, Mental health

Empowering NP’s/APN’s for co-creation of good care by means of moral case deliberation (MCD)

Workshop152Mariël Kanne, University of Applied Sciences Utrecht, Institute for Nursing Studies/MANP, UTRECHT, Netherlands

Schadee ZaalTue 11:30 - 12:30

Introduction

Nurse practitioners/advanced practice nurses work in multidisciplinary teams, often in a complex organizational or social context. They collaborate with other professionals to realize good care for patients/clients in a wide variety of social, cultural and religious settings. As a consequence of this, they encounter many conflicts regarding the question ‘what is good care for this person in this situation?’. The answer not only depends on the professional background of the caregiver (doctor/nurse/social worker/physiotherapist/psychologist, etcetera) but also on the personal background of the care receiver (male/female, old/young, rich/poor, living alone/part of a large family, etcetera). Because care is a process, not a product (Tronto, 1993; 2013), good care can only be a result of co-creation (Wierdsma, 1999). In the process of co-creating good care, NP’s/APN’s have an important role, because they are the ‘linking pins’ between different professionals, patients, relatives and other stakeholders. And because care as a process is inherently ethical (Ricœur, 1992) and the expression good care has an inherently moral/normative dimension, it is necessary that NP’s/APN’s take time for reflection to become aware of their ethical identity and their way of moral reasoning. This can be facilitated in sessions for moral case deliberation (MCD) within organizations and institutions.

Purpose of the workshop

Presentation of results from a PhD research project on the effects of MCD in health care and social work, with a specific focus on the (ethically relevant!) existential and political meaning of the work of NP’s/APN’s.

Participants get acquainted with a method for MCD in organizations, that has been specifically developed for NP’s/APN’s who want to take the leadership role when ethical questions on good care have to be answered.

The workshop might be a start for the development of an international network of NP’s/APN’s who want to focus on ethical reflection within organizations and institutions.

Ethics and Moral Dilemmas
ethical reflection, good care, moral case deliberation, Research

Adult and pediatric respiratory examination and related case studies for APNs

Clinical WorkshopCW6Minna Miller, BC Children's Hospital/Provincial Health Services Authority/University of British Columbia, VANCOUVER, Canada; Bongi Sibanda, Queen's University Belfast, BELFAST, United Kingdom

Van Rijckevorsel ZaalTue 11:30 - 12:30

The presentation includes a brief overview of respiratory anatomy and physiology, including a review of the differences between adults and children. Physical exam of the respiratory system will be reviewed with normal and abnormal findings. Both adult and pediatric case studies will be presented within the context of pertinent history, physical exam findings and related investigations.

Biography

Dr. Miller was born and grew up in Finland. She currently lives and works in Vancouver, Canada. She is a consultant nurse practitioner at BC Children’s Hospital. She is on the nursing executive as the NP Collaborative Practice Leader within Provincial Health Services Authority and holds a faculty appointment at the University of British Columbia. She is a member of the American Association of Nurse Practitioner’s International Committee and the only Canadian NP as a AANP Fellow. She is the co-chair of ICN NP/APN Network Health Policy Subgroup with an interest in NP role implementation, development, evaluation, regulation and policy.

Bongi is an Advanced Nurse Practitioner in Unscheduled /Primary Care & DNP Candidate at Queen's University Belfast, United Kingdom. She is also an educator and healthcare consultant practicing in both UK and Zimbabwe. Bongi has special interests in Interprofessional Education (IPE) and workforce development in primary and emergency care.

Evidence based clinical practice/scientific research
Respiratory anatomy

Transition in care and nurse leadership

Symposium75Jan Sitvast, University of Applied Sciences Utrecht, IVS MANP, UTRECHT, Netherlands

Eduard Flipse ZaalTue 11:30 - 12:30

Everywhere in the world we see the problem of aging, rising prevalence of chronic diseases, of health-care consumption, of rising health-care costs, and changing needs of health-care consumers. Tackling the challenge of maintaining a health care system with good care at affordable cost we need more shared decision making, co-creation, and self-management. These will be important concepts of the next decade within the healthcare system. For their realization, collaboration is necessary, i.e. collaboration between the healthcare professional and the patient, between the healthcare professional and the family and informal networks around the patient, between healthcare professionals with various backgrounds, and between institutes. For good collaboration, transformative leadership is needed. We believe that advanced nurse practitioners are the linking pin between the afore mentioned themes. They not only have the necessary liaison skills, but they also have the skills to take the lead. Nurse practitioners can play a central role in these developments as they are familiar with a lot of healthcare professionals and they focus on the patient.

Since 2015 nurse practitioners are designated in the Netherlands by law as professionals with own discretional and decisional powers in the treatment of patients, juxtaposed with medical specialists in this respect. A main condition for a safe and responsible care and cure has been fulfilled in the Netherlands: a clear definition of Advanced Nursing Practice, legal registration and credentialing. They are ideally positioned to make a difference in health care chains, because beside the substituted medical tasks which they act upon as clinical attendent with discretional powers they also remain nurses with a special eye to caring needs. A more integrated way of providing healthcare is the challenge for the future. Advanced nurses have to take responsibility in this changing healthcare landscape. And they do, as we will illustrate with 3 cases. The request for cases has been put forward to nurse practitioners working in healthcare.

Leadership
Best practice, care coordination, Primary care, self-management

Devloping a framework for prescribing by registered nurse in Australia

Oral Presentation534Petrina Halloran, Australian Health Practitioner Regulation Agency, Strategy and Policy, MELBOURNE, Australia

Mees ZaalTue 11:30 - 12:30

In Australia, under the Health Practitioner Regulation National Law Act, as in force in each state and territory (the National Law), the Nursing and Midwifery Board of Australia (NMBA) is able to endorse the registration of registered nurses (RN) and midwives as qualified to administer, obtain, possess, prescribe, supply or use scheduled medicines if they meet the requirements of the respective registration standards. Currently autonomous prescribing is limited to Nurse Practitioners.

While Australians in general have reasonable access to health care services it is widely acknowledged that there are many people who are underserved because they live in areas or in circumstances where access to health care is restricted, either because of their location, a shortage of health care practitioners or the demands on the health care system. Further, the impact of an ageing population and the increasing level of chronic and complex disease places greater demand on available health services.

Providing equity of access to health care for all consumers requires new ways of delivering that care. One way of addressing the issues associated with access to health care is to expand the scope of practice of health practitioners to provide them with the required skills and competence to provide safe and effective health care and enable them to work to their full scope practice.

The expansion of the scope of practice of RNs in the area of prescribing provides the opportunity to develop innovative models of care that provide safe and effective access to health care for consumers.

The NMBA has worked with the nursing profession to develop a framework for prescribing by RNs. This paper will present the outcomes of this work including the educational and regulatory requirements for prescribing by registered nurses

Changing healthcare and the role of the NP/APN
prescribing

The link between opioid prescribing & overdose: lessons from the United States

Oral Presentation145Emily Pierskalla, Augsburg University, MINNEAPOLIS, United States of America

Mees ZaalTue 11:30 - 12:30

The purpose of this oral presentation is to highlight the features of the culture and policies in the United States that precipitated the country’s current opioid crisis. There have been recent efforts to expand opioid availability and prescribing to countries other the United States, in the guise of improving pain management. The United States far outstrips any other country in opioid prescriptions, and currently consumes 80% of the world’s opioids. The causes of the high rates of opioid prescribing can be traced to aggressive and misleading marketing practices by pharmaceutical companies that started in the 1990s. The power of these billion-dollar corporations was enough to influence the recommendations and regulatory standards of healthcare accrediting organizations such as the Joint Commission as well as medical educational institutions. Current research now suggests opioids are not an effective treatment for chronic pain, and long term use is correlated with increased risk of overdose and death. Additionally, surveys of heroin users indicate many of them started their addiction with a prescription to opioids.

The Centers for Disease Control and Prevention revealed that 33,091 people died from drug overdoses involving opioids in 2015, or roughly 91 people per day. The rise in death rates correlate directly with the rise in written prescriptions for opiate medications. There are great regional and demographic disparities in opioid related deaths throughout the United States. Death from opioid overdoses disproportionally affects white and rural Americans. Some of the reasons for these disparities may be from white Americans having greater access to healthcare, and providers’ discriminatory practices in prescribing opioids. In conclusion, countries seeking to expand access to opioids for patients should look to the CDC’s newest opioid prescribing guidelines, which include limiting dose & duration of treatment, as well of the use of prescription monitoring programs.

Evidence based clinical practice/scientific research
Best practice, inequity, opioids, pain, Prevention and public health

Results of a national prescribing survey of registered nurse and midwifery prescribers in Ireland

Oral Presentation141Mary Casey, University College Dublin, UCD School of Nursing, Midwifery and Health Systems, DUBLIN, Ireland

Mees ZaalTue 11:30 - 12:30

Since May 2007, registered nurses and midwives in Ireland who have successfully obtained a level 8 prescribing qualification and have met the relevant requirements can register with the Nursing and Midwifery Board of Ireland (NMBI) to become nurse or midwife prescribers. This presentation presents findings from a national prescribing survey. Data were collected through an online survey open to all Registered Nurse Practitioners in Ireland who prescribe medications as part of their role. This study builds on the previous international work (Cashin et al 2009; Drennan et al 2011, and Buckley et al, 2013, Creedon et al. 2015).

The paper will report findings on the most frequently prescribed medications, models of prescribing, elements of prescriber confidence and influences on prescriber behaviour.It is concluded that Nurse Practitioner prescribing behaviour continues to develop in Ireland and that Registered Nurses and Midwife prescribers improve patient outcomes through promoting access to medications for the Irish population through their quality use of medicines.

Research
Midwife, Nurse, Research

CANCELLED: Eating habits, influences on food choice and preferences among adolescents aged 13-15 years

Oral Presentation178Gaonyadiwe Lubinda-Sinombe, University of Botswana, School of Nursing, GABORONE, Botswana

Plate ZaalTue 11:30 - 12:30

Introduction

The prevalence of overweight and obesity is an increasing health problem among adolescents due to unhealthy eating habits. At a global level, the overweight epidemic is a top priority health problem that needs urgent intervention. With the increase in prevalence of overweight world-wide, there has been an associated increase of Non-Communicable Diseases (NCDs). The prevalence of overweight among adolescents aged 12-18 years in 2011 in urban private secondary schools in Botswana was 27.1% (192/702) and 13.1% (93/702) in public secondary schools. There is, however, a paucity of data on eating habits and no published evidence was located on the prevalence of overweight among 13-15 year old adolescents in public junior urban secondary schools in Botswana. This study seeks to describe eating habits and identify self-reported influences on food choice and preferences.

Methodology: a descriptive cross-sectional design by validated questionnaire was done in Junior secondary schools in Gaborone, Botswana among 252 adolescents aged 13-15 years old randomly selected from eight (8) junior schools.

Results: Most of the respondents (153/252, 53.6%) had a low socio-economic status as categorised by the present study. The most frequently eaten foods were sweets (132/252, 52.4%) and snacks (92/252, (38.1%). Television adverts were sometimes (137/252, 62.3%) considered to be honest. Parents controlled slightly more than half (128/252, 50.8%) of the respondents’ food choices whereas peers had little influence (21/252, 8.3%). Of the food types, most ate breakfast comprising of coffee and bread (115/252, 45.6%). Dinner was mostly eaten at home with the whole family (181/252, 71.8%). Of the listed foodstuffs, the majority preferred foods that contained sugar (41/252, 16.3%).

Conclusion: Adolescents engaged in unhealthy eating habits. Their parents controlled their food choices and but not their peers. They preferred sugary foods. Lifestyle intervention program is needed to promote healthful living.

Research
Eating habits, Food preferences, Influence on food choice, Non-communicable diseases, Research

Improving the supporting role of nursing communication between parent with breastcancer and their child

Oral Presentation275Joyce Roijen, Maastricht UMC+, Oncology, MAASTRICHT, Netherlands

Van Beuningen ZaalTue 11:30 - 12:30

Background

A diagnosis of breast cancer has a major impact, especially in families with (young) children. Often changes occur in the daily routines due to the changing role from parent to patient. Patients and partners are worried about the impact of the disease on the lives of their children. They may find it difficult to inform children correctly and may doubt their own competences.

Aim

Improving the supporting role of nurses with regard to communication between patients with breast cancer and his/her child (ren).

Design

A descriptive qualitative process evaluation of an educational training on communication.

Method

Data collection took place from February-March 2016 at the Breast Unit of the Maastricht Comprehensive Cancer Center. Three focus group discussions took place after a training regarding knowledge and skills on communication. Six certified dedicated breast cancer nurses participated. In this study three questions are answered: 1.How did the nurses experience the quality of the training 2.In what way did this training promote knowledge and skills at the nurse? 3. Which aspects of the training are applied in daily practice? The first two focus group discussions focused on the quality of the training and the third focus group discussion on the aspects of the training that were used in practice. Data were analyzed according to inductive content analysis.

Results

The nurses found the training valuable and experienced increased confidence in their ability to provide information and support to patients and partners in communication with their child (ren). After the training, especially the knowledge and skills regarding age-specific characteristics in children and the awareness of the importance of the signaling of the nurse during the entire care process were increased.

Conclusion

This communication training improved the skills and self-confidence of dedicated nurses to support patients diagnosed with breast cancer in communication with their children.

Research
breast cancer, children, Research, Women's health

Hope dies last... a qualitative study into the meaning of hope for people with advanced cancer

Oral Presentation239Corine Nierop- van Baalen, Haaglanden MC, Oncology, Netherlands

Van Beuningen ZaalTue 11:30 - 12:30

Introduction

Palliative patients may have strong hope, even hope for a cure, despite knowing their prognosis. Health professionals do not always understand patients who have this kind of hope. The aim of this study is to elucidate the meaning of hope for patients with cancer in the palliative phase.

Material and method

This study contains a secondary analysis of data obtained in a series of small studies in the Netherlands and Flanders on living with cancer with a short life expectancy (between 3 and 12 months). A constant comparative analysis was conducted to uncover the processes underlying the maintenance of hope.

Results and discussion

The meaning of hope is related to the importance of the object it is attached to, rather than to a real chance of achieving this object. Hope has a dual function: patients hope because they cannot forsake it and because they benefit so much from it. Hope can spring from many sources and is influenced by various factors. The true source of hope is the desire to live. A strong factor influencing hope is the reporting done by physicians (e.g. a positive scan result). If there are fewer potent sources to tap into, people create hope themselves and this type of self-created hope takes more effort to maintain. Patients use different strategies to increase their hope, described as the 'the work of hope'.

Conclusion

Our analysis of 76 interviews with palliative cancer patients reveals the logic underpinning the types of hopes which patients cherish and which do not run parallel with medical expectations. Patients need hope to live their lives. Supporting this hope, without enticing patients to undergo useless therapies, is a special challenge for professionals, including nurses who, in their daily contacts with patients, convey many messages that affect the work of hope.

Evidence based clinical practice/scientific research
Hope cancer palliative care qualitative research, Research

Ensuring organisational understanding to secure the advanced practice workforce

Oral Presentation86Ailsa Hayes, Velindre Cancer Centre, Nursing, CARDIFF, United Kingdom

Van Beuningen ZaalTue 11:30 - 12:30

Increasing numbers of people are being diagnosed with cancer. It is forecast that half of all people born after 1960 will be told they have cancer at some point during their lifetime (Alamad 2015).

Such is the enormity of the challenge facing the future of cancer care in the UK, all strategic frameworks reflect that redesign of the traditional clinical workforce will be required to ensure provision of sustained, expert, flexible and transformational care for cancer patients (Welsh Government 2016, NHS England 2016, Scot Gov 2016)

Advanced Nursing Practice is leading the way in which the services we provide to patients are delivered, ensuring rapid access to expert care that ultimately improves the patient experience and outcomes both clinically and holistically. Additionally Advanced clinical practice skills throughout the professions have been seen as strategically key to ensuring rapid access to specialist skills as part of the Transforming Cancer Services Programme for South East Wales.

However, challenges such as ambiguous role definition within the wider workforce, poorly defined advanced practice service structures, a lack of governance and competence review can be to the detriment of the individual advanced nurse practitioner and compromise patient safety.

At Velindre Cancer Centre (VCC) a robust ANP framework has been developed to support VCC in the delivery of a sustainable workforce who is equipped with the necessary skills and expertise to enable future service growth. This has been achieved by structuring and defining the role of the ANP, ensuring they are consistent with service demands and patient needs. This clarify of the role of ANPs, defined service specification, annual formal governance and competence review in alignment with current professional and government frameworks assists in reviewing the complex issues surrounding advanced nursing practice while future proofing high quality care for the cancer patients of the future.

Changing healthcare and the role of the NP/APN
Definition, Oncology, Service

The health education England (Wessex) advanced clinical practice development programme project

Oral Presentation404Helen Rushforth, Dr, SOUTHAMPTON, United Kingdom

Van Cappellen ZaalTue 11:30 - 12:30

Since 2001 the International Council of Nurses has recommended a Master’s Degree for all Advanced Practice Nurses (APN), but it is only since 2010 that the UK has endorsed M level education for APN roles (DH2010; NLIAH 2010; RCN 2012; HEE 2017). Furthermore, cautious adoption of this educational standard, combined with the absence of UK statutory regulation of Advanced Practice, means that many experienced UK APNs have had limited opportunities to undertake Master’s education, or formal assessment of their APN competency.

In order to address this issue Health Education England (Wessex), in collaboration with two local Universities, has established a regional project which aims to offer alternative workplace based educational opportunities to this group of experienced practitioners. This culminates in an assessment designed to assess their clinical competence and underpinning M level ‘thinking’ (i.e. advanced reasoning).

The project offers a group of primary/secondary care based APNs (and allied health practitioners) support with a mapping activity to identify gaps in their education and experience, as the basis for developing an individualised development plan. Then, workplace learning based education (plus more formal education where required) is offered to prepare these practitioners for assessment of their clinical competence and underpinning M level ‘thinking’. Assessment uses a portfolio approach, benchmarked against current UK advanced practice frameworks. Expert clinical supervision and assessment is key; thus supervisor/assessor preparation is also a central part of the project.

By mirroring established local MSc APN assessment processes, it is hoped the project will enable experienced practitioners to demonstrate similar competencies to their more traditionally educated peers via a more experiential and workbased learning route. It will also help to identify which aspects of practice/M level ‘thinking’ can be successfully achieved via experience/practice based education, and which to prioritise as requiring more traditional University approaches.

Education
advanced practice competency, Best practice, Master's education, Workbased learning

Putting 'addiction' into all nursing prequalifying educational programmes

Oral Presentation482Carmel Clancy, Middlesex University, Mental Health, Social Work & Integrative Medicine, LONDON, United Kingdom; Dana Murphy-Parker, Widener University, PHILADELPHIA, United States of America

Van Cappellen ZaalTue 11:30 - 12:30

There is extensive evidence to suggest that health and social care practitioners are not sufficiently prepared during their undergraduate or prequalifying training to work with patients with substance use problems (Loth et al 2011; Clancy et al, 2007; Martinez & Murphy-Parker 2003)

Nursing literature is peppered with studies highlighting the deficits in nurse education in the preparation of nurses around addiction, and this seems to be co-located with literature on ‘negative attitudes’ within the same groups. Unfortunately, this position remains largely unchanged over the last 20 years. The recommendations arising from such studies repeatedly call for better and improved courses and skills training within nursing curricula both at the Undergraduate and postgraduate level. However, these recommendations do not take into account knowledge and skill deficits among the nurse trainers or nursing faculty. Anecdotally there is some evidence to suggest that the nurses of the future are being trained by nursing academics who themselves have not received formal education in the area of addiction, and who equally may carry their own prejudices into their teaching /classrooms.

This paper will present the findings from a study exploring the impact on knowledge, skills and attitudes (KSA) year on year, among a cohort of undergraduate nursing students during their three-year training; and how these findings influenced the development of a transnational cross nursing institutional survey on faculty’s role and response to delivering addiction education to pre-qualifying Bachelor nursing students.

Education
Addiction, Best practice, Education, Nursing

Delineation of specialized and advanced practice nursing roles

Oral Presentation281Krista Jokiniemi, University of Eastern Finland/ McMaster University, Department of Nursing, KUOPIO, Finland

Van Weelde ZaalTue 11:30 - 12:30

Introduction: The World Health Organization’s strategic priorities include improving global health through the effective introduction of specialized and advanced roles within healthcare systems. Literature confirms the lack of role clarity as a significant barrier to the optimal utilization of nurses in non-advanced specialized and advanced practice nursing roles. The objective of this Canadian study was to differentiate non-advanced specialized, clinical nurse specialist, and nurse practitioner roles in order to determine how they may complement and be optimally utilized within healthcare teams.

Method: This comparative descriptive study, using an online self-report questionnaire, was conducted across Canada from June to August 2017. Eligible participants had to be working in a clinical role and be a specialty certified registered nurse, or a clinical nurse specialist or nurse practitioner with a master's or doctorate degree. The validated Advanced Practice Role Delineation tool was modified, translated into French, and piloted to ensure relevance to the Canadian healthcare context. The data were analyzed using descriptive and inferential statistics.

Results: A total of 1447 nurses participated in the study including 576 specialty certified nurses, 345 clinical nurse specialists, and 526 nurse practitioners, (response rate= 35%). Differences in how nurses implemented non-advanced specialized, clinical nurse specialist, and nurse practitioner roles were identified related to types of activities and time spent in different domains of advanced practice. Factors associated with role differences related to education, experience, role titles, and practice settings were examined. The results are consistent with previous studies using the Advanced Practice Role Delineation tool.

Conclusion: These results are relevant to clarifying role definitions, delineating non-advanced and advanced nursing roles, informing the development of educational program curricula, regulation and credentialing, as well as other healthcare policies to support the optimal implementation and utilization of these roles. Study results will be relevant to international advanced practice nursing community.

Research
Research, Role delineation, Specialist nursing

Pushing the boundaries: rolling out the first advanced practice nursing program in Saudi Arabia

Oral Presentation573Therese Leufer; Carol Barron; Daniela Lehwaldt, Dublin City University, DUBLIN, Ireland;

Van Weelde ZaalTue 11:30 - 12:30

Introduction: The purpose is to present the opportunities and challenges associated with the overall process in the successful 2017 roll-out of the first Masters in Nursing: Advanced Practice programme in the Kingdom of Saudi Arabia.

Brief description: The Kingdom of Saudi Arabia (KSA) is undergoing fast-paced changes in their cultural, economic and political arenas. This includes a move towards ‘Saudization’ – the policy to increase the number of Saudi nationals and reduce the number of expatriates in the workforce. Central to this is to ensure a workforce within the kingdom that is suitably prepared with the requisite knowledge and skills needed to respond to this challenge. This is particularly important in healthcare that has traditionally enjoyed strong input of clinical expertise from expatriates. Growing local and national clinical expertise in the field of nursing, in particular at the advance practice level, presented a unique opportunity for international collaboration for nurse educators.

Summary of new unpublished information: Nurse academics from two higher education institutions; one based in KSA, the second in the Republic of Ireland came together to design and plan a programme to prepare nurses for advanced practice in KSA. The journey towards successful university accreditation of this programme involved much in the way of shared learning. Navigating the unique cultural differences that existed between collaborating parties and responding to the needs of Saudization in both programme design and roll-out negotiations presented many challenges. In addition, a variation in how professional nursing practice is legislated and frameworks that can serve to underpin it provided an interesting lens from which development was contextualised.

Conclusion: International competencies for what exemplifies and guides how best to prepare nurses for advance practice were used in a collaborative approach to developing the first advanced practice programme in Saudi Arabia.

International developments and collaboration
Advanced Practice, Saudi Arabia

Task performance and competences of advanced nurse and midwife practitioners: a crosssectional study

Oral Presentation249Ann van Hecke, Ghent University, University Centre for Nursing and Midwifery, GHENT, Belgium

Van Weelde ZaalTue 11:30 - 12:30

Aims and objectivesTo examine advanced practice nurses’ (APNs) and advanced midwife practitioners’ (AMPs) task performance and competences, and factors associated with task non-execution.

BackgroundAdvanced practitioner roles are increasingly implemented internationally. Evidence about APNs’/AMPs’ contribution at a clinical, organizational, and professional level is growing. However, studies examining associations between APNs’/AMPs’ task performance and competence levels, and factors correlated with task non-execution are lacking. This information could support role delineation and curriculum development.

DesignA questionnaire-based, cross-sectional study.

MethodsA survey among APNs/AMPs in Flemish hospitals (Belgium) was undertaken between autumn 2015-spring 2016. Tasks were categorized in the following domains: clinical expertise, expert guidance/coaching, consultation/consultancy, research, change management/innovation, multidisciplinary cooperation/care coordination, ethical decision-making, and clinical/professional leadership. Task performance and competence level frequencies were calculated. Multivariate binary logistic regression analysis identified factors associated with task non-execution.

ResultsAPNs/AMPs (n=63) were relatively young, had limited advanced practitioner experience, used their time mainly for direct patient contacts, and executed tasks in all advanced practice domains. Several tasks were executed by few APNs/AMPs despite many feeling competent. Task non-execution was associated with work setting, years of work experience, position appointment percentage, perceived competence level, financing source, and type of hierarchical supervisor.

ConclusionAPNs/AMPs practiced according to all advanced practice domains. Examining barriers hindering APNs/AMPs in reaching their full potential seems appropriate. As feeling incompetent was associated with task non-execution, optimization of APNs’/AMPs’ training should be considered.

Relevance to clinical practiceSupervisors could play an important part in enhancing role development and expertise of APNs/AMPs with limited advanced practitioner experience. For tasks executed by few APNs/AMPs despite many feeling competent, providing APNs/AMPs with task execution opportunities might prevent job dissatisfaction and leaving the profession. As task non-execution was associated with physicians as financing sources or supervisors, the nursing/midwifery focus of task performance remains important.

Changing healthcare and the role of the NP/APN
advanced midwifery practice, Research

A comparative study of clinical decision-making processes from a Nordic perspective

Oral Presentation148Rika Levy-Malmberg, University College of Southeast Norway, Nursing, VASSA, Finland

Van der Vorm ZaalTue 11:30 - 12:30

Background: In recent years, many studies have examined various areas of the decision-making process, especially in the fields of psychology and economics, and the cognitive biases that affect this process. In the nursing domain, clinical decision-making has been described as balancing experience, awareness, knowledge and information gathering, using appropriate assessment tools; consequently, the nursing process corresponds considerably to the decision-making process. Three models illustrate the process; the information-processing model, the intuitive-humanist model, and a multidimensional model that includes elements of the information-processing model to allow for the examination of patient-specific elements, i.e. the probability to facilitate a strategy while solving nursing-related problems.

The purpose of this study was to accumulate new insight by examining and comparing the decision-making processes used by nurses of different educational levels when making clinical decisions.

Sample design and methods: Data were collected through structured observation followed by clarifying questions in the form of semi-structured interviews during winter 2017. Three groups of nurses; registered nurses (RNs), nurse specialists (NSs) and advance nurse practitioners (ANPs) took part in the study ( N=12) in the context of emergency care at two central hospitals in the Nordic Counties. Qualitative manifest content analysis, an inductive approach, was conducted in order to identify unique patterns in the process through interpretation.

The results indicate three ‘key’ themes (followed by six sub categories) that act as a strategy in the clinical decision-making process. Those categories are: acting according to guidelines routines and intuition, using critical thinking from a patient’s perspective and facilitating and weighing new alternatives. While RNs mainly use the first strategy, NSs uses the first and the second strategies, and ANPs use all three strategies.

Evidence based clinical practice/scientific research
clinical alternatives, clinical decision-making, critical thinking, Emergency care, Research

Measuring leadership skills of nurses necessary to implement EBP

Oral Presentation402Anneke van Vught, HAN University of Applied science, Netherlands

Van der Vorm ZaalTue 11:30 - 12:30

Introduction statement indicating purpose of presentation

Insight into leadership skills of nurses is necessary when implementing Evidence Based Practice (EBP). The Leadership Practice Inventory (LPI) is a questionnaire, measuring leadership behavior. It is unclear whether the LPI is suitable to provide insight into the required leadership skills of nurses when implementing EBP. We aimed to understand the value of the LPI in the implementation of EBP.

Brief description of pertinent research or other methods adopted

Experienced vocational nurses who are in the last phase of their training to become a bachelor nurse filled out the LPI. In addition, these participants participated in three focusgroups. Focusgroups were held to get insight into the leadership skills of nurses directly related to the implementation of EBP. The LPI and the focusgroups were analyzed based on the subscales of the LPI. The results of both research methods were compared and discussed by a panel of experts.

Summary of new unpublished data and/or other relevant information

A total of 45 questionnaires were returned (response 30%). The participants rated themselves on average 7.1 ± 1,3 on a scale of 1-10 on leadership behavior. A total of 20 participants were included in three focus groups. Participants indicated that they lack leadership skills to implement EBP. They also indicated that they felt no responsibility in the application and implementation of EBP. They considered EBP as the responsibility of the physician and the hierarchical supervisor.

Conclusion The results of the LPI, completed by nurses, do not correspond with the leadership behavior of nurses extracted from focusgroups. The LPI, as the only instrument to get insight in leadership skills necessary for the implementation of EBP, is too limited. It is recommended to use other (additional) methods to provide insight into leadership skills when implementing EBP.

Leadership
Leadership, Research

Leadership competencies and attributes in advanced nursing practice; an integrated review

Oral Presentation446Maud Heinen, Radboud university medical center, IQ healthcare, Netherlands

Van der Vorm ZaalTue 11:30 - 12:30

Background: Developments in healthcare and within the nursing profession ask for well trained nurses with leadership qualities at all levels of the healthcare system. Clinical nurses whom are trained at master’s level, e.g. Advanced Practice Nurses (APN’s) and Clinical Nurse Leaders (CNL’s) are ideally positioned to lead health care reform in nursing. Identifying leadership competencies and attributes internationally is the first step for an evidence based curriculum on leadership.

The aim of this study is therefore to contribute to defining leadership by establishing what leadership competencies and attributes are expected of the Master level educated nurse (APN & CNL) from an international perspective.

An integrative review design was used which allows for the combination of various methods to synthesize the findings of included studies and literature. A literature review was conducted using the Embase, Medline and Cinahl databases. A second search was conducted in the websites of international professional nursing organizations for publications on leadership competencies in APNs and CNLs.

Results: 78 competencies were identified in ten studies and six frameworks. A thorough process of synthesis led to the identification of 26 core competencies within a model of four leadership domains, the clinical, professional, health systems and health policy domain as described by Hamric et al (2014). The least number of competencies were identified in the health policy domain Also knowledge, skills and attributes could be linked to the four domains.

Conclusion: This model of leadership core competencies could be used as a solid base for international leadership development in advanced practice nursing.

Leadership
international, Research

Fecal incontinence in IBD: an inconvenient truth

Oral Presentation480Nynke Boontje, UMC Utrecht, Gastroenterology, UTRECHT, Netherlands

Zeelenberg ZaalTue 11:30 - 12:30

BACKGROUND

Little is known in today’s literature about (the fear of) fecal incontinence and its impact on quality of life in patients diagnosed with inflammatory bowel disease (IBD). It has an imaginably great impact that can cause suffering on a personal, emotional and social level. It is often underreported by patients.

METHODS

From January until June 2017 a mixed-method study was conducted in IBD-patients from a tertiary hospital. Aim was to measure the prevalence of fecal incontinence in IBD-patients, its impact on quality of life and what patients wish to change in daily practice. An online survey was used for this purpose, with quantitative measurements (incontinence-scale and quality of life-scale) and qualitative free-text responses.

Secondly, we aimed to determine what a nurse specialist can contribute in this manner by exploring relevant literature.

RESULTS

A total of 215 (1501) responses were analyzed. Of all respondents thirty-six percent experience some degree of fecal incontinence. This has a significant negative impact on quality of life. Patients desire more support and counseling from their healthcare providers. The nurse specialist has a fitting job-profile to organize and provide the desired care.

LIMITATIONS

Our sample-size was small. Relatively short study period.

CONCLUSION

The prevalence found in our study is slightly higher compared to other data. Fecal incontinence is a prevalent condition among IBD-patients, for which a coherent approach is lacking. More awareness, guidance and education is needed. A nurse specialist specialized on fecal incontinence can deliver the desired and needed care.

Changing healthcare and the role of the NP/APN
Fecal incontinence, IBD, nurse specialist, Research

Evaluation of case manager role implementation at Vasa central hospital

Oral Presentation455Carola Wisur-Hokkanen, Vasa central hospital, VAASA, Finland

Zeelenberg ZaalTue 11:30 - 12:30

Purpose of presentation: An aging population in combination with complex care needs challenges the healthcare system. The care of these patient groups is often fragmented, and the patients may feel disappointed with available healthcare services. When situation escalates, they seek help from emergency rooms where professionals do not have the possibilities to understand the patient's complex situation. Unsuitable treatment and new medical prescriptions may worsen the patient's situation, and increase patient's experiences of non-care or absence of care. The purpose is to describe the Nurse Practitioners’ (NP) role as case manager (CM) in specialized hospital care.

CM is an international title and the role began in the US in 1960. The role includes cooperation and coordination of multi-professional care and services between different organizations. Main task is to ensure that patients with long-term illnesses receive the necessary care/service.

NP as CM:s hold the knowledge to act as a coordinator for the patient between professional groups, evaluate care needs and make clinical decisions at an advanced level. The model has proved good patient outcomes, reduced visits to emergency rooms and efficient care.

Summary of new unpublished data: The data is based on a total sample of patients (n=80) visiting the NP in CM role at an emergency clinic in Finland during the period 3/2017 – 3/2018. Descriptive statistics of characteristics and background information of the patients were analyzed. The patients’ most common health problems were symptoms related to chronic pain, mental illness and not coping at home. These problems were found in especially two age groups (70-80 and 30 years old). CM supported and promoted patients’ health by person-centered health interventions.

Conclusion: Preliminary results shows that interventions by CM can reduce readmissions improve their overall health situation as well as promote multi-professional teamwork.

Changing healthcare and the role of the NP/APN
case manager, evaluation, implementation, Research

Care of the medically complex patient in post acute settings

Oral Presentation277Alison Mitchell, Houston Methodist Hospital, NP Service, Internal Medicine, HOUSTON, United States of America

Zeelenberg ZaalTue 11:30 - 12:30

Care of the medically complex patient in post acute settings

With increasingly complex patients such as left ventricular assist devices (LVADs), transplant of all kinds, medically complex oncology patients, and severe ischemia limiting the healing of wounds, post acute care has become a form of critical care. When emergencies happen, the acute care required is a role that can be filled by an acute care nurse practitioner.

At Houston Methodist Hospital the acute rehab and skilled nursing floors of the West Pavilion, house many medically complex patients with heart, lung, liver and kidney transplants. LVAD patients with driveline infections and other medically complex patients with severe protein malnutrition and deconditioning due to neurosurgery and stroke make up most of the population. Episodic care by an advanced practice nurse (APN) has provided life saving care in emergencies and coordination of care with difficult discharges. Discharge data is used to verify and validate the role of the APN. The APN has the opportunity to learn and become expert in many new technologies as they go from research to actual patient treatments in the post acute setting. Being willing to read, interact with many consultant teams enables the APN to learn then teach the nursing staff about these treatments so the patients can be appropriately cared for. The burden is on the APN to keep up with reading, to seek learning opportunities from conferences and physician staff implementing these new cutting edge treatments.

As medicine continues to advance, nursing has a specific responsibility to maintain the education curve to provide the best care available for these medically complex patients that give internal medicine a new meaning.

Post acute care requires expert intervention that can be provided by the critical care APN.

Changing healthcare and the role of the NP/APN
Best practice, Critical/ acute care, medically complex, skilled nursing unit

14:30 - 15:30 Parallel Sessions Round 7

Poster & Pitch

Critical care course improves level of confidence and knowledge among acute healthcare providers

Poster & Pitch289Susan Bionat, Houston Methodist Hospital, NP Service, HOUSTON, United States of America

Arcadis Zaal corner CTue 14:30 - 15:30

With the increasing morbidity and aging population of the inpatients, there is a need for rapid surveillance in the acute setting outside of the critical care units. Potential changes and rapid deterioration of patients can happen instantaneously; critical care training and knowledge, skills and confidence of the clinicians outside of ICU are crucial. In our setting, an academic hospital of 1000 bed, our rapid response team composes of nurse practitioners (NP), and respiratory therapists. Training and preparation for this team is just as important to maintain their confidence and competence. The Fundamentals of Critical Course (FCCS) by the Society of Critical Care Medicine is offered quarterly in our institution.

95 participants comprise of [(NPs), 41%], MDs (22%), RNs (34%) and Respiratory therapists (2%) attended the FCCS course and completed an evaluation which assesses participants’ level of confidence pre and post FCCS course in the following areas: prioritization of needs, selection of diagnostic test, identification and response to unstable patient, treatment of life threatening condition and preparation of patient and expert consultation. Preliminary results reported fair- good (35-40%) level of confidence prior to the class which improved to outstanding (75%) after the class that signified a higher level of confidence. Knowledge was also tested pre and posttest with a significant increase in scores. 100% also indicated that they will positively change their practice with positive comments of the course. Final report and statistics to follow upon completion of data analysis.

Academic training institutions, community hospitals with rapid response teams and high acuity hospitals should continue to support critical care courses for RNs, NPs, physician assistants (PA) and physicians. This is a requirement for nurse practitioners in our service managing acute events in the hospital.This course promotes confidence and level of competence in managing critically ill patients outside of the ICU.

Education
Best practice, confidence, Critical Care course, Critical/ acute care, FCCS

The effects of digital method on learning of nursing students in CHALOUS, Iran

Poster & Pitch278Zahra Gholipour, Islamic Azad University, TEHRAN, Iran

Arcadis Zaal corner CTue 14:30 - 15:30

Introduce:

Individual differences of students, differences in the quality and quantity of clinical learning, unequal educational opportunities and etc. make teaching hard and complicated for nursing teachers. Teachers try to use different ways to solve these problems such as using E-Learning.

Methods:

The experience of my nursing teaching has led me to reconsider the previous methods of teaching. Nowadays as what we see we have different soft wares and applications which can make our life easy. The MOJ-NA digital learning nursing group's efforts in October 2015 were recorded and applied a pilot project 2 groups of nursing students have done. By simulating nursing methods with audios, videos, slide shows and design the references texts in a question-answer format alongside teaching the theories, students can understand the lessons completely.

Results:

This software was using by 2 groups of the first year nursing students at CHALOUS branch of Islamic Azad University, after teaching theories in classes and nursing cares in practical room for all of them, students use their CDs to see all the related items individually. By repeating this way, it can be fix in their mind.

Conclusion:

Digital learning is a method that learners can training at any time and place with choosing the speed of training based on individual needs and it helps them to reduce learning time and costs.

Education
Digital learning, Education, Nursing, Research

Mental health nursing in the UK and the development and impact of advanced practice roles

Poster & Pitch228Clare Allabyrne, London Southbank University, Mental Health and Learning Disabilities, LONDON, United Kingdom

Arcadis Zaal corner CTue 14:30 - 15:30

To highlight the promotion of parity of esteem through validated, accredited advanced nurse practice in mental health across the life span and evidence impact on patient care in the UK.

There is increasing recognition there needs to be parity of esteem between physical and mental health care. (Mental Health Taskforce, 2015).

The role of the Advanced Nurse Practioner (ANP) is well established in physical healthcare and the benefits evidenced across the life course. Parity of esteem suggests that mental health clients and nurses should have access to the same high level expertise through accredited training, evaluation of the impact of this role and its’ inclusion in workforce planning.

To date, there has been no accredited Advanced Nurse Practitioner Course for mental health nurses. We need to develop our future mental health nurse leaders as validated experts to enable our profession to position itself where we can have the most impact on patient care. To support this, the first Advanced Nurse Practitioner (ANP) course in the UK specifically for mental health nurses has been developed at London Southbank University (LSBU). The course is accredited by the RCN which is the only quality marker for ANP programmes in the UK (RCN, 2008, 2012) and commenced in 2016.

The course focuses on four themes: clinical/direct care and practice; leadership and collaborative practice; improving quality and developing practice and developing self and others. (DOH, 2010).

Advanced Nurse Practice in mental health now has a platform for consideration in workforce development, through the establishment of this course. Our first cohort from 2016 is already proving impact, through promotion into leadership roles, nurse led clinics and invitation to publish.

This is the beginning of gathering the evidence and undertaking further research into the efficacy and impact of these roles, validating consideration in future workforce development.

Education
Best practice, development, impact, Mental health

The quality of the final thesis: do evaluators agree?

Poster & Pitch219Ercolie Bossema, HAN University of Applied Sciences, Master Advanced Nursing Practice, NIJMEGEN, Netherlands

Arcadis Zaal corner CTue 14:30 - 15:30

Introduction

Education programs in the Netherlands often have two evaluators assess the quality of the final thesis. The aim of this study was to examine the agreement between these two evaluators.

Methods

Data consisted of grades (on a scale from 1 and 10, with 6 being the passing grade) for the final theses of students who between 2012 and 2015 started the two-year dual advanced nurse practitioner education program at the HAN University of Applied Sciences in Nijmegen, the Netherlands. These were the grades assigned by a first evaluator (the student’s supervisor) and by a second evaluator, as well as their joint grade. If one of them had assigned a grade lower than the passing grade, a third evaluator’s assessment was decisive and a joint grade was assigned, accordingly.

Results

A total of 126 theses were evaluated by 22 evaluators. The mean grade of the first evaluators was 7.0 (SD 1.0), of the second evaluators 6.4 (SD 1.0), and of the joint evaluations 6.6 (SD 1.1). The intraclass correlation between the grades of the first and second evaluators was 0.42 (p<0.001) and between the grades of the two evaluators in the joint evaluations 0.72 (p<0.001). Six theses (5%) obtained a grade lower than the passing grade from both the first and second evaluator, three theses (2%) from only the first evaluator, and 24 theses (19%) from only the second evaluator. Thus, the level of agreement between the first and second evaluator was 0.78 and Cohen’s kappa 0.22 (p=0.002), and logically in the joint evaluation both 1.00 (p<0.001).

Conclusion

Supervisors tended to assign a somewhat higher grade and more often a passing grade than second evaluators. This indicates the necessity of a second and sometimes third evaluator to assess the quality of the final thesis.

Education
Evaluator agreement, Research

Effect of providing education about alcohol use disorder and compassion fatigue to emergency nurses

Poster & Pitch155Dawn Williamson, Massachusetts General Hospital, Addictions Consultation/ED, BOSTON, United States of America

Arcadis Zaal corner CTue 14:30 - 15:30

Background: Emergency Departments (ED) treat over 20,000 patients daily with Alcohol Use Disorders (AUD). Nurses receive limited education about AUD. Studies show ED nurses have negative attitudes about AUD patients. Symptoms of Compassion Fatigue (CF) contribute to dissatisfaction with work. Purpose: Design, implement and evaluate education about AUD and CF for ED nurses. Design: Quasi-experimental pretest- posttest within subjects design. Sample: Convenience sample of 44 nurses at a large urban ED. Methods: Nurses completed demographics, Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL), and Short Alcohol and Alcohol Problems Perceptions Questionnaire (SAAPPQ). Then they participated in five hours of an on-line education and a one hour live class about AUD and CF. Surveys were re-administered. Results: The difference in pretest and posttest SAAPPQ subscales of Role Security (Expected Value 4.25, p<.006) and Therapeutic Commitment (Expected Value 7.50, p=.018) were statistically significant. For ProQOL constructs no statistical significance was found. The ProQOL subscales were compared with norms and were statistically significantly different. Conclusion: Nurses attitudes about patients with AUD improved after completing the curriculum. Studied nurses had higher levels of professional satisfaction at baseline.

Education
alcohol, attitudes, Research

The need of compression stockings in the care of patients undergoing a radical prostatectomy

Poster & Pitch447Maarten van Elst, UMC Utrecht, Cancer Center - Urological oncology, Utrecht, Netherlands

Arcadis Zaal corner GTue 14:30 - 15:30

BACKGROUND

The department of Urology at the University Medical Center Utrecht (UMC Utrecht) and the Netherlands Cancer Institute (Antoni van Leeuwenhoek hospital (AVL) collaborate in the care of prostate cancer. To avoid delay, patients diagnosed with prostate cancer in the UMC Utrecht are offered surgical treatment in the AVL. In contrast with the AVL, patients in the UMC Utrecht have to wear compression stockings. This difference in policy of thromboprophylaxis leads to the question if patients are overtreated in the UMC Utrecht or are at risk for thrombosis in the AVL.

AIM

Achieve policymaking for the department Urology of the UMC Utrecht for robotic assisted laparoscopic prostatectomy procedures (RALP), whether or not combined with pelvic lymph node dissection (+/- PLND), so tromboprofylactic interventions will be adjusted based on relevant patient related predisposing factors for developing venous thromboembolism (VTE).

METHODS

To get answers at the problem statements, the following methods were used:

a literature study;

a retrospective chart review;

benchmark.

Results

Data analysis from the different research methods showed that:

the incidence of VTE by RALP (+/- PLND)-procedures is low;

VTE is the number one cause of death by RALP (+/- PLND);

there are many predisposing factors for developing VTE;

literature is inconclusive on relevant predisposing factors for RALP (+/- PLND);

advice from general guidelines are not included into urological guidelines;

general risk assessment models (RAM) are not used for prevention of VTE in the care of prostate cancer patients;

a specific RAM for VTE prevention by RALP (+/- PLND)- procedures is lacking.

CONCLUSION

There is no consensus about relevant predisposing factors for VTE RALP (+/- PLND) procedures. A specific RAM for prostate cancer patients, treated with RALP (+/- PLND) needs to be developed and implemented. It enables to adjust patient related thromboprophylactic interventions for patients who undergo RALP (+/- PLND)-procedures.

Evidence based clinical practice/scientific research
Prostatectomy, Research, Risk assessment, venous thromboembolism

Effect of telemonitoring on the compliance of CPAP therapy in patients with OSAS

Poster & Pitch351Danielle Wester-van de Pieterman, Spaarne Gasthuis, Lungdepartment, HAARLEM, Netherlands

Arcadis Zaal corner GTue 14:30 - 15:30

Introduction

Compliance with continuous positive airway pressure (CPAP) therapy for patients with obstructive sleep apnoea syndrome (OSAS) is a big problem. Compliance is defined as the use of CPAP for more than 3 hours a night and more than 5 days a week (e.g., 1-2). It is known that many patients do not reach compliance (46-83%). A consequence of noncompliance may be more daytime sleepiness and tiredness for the patient and higher medical costs, caused by patients visiting their doctors frequently. A relatively new treatment modality is telemonitoring. It is hypothesized that by using telemonitoring, related to the CPAP use, patients will show less noncompliance because health care providers can notice possible noncompliance at an early stage and adapt the CPAP accordingly in correspondence with the patient. The first results are encouraging (3), although more research is needed. The aim of this pilot study is to investigate the effect of telemonitoring on the compliance of CPAP use in patients with mild to severe OSAS.

Methods

In the Spaarne Gasthuis, The Netherlands, N = 120 patients with mild to severe OSAS (i.e., with AHI scores = 15) are included between November 2017 and February 2018. Half of the patients will be randomly assigned to regular CPAP therapy and half to CPAP therapy with telemonitoring. Both patient groups will be monitored for CPAP compliance, daytime sleepiness and quality of life before they will start their CPAP therapy, and two weeks later, during a regular visit at the hospital. CPAP compliance is measured using the CPAP SD-card (regular treatment) or with the telemonitoring system. Daytime sleepiness is measured using the Epsworth Sleepiness Scale (ESS) and quality of life using Functional Outcomes of Sleep Quality-10 (FOSQ-10).

Conclusion

Results of this pilot study will be presented.

Evidence based clinical practice/scientific research
OSAS, Research

Care organization for HFE haemochromatosis patients: an importance-performance analysis

Poster & Pitch313Annick Vanclooster, University Hospital Leuven, LEUVEN, Belgium

Arcadis Zaal corner GTue 14:30 - 15:30

This research describes the use of an importance-performance analysis (IPA) by linking care activities with a high level of importance with intervention adherence rates (i.e. “performance”). To our knowledge, there are no data available in the literature, on the quality of care hereditary haemochromatosis (HH) patients receive. Hence, there is no information about the areas of care susceptible to improvement. Performing an IPA, a priority list of care activities can be designed.

Own research confirms poor consistency between three available guidelines for HH (EASL, AALSD and DUTCH guideline on HH), a situation which hampers qualitative care and its evaluation. Performing a five step RAND-Modified Delphi Method, 15 key-interventions (KIs) were developed, from a list of 41 recommendations extracted from three guidelines. Now, an IPA was performed at an academic medical center (University Hospital Leuven, Belgium) to measure the quality of care delivered to HH patients using these 15 predefined KIs via electronic patient records.

Evaluation of the care delivered to 384 HH patients was performed via an IPA. The analysis shows that suboptimal care is delivered to HH patients. For instance, only 32% and 33% of the HH patients were immunized against hepatitis A en B respectively and only 52.6% of the cirrhotic patients underwent a six-monthly ultrasound of the liver was performed, despite an importance of 84.6% attributed to these KIs by clinicians. Only one process indicator reached a performance of more than 80% (i.e. genetic screening of first degree relatives). An APN out-patient clinic is started to evaluate the further care delivered to HH patients.

This study highlights the shortcomings in treatment and follow-up of patients with HH. Developing and follow-up of care pathway indicators could increase the quality of in-hospital care. By using importance-performance analysis clinicians and managers can be supported in prioritizing improvement initiatives.

Evidence based clinical practice/scientific research
importance-performance analysis, Research

Frailty in geriatric rehabilitation

Poster & Pitch264Robbert Gobbens, Associate lector at Hogeschool Inholland; coördinator program MANP Rotterdam, AMSTERDAM, ROTTERDAM, Netherlands

Arcadis Zaal corner GTue 14:30 - 15:30

Introduction

Due to lacking measurement, data for frailty in patients at discharge after Geriatric Rehabilitation cannot be determined, neither can be predicted what consequences this frailty might have for the patient at home. Correlation between frailty and adverse health outcomes as disability on (instrumental) activities of daily living and decreasing quality of life was researched. Also the predictive validity of the TFI for adverse health outcomes and health care utilization was researched.

Purpose

The risk of adverse health outcomes and increasing health care utilization after rehabilitation can be estimated by measuring frailty.

Method

Quantitative, longitudinal survey, as part of masterthesis for Master Advanced Nursing Practice in 2014. Aimed number of participants N=75. At discharge (T1) and a month after discharge (T2) a total of 64 participants answered three questionnaires (TFI, GARS and WHOQOL-BREF), completed with additional questions on health care utilization at T2.

Results

Correlation between the TFI in total and the domains of the GARS and WHOQOL-BREF questionnaires is strong.

TFI, together with characteristic of participants, shows a strong to very strong explained variance (37% to 55%) with a strong statistical significance for results on the GARS and WHOQOL-BREF questionnaires. The influence of the physical domain of the TFI was more significant than the psychological domain, the social domain did not have a significant role.

Conclusion

A strong correlation between frailty and disability in (I)ADL and quality of life is shown.

The TFI has a strong predictive validity for disability in (I)ADL, for decreasing quality of life, for falling and for hospital admission within a month after discharge.

Keywords: frailty, disability, negative health outcomes, geriatric rehabilitation, predictive validity

Evidence based clinical practice/scientific research
Elderly care, frailty, geriatric rehabilitation, negative health outcomes, Research

Occurrence rate and correlates of urinary incontinence in women with type 2 diabetes

Poster & Pitch258Yuan-Mei Liao, National Yang-Ming University, Institute of Clinical Nursing, School of Nursing, TAIPEI CITY, Taiwan

Arcadis Zaal corner GTue 14:30 - 15:30

Purpose of presentation: This presentation will deliver the information related to occurrence rate and correlates of urinary incontinence (UI) in women with type 2 diabetes.

Methods: This study was a cross-sectional, correlational study. Data collection was conducted in three hospitals. A study questionnaire was used to collect information on individual characteristics and lower urinary tract symptoms.

Results: Study sample included 332 Taiwanese women aged 50 to 89 years with type 2 diabetes. Women’ mean age and body mass index were 62.64 (SD=6.94) and 26.04 (SD=4.37), respectively. The majority women were diagnosed with diabetes for more than 5 years (n=225, 67.8%), had a waist circumference of =80 cm (n=259, 78.0%), and had an A1C level of > 7% (n=242, 72.9%). Only three symptoms had an occurrence rate of higher than 25%: nocturia (=2 voids/night; n=167, 50.3%), increased daytime urinary frequency (>8 episodes/daytime; n=92, 27.7%), and UI (n=88, 26.5%). Analysis of multivariate logistic regression identified five correlates of UI. Women who were =65 years, had a waist circumference of =90 cm, had given birth =3 times, and had experienced chronic constipation or increased daytime urinary frequency had a higher odds of experiencing UI than those who did not have these characteristics.

Conclusions: Our study results showed that the occurrence rates of three urinary symptoms were high. While the beneficial effects of non-drug lifestyle management, behavioral interventions, and pharmacotherapy on UI have been reported, health care professionals should provide related interventions to this specific population. Related interventions aimed at 2-3 modifiable correlates (waist circumference, chronic constipation, and increased daytime urinary frequency) may include maintaining a normal body weight and regular physical exercise for maintaining a normal waist circumference, and using related strategies such as monitoring diet/fluid consumption, medication usage or bladder training to improve chronic constipation and increased daytime urinary frequency.

Research
Correlates, Diabetes, Research, Urinary incontinence, Women's health

Supporting frail elderly cohort - multiple comorbidity. Patient activation measures. Personalisation

Poster & Pitch537ANNE Lloyd, Blackpool Teaching Hospitals NHS Trust, Adults and Long Term Conditions Division, BLACKPOOL, United Kingdom

Arcadis Zaal corner KTue 14:30 - 15:30

Extensive Care Service (ECS) - New Models of Care on the Fylde Coast in Lancashire, UK.

Multi-disciplinary team (MDT) working in the community setting providing ‘Holistic’ care provision. Identifying frailer, older people with two or more long term conditions who would benefit from a Comprehensive Geriatric Assessment in the community setting and a Care Plan developed with the patient for actual and anticipatory care needs fully incorporating carers needs.

One contact number 24 hrs for patients to contact for acute clinical episodes and non-health related issues. Patient Activation Measure (PAM) identify patient and carer confidence, knowledge and skills levels to enable a tailored approach by all ECS Clinicians and Health and Well-being Support workers for improved patient outcomes and effective service delivery. Patient and carer engagement is key in supporting the self-management of their long-term conditions.

Patient reported outcome measures are incorporated into an Individual Health & Well Being Care Plan. Evidence supports reduced hospital admissions and greater patient satisfaction.

Service Key Performance Indicators are achieved monthly with reduced unscheduled admissions and excellent patient feedback reporting increase in self-management confidence. With simultaneous increase in PAM level evidence supports an overall reduced risk of hospital admission.

Advanced Nurse Practitioners (ANP) within ECS provide a prompt reactive response for acute exacerbations plus a proactive anticipatory provision to reduce crisis escalation and occurrence. The ANP in ECS provide leadership, support, supervision, knowledge and skills sharing with all ECS team members to enable continuous professional development.

To reduce duplication and fragmentation of care ECS ANP provide in reach into hospital when a patient needs a hospital admission to share information, assessments and home situation information to facilitate a safe discharge to the desired place of residence.

ANPs discuss all treatment options and involve all patients to ensure ‘no decision about me, without me’.

Collaboration and Inter-Disciplinary Practice
Activation, Best practice, Elderly care, Personalisation

Cardiogenic shock and high-risk percutaneous coronary intervention assisted by ECMO: our experience

Poster & Pitch280Miryam Gonzalez Cebrian, Hospital Clinico Salamanca, Cardiologia, SALAMANCA, Spain

Arcadis Zaal corner KTue 14:30 - 15:30

INTRODUCTION

Veno-arterial extracorporeal membrane oxygenator (VA-ECMO) is a mechanical circulatory assist device capable of providing hemodynamic and pulmonary support.

ECMO in the cath lab was initially used in the setting of refractory cardiogenic shock in emergency situations. Currently, its use has been extended to programed percutaneous coronary intervention (PCI) in high risk patients with severe coronary disease and ventricular dysfunction.

The use expansion of the ECMO in the cath lab requires the training of the multidisciplinary team involved in its implant and removal. The protocols development allows to unify criteria avoiding associated risks, complications and improving results.

MATERIAL AND METHODS

Descriptive, observational and retrospective analysis of all patients with ECMO implantation in our interventional cardiology unit.

Baseline characteristics, diagnosis, indication, associated complications and mortality were collected.

RESULTS

We included 21 patients with VA-ECMO implantation our cath lab.

47.6% were implanted in cardiogenic shock and 23.8% during cardiac arrest. The ECMO was also used in high-risk percutaneous intervention (14.3% PCI and 4.8% for structural disease).

It was indicated as bridge to recovery in 76.2% of patients, bridge to transplant in 19.1% and bridge to another type of assistance in 4.8% of them.

We used femoral access in 95.2% of the patients ECMO with femoral access.

19.1% of patients presented vascular complications, 19.1% lower limb ischaemia, 38.2% infection, 38.2% bleeding, 9.6% circuit alterations and 4.8% iliac perforation. On month mortality was 47.6%.

CONCLUSIONS

VA-ECMO is an effective tool for hemodynamic support in cases of acute circulatory compromise but also in programmed high-risk percutaneous intervention.

It is necessary for nursing to be formed through training programs and their participation in protocols development to know about the procedure, material and specific care.

The involvement of nursing allows to improve both patient and professionals safety, minimizes complications and facilitates the decision making.

Innovation
Critical/ acute care, ECMO, Nursing, Training

Functional decline in older acute medical in-patients

Poster & Pitch124Cecília Rodrigues, Centro Hospitalar do Porto, PORTO, Portugal

Arcadis Zaal corner KTue 14:30 - 15:30

Background

Older patients hospitalised for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes. The aim of this study was to compare basic self-care needs in older acute medical in-patients between 2 weeks before hospitalization and discharge.

Methods

Single-centre, observational, and prospective cohort study. Data were collected between May and September 2017 and included 91 patients aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Performance in basic activities of daily living (BADL) at home (self-reported), at hospital admission (observed) and at discharge (observed) was collected. Functional status of the elderly patients at 2 weeks before hospitalization (baseline), at hospital admission, and at discharge was measured by the Katz Index. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline.

Results:

Pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the patients, respectively. Patients were independent on average in 3.63, 1.41 and 1.90 BADL 2 weeks before admission, at hospital admission and at discharge, respectively. In-hospital functional improvement occurred in 36.3% of the patients.

Conclusion:

Due to their aptitude to observe, support and guide patients and their 24 hours patient supervision, nurses play a key role in strategies to prevent functional decline in older patients. An adequate planning of nursing care that includes interventions to promote and maintain mobility, in the logic of self-care, can be a valuable contribution in the prevention of functional decline and in the reconstruction of independence in self-care after a generative event of dependence.

Research
Acute care, Elderly, Elderly care, Functional decline, Research

Concurrent Sessions

Integrating medical and nursing reasoning as core business for the Nurse practitioner: Where do you stand?

Clinical WorkshopCW7Gabriël Roodbol, Lecturer HAN University of Applied Sciences; Master Advanced Nursing Practice, NIJMEGEN, the Netherlands

Van Rijckevorsel ZaalTue 14:30 - 15:30

Nurse practitioners build a bridge between a patient’s health problems and medical treatment on the one side, and the consequences these bring for the patient’s daily functioning and social environment on the other. To this end, they combine medical reasoning with nursing reasoning. They are challenged, however, by the fact that medical treatment results form the basis for healthcare financing and policy making. Although the patient’s functioning is increasingly recognized as a primary healthcare outcome – the core of the nursing profession – nursing reasoning is still being neglected and, with that, the nursing profession. How do nurse practitioners combine nursing information with the medical findings? Literature shows that attention is paid to the 'mapping' of nursing and medical terminology, but the 'combined reasoning process' seems to be still unexplored territory.

How do nurse practitioners combine these two tracks in their reasoning process? To what extent do they use nursing classification systems such as NANDA-NIC-NOC, or OMAHA, or the ICF as a knowledge domain for the formulation of nursing diagnoses, interventions and care results?

During this workshop we would like to learn how you give shape to this in your clinical practice. The clinical reasoning cycle (Levett-Jones, 2013) is being modified as an overarching model for integrated medical and nursing reasoning within the HAN MANP (Master of Advanced Nursing Practice in Nijmegen) program. This is facilitated using the PES=structure (Gordon, 1994) with the bio-psycho-social model. We would like to discuss this framework with you.

Purpose: To exchange clinical experiences with the integration of medical and nursing reasoning.

G.J.M. (Gabriël) Roodbol MScN, nurse and nursing scientist, is Nurse Specialist Mental Health and Head instructor Nursing Specialists Mental Health at the University Medical Center St Radboud. In addition, he is Head Lecturer / coordinator in the field of learning lines clinical reasoning and interventions at the HAN University of Applied Sciences, training MANP (HAN Master Advanced Nursing Practice).

Changing healthcare and the role of the NP/APN
medical reasoning, nursing reasoning

Building sustainable psychiatric mental health nursing education systems: dynamicity and resiliency

Symposium17Karan Kverno, Johns Hopkins University School of Nursing, Acute and Chronic Care, BALTIMORE, United States of America

Eduard Flipse ZaalTue 14:30 - 15:30

The World Health Organization (WHO, 2013) calls for the development of comprehensive, integrated and responsive mental health and social care services in community-based settings. Key to achieving this goal are workforce growth strategies that include the identification of gaps, specification of needs, educational requirements and core competencies for healthcare workers and the development of undergraduate and graduate curricula. Nurses make up 43% of the global mental health care workforce (WHO, 2015). Educating nurses at the advanced practice level will have an immediate effect on access to more comprehensive and competent mental healthcare services. In this symposium, faculty from the Johns Hopkins University School of Nursing and Tehran University of Medical Sciences, Nursing and Midwifery School, will examine the theoretical and practical considerations in developing advanced practice psychiatric mental health nursing (PMHN) curricula. The two countries report a similar prevalence of mental disorders across the lifespan and considerable gaps in adequately meeting treatment needs. The presenters will address the following question: What are the main constructs that must be considered for designing dynamic and resilient PMHN education in the U.S. and Iran? While growing the workforce of advanced practice PMH nurses will be essential to mitigating the current workforce crisis, competency alone is insufficient to support sustainable development. PMHN programs need to incorporate systems thinking models in to their curricula to become more dynamic and resilient to respond to unpredictable changing situations. The presenters conclude by discussing how the perspective of complexity in PMHN education focuses our attention on how we are together as human beings and respond to and frame the issues of learning and understanding that challenge contemporary mental healthcare and, by extension, PMHN education, in a complex and rapidly changing world that can have profound effects on the preparedness of tomorrow’s professionals and their impact on society.

Education
Curriculum development, Integrated care, Mental health, Systems Theory

Making numbers make sense: statistics essentials for APN practice

Workshop295Gene Harkless, University of New Hampshire, Department of Nursing, DURHAM, United States of America

Schadee ZaalTue 14:30 - 15:30

Advanced practice nurses are required to critically analyze evidence and translate research to improve practice. Underlying these competencies is high-level statistical literacy. This requires understanding the strengths as well as the limitations of descriptive and inferential null hypothesis statistical tests and how to translate these findings for shared, informed decision-making. As an alternative to null hypothesis statistical tests, advanced practice nurses, students, and faculty need to master the tools and techniques of estimation and effect size. As clinical outcomes are often probabilistic, clinically important information is lost if the analysis only relies on the dichotomous thinking of null hypothesis statistical tests, answering the question of “Is it significant?” Estimation and effect size provide clinically useful information to answer the questions of “How much…?” or “To what extent…?” Meta-analyses are useful for summarizing research across a specific area of clinical practice. Further, methods using Bayesian inference are essential to understand for clinical practice as they are used to answer questions such as “How likely is a diagnosis, given a particular test result?” Therefore this workshop focuses on enhancing advance practice nurses' knowledge and skills in evaluating the use of null hypothesis statistical tests, estimation and effect sizes, meta-analyses, and Bayesian inference for their application in diagnostic reasoning and clincial decision making. Practical tools and resources on these topics will be provided.

Education
Best practice, informed decision-making, numeracy, Primary care, Statitics

Nurse practitioners: the key to providing integrated mental health care in primary care

Workshop546Susan Van Cleve, University of Iowa College of Nursing, Iowa City, United States of America

Hudig ZaalTue 14:30 - 15:30

Providing high quality mental health care to children and adolescents is a global priority. Multiple models have been examined on how to integrate mental health into primary care practices, but many barriers exist. Pediatric and Family Nurse Practitioners who have added training and skills in working with children and adolescents with mild to moderate mental health disorders may be the key to expanding care to this vulnerable population in primary care settings.

This workshop will provide primary care nurse practitioners with a greater understanding of how to integrate behavioral and mental health care into pediatric primary care practices. A review of current research on behavioral integration models in primary care will be presented, with a focus on the role of the nurse practitioner providing the mental health care. The use of developmental and behavioral screening tools, including parent-completed and directly administered assessments, will be described. How to implement an integrated mental health program in a primary care pediatric practice will be presented including systems changes, billing and coding, instruments, and development of resources and referrals. A focus on tailoring visits to maximize practice will be described.

Changing healthcare and the role of the NP/APN
Best practice, Integration, Paediatrics, Pediatrics

Key role of NP in multicultural nursing home with somatic, psychiatric and psychogeriatric health

Oral Presentation227Lianne Buitendijk, Stichting Humanitas, ROTTERDAM, Netherlands

Jurriaanse ZaalTue 14:30 - 15:30

Introduction

This presentation is an example of best practice of the role of a nurse practitioner (NP) in the subject of changing healthcare and collaboration within a multicultural nursing home in Rotterdam for elderly with a combination of mental and somatic health.

Brief description methods adopted

This presentation is underlined by a literature research on the internet.

Summary of other relevant information

The nursing home ‘De Leeuwenhoek’ by Stichting Humanitas is an exceptional nursing home in the Netherlands. ‘De Leeuwenhoek’ has one ward with 32 psychogeriatric clients, and 2 wards of clients with somatic health problems, mental health problems or a combination of these. 60% of the clients and 80% of the nursing staff is of non-Dutch origin, mainly from Surinam, Antilles, Cape Verde and Indonesia.

Non-western older migrants are found to be in unfavourable physical and psychosocial health. In general they experience more feelings of loneliness, more psychic problems and feel left out more often (Aedis-Actiz, 2017). Living together in ‘De Leeuwenhoek’ solves a part of these problems, but gives new challenges to provide good quality of care. Two main challenges are:

How to deal with the seemingly clash between multicultural values in health care and the requirements of the national Inspection of Healthcare.How to increase the advantages and to decrease the disadvantages of people with mental health issues and somatic health issues living in the same home.To face these challenges the NP plays a key role in ‘De Leeuwenhoek’. The NP is part of the medical team and innovates care by strengthening the collaboration between all players in the health field around the client (Wallenburg, 2015).

Conclusion

The NP plays a key role in facing the challenges in providing good quality of care to a multicultural, multi-morbidity population of elderly in ‘De Leeuwenhoek’.

Collaboration and Inter-Disciplinary Practice
Best practice, Elderly care, role NP in nursing home

Utilizing a cultural approach to promote exercise in older adults

Oral Presentation516Lori Martin-Plank, University of Arizona, College of Nursing, TUCSON, United States of America

Jurriaanse ZaalTue 14:30 - 15:30

The purpose of this presentation is to discuss strategies and examples to engagesedentary older adults in exercise geared to maintain or increase function and physicalhealth by incorporating cultural approaches to exercise.

Advanced practice nurses care for frail older adults in multiple settings, however the focus of healthcare for older adults has been primarily in the areas of acute care and management of chronic health conditions rather than preventive care that delays the onset of illness and frailty. With the worldwide increase in the older adult population, there is a need to refocus on health promotion and prevention in this group. Exercise, even in small doses, is one lifestyle change that has demonstrated a reduction in morbidity and mortality in older adults (Hupin et al, 2015), but it is often overlooked or dismissed during health care visits. While the response of older adults to exercise programs has been mixed, studies have demonstrated the value of using cultural norms that support exercise and promote health in older adults (Belza et al, 2004; Ceria-Ulep, Serafica, & Tse, 2011; Lim, Kayser-Jones, J.S., Waters, & Yoo, 2007) and some studies have detailed how culturally perceived barriers to exercise can be turned into incentives (Belza et al, 2004; Olanrewaju et al, 2016). Older adults honor and respect cultural values and perceive themselves as culture-bearers, so programs that incorporate cultural perspectives are more likely to be accepted. Advanced practice nurses have the opportunity to intervene on the level of population health by working with exercise professionals and recreational therapists to design individual and group exercise programs for older adults, similar to the examples presented, that are consistent with cultural norms and values and to educate participants on the benefits of physical activity in promoting health and delaying the onset of chronic illness.

Changing healthcare and the role of the NP/APN
Best practice, Cultural Approach, Exercise/Physical Activity, Older Adults, Prevention and public health

Implementing nurse practitioners in long term care: a formative evaluation

Oral Presentation209Kelley Kilpatrick, Université de Montreal, Faculty of Nursing, Canada

Jurriaanse ZaalTue 14:30 - 15:30

Introduction: Caring for the frail elderly is a global concern. Internationally, decision-makers are looking to shift care activities from physicians to nurses and nurse practitioners (NPs) to improve access to and the quality of long-term care (LTC). The presentation will focus on quality indicators and identify factors that influenced NP implementation.

Methods: A formative evaluation of NPs in LTC was undertaken across six sites. Data were collected from September 2015 to March 2017 to examine models of care (consultative, shared care), characteristics of residents (patients requiring LTC care) under NP care, outcomes over the first 12 months of implementation and provider (n=91) perspectives. Quality indicators included transfers to acute care, medication, restraint use, pressure ulcers, and falls. Analysis: Descriptive statistics, analysis of occurrence of events over time, and content analysis were used.

Results: NPs undertook 3798 indicator-related interventions. The average age of residents was 82. The most common diagnosis on admission was dementia (62%, n=331). The number of interventions/resident depended on the model of care. The incidence of polypharmacy, falls, restraint use and transfers to acute care decreased. The average number of medications/resident decreased by 10% per 30-day period. Weekly meetings with physicians and nurse managers, and an office for the NP located near the healthcare team facilitated communication and improved NP integration. Healthcare teams noted an improvement in the quality of documentation as a result of close monitoring of residents by NPs.

Conclusions: The consultative model and collaborations between physicians, pharmacists and NPs led to better resident outcomes. A structured presentation to the healthcare team, and regular meetings with nurse managers and physicians throughout the implementation process ensured a more effective integration of roles. Half-time positions for NPs facilitated recruitment. NPs in LTC represent an effective and safe solution for improving care quality for residents and their families.

Innovation
Elderly care, Research, Residential care

Nurse practitioners’ focus on health care in terms of cure and care: analysis of graduate theses

Oral Presentation316Hillegonda Stallinga, UMCG, Health Sciences, GRONINGEN, Netherlands

Mees ZaalTue 14:30 - 15:30

Introduction statement. Advanced nursing practice finds its origins in the task substitution and delegation of certain medical activities from physicians to nurses. As a consequence nurse practitioners are expected to act on the intersection of cure and care. However, in clinical practice and education, a clear model covering this area is lacking. The WHO’s conceptual biopsychosocial model of health including the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF), represents the integration of cure and care, and should be considered for incorporation in curricula of the Master of Advanced Nursing Practice (MANP).

Brief description of the research. The aim of this study was to explore the focus of nurse practitioners on health care by answering the research question to what extent graduate theses are focused on cure, care, or on the intersection of cure and care. In a sequential-exploratory mixed-method design, 413 published abstracts of graduate theses of a Dutch MANP (2000-2015) were analyzed using the WHO’s conceptual model including ICD and ICF, and classified in terms of cure, care, or on the intersection of cure and care. Data included aim, question, and outcome of each thesis, and graduates’ characteristics.

Summary of data. A small majority of 53% (n=219) of the theses addressed patient's health status and could be classified. Of the classified theses, 48% were focused on cure, 39% on the intersection of cure and care, and 13% on care. While the percentage of theses addressing health status increased significantly over the 15-year period, the percentage focused on cure, care and on the intersection of cure and care remained the same.

Conclusion.The graduate theses reflected that nurse practitioners are increasingly oriented toward patients’ health status. However, their focus is predominantly on cure rather than on the intersection of cure and care.

Education
Human functioning, ICF, Mixed method design, Research

Best practices of teaching environment for nurse practitioners

Oral Presentation238Lucyl Verhoeven, Jeroen Bosch Hospital, 'S HERTOGENBOSCH, Netherlands

Mees ZaalTue 14:30 - 15:30

Introduction

This presentation will focus on the teaching of nurse practitioners in Jeroen Bosch Hospital. The key points of this working method are discussed.

Background

A nurse practitioner is a Master of Science educated nurse. The educational programs to become a nurse practitioner consist of theoretic and practical learning by following the cognitive apprenticeship model. The work setting demands a direct trainer on the job or a practice teacher who has responsibility over the whole teaching group.

Best practice

Driven by quality improvement and changing demands the Jeroen Bosch Academy employs a nurse practitioner with extensive experience as a central practice teacher for the complete training of all nurse practitioners in the Jeroen Bosch Hospital.

Since the assignment (2012) the role of the central practice teacher has continuously been expanding. For example participation in the recruitment and selection of student nurse practitioners and practice teachers got added.

Several factors have led to this expansion in the role of practice teacher, including issues of cost, the need to increase overview of quality of education and the skills of nurse practitioners.

Assessment of learning is considered to be essential and leads to the implementation of interprofessional education groups. Additionally the central practice teacher participates in an interprofessional education group with teachers from other hospitals. The aim is to reflect on and improve educational practice and skills.

Collaboration with teaching institutions, stakeholders and policy makers is organized on a regular base. Other tasks include monitoring student progress, recognizing educational barriers and stimulating behaviors that lead to improvement in education.

Summary

Best practices include the need for a central practice teacher and interprofessional programmatic infrastructure as key components for a successful teaching environment for nurse practitioners.

Conclusion/discussion

It is important that the central teacher has mandate in the selection process and the educational assessments.

Education
Best practice, central practice teacher, interprofessional programmatic infrastructure, teaching environment

Exploring preceptorship supports for nurse practitioner students in distance learning programs

Oral Presentation196Mary Ellen Andrews, University of Saskatchewan, College of Nursing, SASKATOON, SASKATCHEWAN, Canada

Mees ZaalTue 14:30 - 15:30

Objective: To discuss a quality improvement initiative to enhance support for Preceptors in a distance Nurse Practitioner (NP) program.

Background: There is a growing body of international literature exploring barriers and facilitators to NP student preceptorship, with distance education programs identified as a particular challenge (Roberts, Wheeler, Tyler, & Padden, 2017). Recognizing the importance of preceptorship support in facilitating student learning as well as preceptor satisfaction, retention and recruitment, the College of Nursing University of Saskatchewan has undertaken a quality improvement project to enhance preceptorship supports.

Methods: A review of literature was conducted to identify the current state of knowledge regarding supports for NP Preceptors. Based on the literature review and experience of NP faculty, an online survey was developed to explore preceptor perceptions of supports for supervising distance NP students. Preceptors of primary care NP students between 2013-2017 were sent an email invitation to participate in the survey. Results of the survey will be available in January 2018 and used in combination with accreditation standards, international research, and program data to develop a comprehensive preceptorship support program.

This study was reviewed and exempt by the University Research Ethics Board as a quality improvement project.

Results/New Knowledge: To optimally support preceptorship of NP students, individual (i.e. preceptor/student), program and external (i.e. clinical agency) factors must be jointly considered. While a variety of activities and interventions have been proposed in the literature to support Preceptors of NP students, an individualized needs assessment and evaluation is required to ensure the unique needs and outcomes of involved parties are addressed.

Summary: This study provides a Canadian perspective to a growing body of global research on NP student preceptorship, contributing to development of best practices for supporting NP preceptors and students in distance education programs.

Education
Best practice, Distance Education, Preceptorship, Primary care

Bridging gaps to addiction treatment with collaborative practice among advanced practice nurses

Oral Presentation159Dawn Williamson, Massachusetts General Hospital, Addictions Consultation/ED, BOSTON, United States of America

Plate ZaalTue 14:30 - 15:30

Introduction

Substance use disorders (SUD) are increasingly identified in patients presenting to health care facilities. An estimated 25 % of inpatient admissions have SUD as primary diagnosis. 10% of emergency visits are related to substance use.

Summary

In response to this epidemic an urban medical center identified SUD as a priority strategic plan. Advanced Practice Nurses (APRN) with specialization SUD treatment collaborated, to educate staff, motivate patients at risk, promote treatment options, and provide linkages to care.

In the Emergency Department (ED) an APRN evaluates patients with SUD and triages them to inpatient or outpatient settings. Admitted patients are seen by Additions Consult Team (ACT), led by an APRN. Treatment recommendations are made based on individual needs and desires. A key component is connecting patients with care in the community. For many patients, the gap between discharge and the next provider puts them at risk for recurrence of symptoms of SUD.

That connection is proved by an APRN in our outpatient low threshold addiction clinic. Open daily, the clinic provides pharmacotherapy, peer support services, individual therapy, groups, and nasal Narcan distribution.

Conclusion

The ED, ACT and clinic APRNs use innovative models of care to engage vulnerable and high risk patients. Strengthening care for this population decreases high utilization of services and provides supports for health and wellness. The length of stay for SUDs patients admitted was reduced by 0.75 days. APRNs not only provide treatment to patients but provide staff education to promote care of patients with SUD. Data showed decreased negative attitudes among staff and increased feelings of preparedness in treating patients with substance use disorder. The APRNs meet regularly to review treatment, evaluate outcomes and ensure best practices are integrated into patient care

Collaboration and Inter-Disciplinary Practice
Best practice, collaborative, treatment

Advanced practice nurses providing education to nurses working with patients with substance use

Oral Presentation157Dawn Williamson, Massachusetts General Hospital, Addictions Consultation/ED, BOSTON, United States of America

Plate ZaalTue 14:30 - 15:30

Substance Use Disorders (SUDs) contribute to more deaths and illnesses than any other preventable disease. Over 29 million people who use drugs are estimated to suffer from SUD. Clinicians receive limited education about SUD in training programs. Evidence shows that addictions education improves patient outcomes and decreases costs.

Purpose

Utilizing Advanced Practice Registered Nurses (APRN) to provide education and support to increase United States (US) and Tanzanian clinicians’ comfort levels and knowledge when caring for patients with SUDs.

Summary

Curriculum to promote professionalism in SUD treatment, developed by APRNs with expertise in SUD, was provided in both Tanzania and the US. Content included; SUD overview, epidemiology, neurobiology, stigma, associated morbidity, and treatment considerations. APRNs served as content experts, mentors, and trainers in comprehensive educational intervention. Attitudes and knowledge levels were examined before and after trainings. Measurement instruments used included; Drug and Drug Problems Perception Questionnaire 2.0 (DDPPQ 2.0), Knowledge Assessment Questionnaire (KAQ), and Clinician Attitudes Questionnaire (CAQ).

In the US 30 nurses from a variety of inpatient areas at an urban medical center participated. The Tanzania cohort consisted of 82 Nurses and 11 Physicians from four Hospitals.

US nurse attitudes became more positive on all domains of the DDPPQ 2.0 and was sustained for the domain of “Role Adequacy”. Average scores on the KAQ trended upward 10% from baseline. Tanzanian CAQ scores indicated positive changes in clinician attitudes at all sites.

Conclusion

Surveys at completion of education revealed positive trends in attitudes, comfort levels, and knowledge in the care of patients with SUD. Curriculum developed and implemented by Advanced Practice Nurses for this project has established benefits in educating both clinicians in the United States and Tanzania. The positive effects of providing support and education to clinicians about SUD were demonstrated and the evidence supports translation of findings into practice.

Education
Addiction, Education, Global

Bipolar and substance abuse: the experiences with a new group therapy

Oral Presentation151Arjan Brouwer, GGz Breburg, Netherlands

Plate ZaalTue 14:30 - 15:30

Background:

Bipolar disorder is associated with a high level of comorbidity with substance abuse problems (50% of the patients). Drugs and alcohol have a negative impact on the bipolar disorder and the other way around.

In the Dutch mental health system, there’s no treatment available yet that does justice to this specific comorbidity problem.

Group therapies are the most effective interventions for patients with a dual diagnosis.

‘Integrated Group Therapy for Bipolar Disorder and Substance Abuse’ (IGT) (Weiss & Connery, 2011) seems to be the only treatment program in the world that focusses specifically on both bipolar disorder and substance abuse.

Quantitative research has showed promising results in the USA, but IGT has never been practiced outside the USA and never has a qualitative research been executed.

The author has implemented a Dutch, slightly adjusted version of IGT at the bipolar disorder policlinics of GGz Breburg and he has executed a qualitative research focussed on the experiences of patients.

Objectives:

The results from this research will contribute to the further development of IGT in the Netherlands.

Methods:

Phenomenological research, in-depth interviews, convenience sample. N=5.

Results:

Four fundamental themes came up: 'personal development', 'peer support', 'relations with nearest and dearest' and 'process technical aspect of GBM'.

Conclusion:

There are encouraging signs that GBM could be a valuable asset to the integrated treatment of patients with a bipolar disorder and substance abuse in the Netherlands. However, participants didn't respond to having a different view on the comorbidity.

Innovation
bipolar disorder, group therapy, Mental health, Research, substance abuse

Caring for immigrant patient - pictures help communicating with non-native patient

Oral Presentation350Taina Suominen, Helsinki University Hospital, ESPOO, Finland

Ruys ZaalTue 14:30 - 15:30

Author: Taina Suominen

Instructor: Minna Elomaa-Krapu (PhD, Senior lecturer)

Caring for immigrant patient - Pictures help communicating with non-native patient

The purpose of the presentation is to describe linguistic barriers in caring and counseling immigrant patients with limited language proficiency. The second priority is to show how to overcome communication problems between nurses and immigrant patients with non-native language and improve care and quality of the immigrant patient care.

The study was implemented by the first three steps of the constructive method. The constructive method phases were 1) to define the clinical problem, 2) gather available research articles and 3) analyze the gathered data by using inductive analyse. Data was collected from literature and scientific surveys.

The results showed that immigrant populations with limited language proficiency didn’t generally receive sufficient treatment, care and advice. They had problems understanding oral and written instructions and reported negative experiences in health care. Nurses reported that they couldn’t fulfill the needs of the ethnic patients, nonadherence of immigrant patients and worried about delays in their work. Difficulties in communication could lead to misunderstandings and severe incidents. Professional interpreters were commonly used to cross difficulties in multicultural contexts. There were not interpreters for all languages available. Thus creativity is needed to cross the linguistic issues.

Health care systems worldwide have a huge challenge to provide culturally appropriate health care to immigrant patients. Immigrants are heterogeneous group of individuals with different kinds of needs, feelings and problems. They all need equal health care. Visual methods and pictures can help to overcome communication barriers and assist immigrant patient to participate.

It is necessary to ensure health care providers to have the skills needed to facilitate immigrant patients. Taking care of multicultural patients has also the idea of greater professional development.

Keywords: communication, immigrant, transcultural nursing

Research
Communication, Immigrant, Transcultural nursing

Contraceptive counselling to female eritrean refugees aged 15-25 in primary care in The Netherlands

Oral Presentation270Ellen van der Stelt, Gezondheidscentrum Asielzoekers Leersum, Leersum, BENNEKOM, Netherlands

Ruys ZaalTue 14:30 - 15:30

Worldwide, refugees are vulnerable to having unmet contraceptive needs. Eritreans are the fourth largest group of refugees in the Netherlands in 2017. A nurse practitioner working at a Dutch Healthcare Center for Refugees, and some of her colleagues, found that Eritrean refugees (<25 years) have limited knowledge regarding reproductive health, and regularly observed unintended pregnancies among Eritrean women. To improve contraceptive counselling to Eritrean refugees, and to increase their knowledge of reproductive health and contraceptives, research was carried out regarding the experiences of contraceptive counsellors with female Eritrean refugees. In 2017, semi-structured interviews were held by a nurse practitioner with ten healthcare workers from the Healthcare Center for Refugees who counselled female Eritrean refugees (15-25 years). Data was audiotaped, transcribed and analyzed. Healthcare workers explained that contraceptive counseling requires a proactive approach, multiple conversations and that it is important to build trust. Because communication is laborious the counsellors felt uncertain as to whether or not the information was understood. The counsellors indicated they have limited knowledge of the background of the Eritrean women, they do see that cultural knowledge is important when it comes to developing a bond. Various educational materials are used, which contraceptives are discussed differs per counsellor. The counsellors feel there is no collaboration between Public Health Services, who offer group counselling, and the Healthcare Center for Refugees, where the contraceptives are available. There is an area of tension experienced between the women’s personal responsibility and being proactive as Healthcare Center. Based on the experiences of contraceptive counsellors, improvements can be made regarding (1) specific knowledge of the target group’s culture and (non-verbal) communication with the target group, (2) consistency in the content of the counselling and the explanation of contraceptive methods, and (3) collaboration between the Healthcare Centers for Refugees and Public Health Services.

Research
contraceptive counselling, female Eritrean refugees, Prevention and public health, Research

Peer support group meetings: experiences of gay refugees in The Netherlands

Oral Presentation225Peter van der Voort, Gezondheidscentrum Asielzoekers, HEERHUGOWAARD, Netherlands

Ruys ZaalTue 14:30 - 15:30

Peer Support Group Meetings: Experiences of Gay Refugees in the Netherlands

Gay refugees are recognized as a vulnerable minority group by the Central Agency of Asylum Seekers in the Netherlands (COA). Gay refugees have a higher risk of developing psychological problems compared to the average Dutch population. Healthcare professionals working at the refugee centre in Heerhugowaard in the Netherlands, experienced that gay refugees hardly use healthcare facilities. When they visit the facility, they often report severe psychological problems. The Nurse Practitioner (NP) working at the refugee centre, initiated and implemented peer-support group meetings, based on literature, practical experiences and needs of gay refugees. The aim was to strengthen their social network, in order to reduce their vulnerability and to prevent psychological problems. The experiences with the peer support group meetings, and how these meetings might prevent psychological problems, will be presented.

The monthly peer-support group meetings were led by COA employees and started in October 2017. All gay refugees in Heerhugowaard were invited. The meetings started with an informal reception, followed by a discussion about a theme with a guest speaker. The meetings ended with questions and issues raised by the participants. After three meetings, semi-structured interviews were held by the NP with a maximum of 12 participants to explore their experiences. The interviews were audiotaped, transcribed and analysed using open, axial and selective coding.

The experiences of the participants and the NP with the first peer support group meeting in October 2017 were positive. Fourteen gay refugees attended this meeting. They got to know each other better, they shared knowledge and they discussed problems they encounter. According to the participants, the risks of social media to contact other homosexuals is an underestimated problem. The final results and conclusions are available in June 2018, and will be presented.

Changing healthcare and the role of the NP/APN
Gay Refugees, Peer Support Group Meetings, Primary care, Research

Delivering fit-for-purpose Advanced Practitioners

Oral Presentation326Gerry dr Lee, King's College London, Adult Nursing, LONDON, United Kingdom

Van Beuningen ZaalTue 14:30 - 15:30

Background

Advanced clinical practitioners increasingly provide patient care in a variety of acute and community settings. Much of their scope of practice involves tasks previously undertaken by physicians and in the UK, there has been a lack of consensus on the definition of advanced practice.

Objectives

To explore key stakeholders’ views regarding the training and education needs of advanced clinical practitioners and to identify perceived barriers and facilitators and to ensure our MSc was fit for purpose from both educational and clinical perspectives.

Design

A qualitative methodology was employed, using focus group discussions supplemented by individual semi-structured interviews.

Four focus group discussions and one individual interview were conducted with a total sample of 16 participants working in London, UK. Inclusion criteria were adults enrolled on an Advanced Practice Masters programme at one Higher Education Institution or advanced clinical practitioners from across two large London NHS hospitals.

Methods

Data collection via focus groups and interviews took place March-April 2017. Following transcription, audio-recorded data were imported into NVivo11 and subjected to a standard process of inductive thematic content analysis.

Results

Three key themes were identified: Recognising advanced practice; Education for Advanced Practice; Programme delivery. Findings highlighted the huge variation in titles, practice responsibilities and management structure, which make the development of a generic programme challenging and the importance of flexibility key to success.

Conclusion

At a time when public services are experiencing significant financial constraints, the need for improved collaborative practices, shared resources and a practice focus is vital to educating future advanced practitioners and this collaborative approach of working with industry partners and current/past students, demonstrates an inclusive strategy that will ensure a fit-for-purpose advanced practice Masters programme that includes a more clincially focused programme with empahsis on clinical competencies.

Education
advanced practice development, Curriculum, Research

The use of simulation in preparing advanced nurse practitioners for decision making around DNACPR

Oral Presentation430David Garbutt, University of Salford, School of Health and Society, MANCHESTER, United Kingdom

Van Beuningen ZaalTue 14:30 - 15:30

Introduction

The use of clinical simulation to aid complex decision making for nurses is an established component in nursing education programmes (Cant and Cooper, 2010). This study sought to explore the effectiveness of High Fidelity Simulation (HFS) as an educational tool to prepare Advanced Nurse Practitioners (ANPs) in the clinical decision making and management of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders.

An end of life HFS programme (©EndoLSim) has been developed at the University of Salford and was utilised as an experiential educational intervention for ANP students to explore the nature of DNACPR decision making within their clinical role. The aim was to explore the effectiveness of this approach in equipping ANP’s with the appropriate level of knowledge and understanding of the DNACPR process and their preparedness and perceived self-efficacy in communicating effectively with patients and their relatives around such a complex and emotive issue.

The project objectives were to:

explore the experience of attending an EoLC High Fidelity Simulation for ANP students and how HFS facilitates learning.

capture ANP’s views on the development of competence in relation to DNACPR priorities.

explore ANP’s views on the transferability of competencies to clinical practice

A qualitative, exploratory design utilising a focus group with a semi structured interview format was employed to gain insight into the experience of attending an EoLC HFS simulation. Data was collected through digital audio recording and the responses transcribed.

Analysis is ongoing with the results to be published.

Conclusion

The study will provide knowledge and insight into how best to prepare ANP’s to make sound legal and ethical decisions in relation to the management of dying patients and will guide the future development of the use of HFS within the University by eliciting the main factors influencing the student experience when undertaking such simulations.

Education
DNACPR, Research, resuscitation

Development of nurse practitioner role in emergency care: a framework based action research project

Oral Presentation498Erika Boman, University College Southeast Norway / Åland University of Applied Sciences, Nursing, MARIEHAMN, Finland

Van Beuningen ZaalTue 14:30 - 15:30

Previous research shows that nurse practitioners (NPs) can fulfil a valuable role in emergency care. This fact has enticed management in an emergency department (ED) in Norway to develop and implement ANP role in cooperation with clinical field, patients, and higher education. However, the NP role in Norway is in its infancy and implementing a new role in the health care system can be challenging. The aim of this study was to describe the development of an NP model in an ED in Norway by using the PEPPA framework; a participatory evidence-based patient-centred process founded in participatory action research, describing nine steps for development, implementation and evaluation of NP role and practice. This paper involves the first five steps: 1. Defining patient population and describing current model of care; 2. Identify stakeholders; 3. Determine need for a new model of care; 4. Identify priority problems and goals; 5. Define the new model of care and NP role. Data has been collected through semi-structured interviews (n=16), observations (40 hours), work-shops (n=5), and through readings of work descriptions, statistical reports and Grey and scientific literature. This paper includes a description of the development process of new NP role in emergency care; suggesting areas for NP implementation and demonstration of the applicability of the PEPPA framework. It is concluded that there is a need of new models in emergency care and the NP role is understood to be a valuable part in that puzzle. However, NP role and scope of practice must be clearly defined before implementation. Further, it is concluded that implementation of NP role is a balancing act between using NP competence to the fullest and starting in a small scale; initially planned to involve non-urgent patient cases with extensive care needs.

Research
Emergency care, Research

Nurse practitioners breaking barriers

Oral Presentation560Chinwe Ekweariri, Texas Woman's University, HOUSTON, United States of America

Van Cappellen ZaalTue 14:30 - 15:30

The purpose of this presentation is to contrast infant mortality rates in the United States with different parts of the world and propose a solution. We will discuss how early access to healthcare through an increase in nurse practitioner presence can improve these figures.

Infant mortality is a predictor of a country's health status. Yearly, infant mortality is calculated based on the deaths per 1,000 births that occurs under one year of age in a specific geographical area. In 2013, the United States infant mortality rate (IMR) was 6.0 per 1000 live births (Mathews, MacDorman, and Thoma, 2015). While in other developed countries such as the Netherlands the rates were 4.0 per 1,000 live births (CDC, 2010). The United States ranked 26th in infant mortality among the Organization for Economic Co-operation and Development countries (CDC,2010). Major barriers that mothers in the United States face include poverty and access to healthcare. It is our belief that if the United States partnered with the World Health Organization (WHO) to standardize care received by expecting mothers, the infant mortality rate would decrease. To achieve this goal healthcare must be more accessible. Multiple teams of nurse practitioners, working from mobile units, would disperse into the communities and provide prenatal care such as taking complete history and physical exams, ordering blood work, ultrasounds, perform STD screening and testing to pregnant women. The WHO currently has statistics on the mortality rates worldwide, yet no solution.

To conclude, our proposition would be for the World Health Organization to maintain a committee that standardizes the healthcare of pregnant woman in the United States and in the future, varying nations, by first improving infant mortality rates. We believe this can be achieved through the use of mobile nurse practitioner teams.

International developments and collaboration
Breaking Barriers

Evidence based nursing in nursing homes, the evidence project

Oral Presentation352Marleen Lovink, HAN University of Applied Science, Netherlands

Van Cappellen ZaalTue 14:30 - 15:30

Introduction statement indicating purpose of presentation

Although the attention on evidence based nursing (EBN) has grown, the nursing staff in nursing homes has difficulties to actually apply EBN in daily routines. It is hypothesized that an EBN culture positively contributes to the quality and safety of care. This project aims to enable the care teams in nursing homes to apply EBN.

Brief description of pertinent research or other methods adopted

EBN is being implemented in 3-4 teams of 4 nursing homes, by Practice Development approach. The teams (nursing assistants and vocational nurses) choose a nursing theme on which they will apply the principles of EBN. This process is facilitated by internal coaches (baccalaureate and master educated nurses) employed by the nursing homes and 2 external coaches (teachers in nursing). Data collection at baseline and at 15-months consists of: 1) nursing discipline questionnaires about EBN knowledge, skills and attitude, 2) patient and family satisfaction questionnaires, 3) interviews with managers and care providers regarding EBN infrastructure and influencing factors, and 4) nursing sensitive outcomes, dependent on the themes.

Summary of new unpublished data and/or other relevant information

At the moment baseline measurements are completed. The baseline results show that the nursing teams are open to EBN, but because of a lack of time, research culture, access to relevant sources, and staff shortage, EBN is not always (consciously) applied. The results also show that clients and family are satisfied with the usual care received. The results of the baseline measurements are presented as feedback to the teams during the project kick-off meetings.

Conclusion

Baccalaureate and master educated nurses may be key in implementing EBN in nursing homes. Starting point of the team coaching may be a discussion of measurements on EBN knowledge, attitude, skills, EBN infrastructure, influencing factors and patient satisfaction.

Evidence based clinical practice/scientific research
Elderly care, evidence based nursing, nursing home, Research

Yes we can! Nurse Practitioners in Dutch nursing homes bridge the gap between cure and care

Oral Presentation282Inge Rinzema, Netwerk VS VPH/ZINN gezondheidszorg, Netherlands

Van Cappellen ZaalTue 14:30 - 15:30

Introduction

As the prevalence of multimorbidity increases with age, the long-term medical and nursing care in Dutch nursing homes is becoming more complex. The population in nursing homes is ageing. The frail residents have a changing demand for care; quality of life is pre-eminent¹. A new definition of health is accepted and the focus has shifted from disease and illness to well-being and quality of life. This requires treatment in which cure and care are combined in order to empower the frail elderly and meeting their wishes².

Brief description

Physician substitution to NP’s has shifted the focus of healthcare from being (totally) medical-oriented to a more holistic treatment. The NP acts as an essential link providing both cure and care. There is still a great variety in the NP deployment³. This workshop shares two examples of best practice regarding the role of NP’s in Dutch nursing homes.

Summary of relevant information

Physician substitution to NP’s in healthcare in Dutch nursing homes may achieve as least as good patient outcomes compared to care provided by physicians4;

The presence of NP’s in nursing homes increases the quality and the accessibility of healthcare5.

Conclusion

NP’s in Dutch nursing homes are an important link in bridging the gap between cure and care. They improve the quality of healthcare for the frail and ageing population and ensure a shift in healthcare from disease and illness to well-being and quality of life. This calls for further fine-tuning and description of best practice.

Changing healthcare and the role of the NP/APN
Best practice, cure and care, Dutch nursing homes, Elderly care, physician substitution to nurse practitioner

Establishment and practice of nurse-led clinics in tertiary hospitals in China: a national survey

Oral Presentation100Shu Ding, Beijing Chao-yang Hospital, Capital Medical University, China

Van Weelde ZaalTue 14:30 - 15:30

Objective: To investigate the establishment and advanced nursing practice status of nurse-led clinics in tertiary hospitals in China. Method: A convenient sampling of 330 tertiary hospitals was conducted using a self-designed questionnaire, covering 19 provinces (autonomous regions and municipalities) in China. Results: Totally 926 nurse-led clinics were established. The top five clinics were Peripherally Inserted Central Catheter (PICC) care, wound / stoma / incontinence care, diabetes mellitus health education, perinatal care and peritoneal dialysis care. In total, there were 2701 registered nurses working in the nurse-led clinics. Among them, 81.2% had a bachelor or higher degree of nursing. Specialist nurses qualification authentication of health administration departments or nursing academic associations were necessary for clinic nurses, comprised 55.8% and 55.2% of cases, respectively. 61.2% of hospitals had set up the charging expense for diagnosis and treatment in nurse-led clinics. Notably, 82.1% of them emphasize that a lack of supporting policies was the main difficulty when establishing clinics, while 73.6% reported the major barrier to operate nurse-led clinics was a lack of explicit charge standard. Conclusions: Nurse-led clinics in China experience a rapid growth. The effectiveness of nurse-led clinics in service delivery and clinical outcomes are expected. It is suggested that relevant regulations and policies should be set up, in order to improve the practice environment and facilitate the sustainable development of nurse-led clinics in China.

Changing healthcare and the role of the NP/APN
advanced nursing practice, Best practice, Nurse-led clinics, Prevention and public health, survey

Develop a personal strategic plan to enhance/guide your leadership skills: learn it & apply it today

Oral Presentation18Maria Kidner, LocumTenens/Essentia Health Care, CT surgery, CHEYENNE, United States of America

Van Weelde ZaalTue 14:30 - 15:30

Values drive behavior and the values one accepts drive acceptable behaviors.. The use of strategic planning for an organization is well understood as fundamental for organizational success. However, have you considered your personal set of values, vision statement, or mission? If we, as leaders and nurses cannot express our personal set of values that we uphold every day and drive our behavior, then how do we develop trust with others? If we do not have a personal vision statement, then how do we know where we are going in life? If we do not have a mission statement that guides us, then how do we expect to be leaders that can make a change and mentor others to success? A personal strategic plan can, and should be made. Then, it should be reviewed daily. Strategic planning is usually thought to be a process for business products, teams, or organizations. However, the same process can be used to develop a personal strategic plan. The process for personal strategic planning is often left for high-ranking leaders. However, if you start a plan now you will have greatly improved leadership skills and be able to develop a high level of trust with whom you work and mentor. This presentation utilizes the foundational concept of LEAP: A Leadership-Mentor Partnership of personal values, vision and mission to help guide participants through the process to develop a personal strategic plan to start transforming their leadership skills and building trust. This process can then be used for teams, problem management, short-term and long-term projects, and organizations. A personal plan of values, vision, and mission will set your foundation and help you find courage and achieve your dreams.

Leadership
Leadership, Personal strategic plan, Personal Values

Leadership experiences of London-based advanced nurse practitioners: a case study

Oral Presentation15Claire Anderson, University of West London, College of Nursing Midwifery and Healthcare, MIDDLESEX, United Kingdom

Van Weelde ZaalTue 14:30 - 15:30

Purpose: The National Health Service (NHS) is widely applauded as the highest quality healthcare system in the world (Grint and Holt 2011). However, there have been many changes to healthcare provision in the UK in the last eight years. These included the introduction of the Health and Social Care Act (2012) in response to rising costs and increasing clinical delivery demands on the National Health Service (NHS). Later the Mid Staffordshire Public Inquiry (HM Government 2013) identified failings in leadership throughout the NHS. These failings were linked to leadership lacking clear definition across all healthcare professions (HM Government 2013). The role of the Advanced Nurse Practitioner (ANP) is seen as part of the solution to this leadership dilemma.

This presentation will explore how eight London-based ANPs define, understand, express and enact their leadership practice.

Brief description: Using a case study methodological approach, each participant ANP expressed views on their leadership practice were considered individually and then comparatively.

Summary: The findings focused around five themes. How the ANP viewed their leadership role and whether this was from within or at the forefront of the multidisciplinary team, their ‘placement on the leadership pyramid’. The leadership position the ANPs often adopted was empowering and ‘motivating the team’. The ANPs had a strong nursing identity, which, at times, they would relate to, by ‘retreating to the safety of the nursing profession’.