Introduction INTRODUCTION: BURDEN OF CHRONIC DISEASES. The prevalence of chronic noncommunicable

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1 Capacity Building of Advanced Practice Nurse Through Residency Training Program in Thailand : A Challenges to Improve Prevention and Management of Chronic Conditions Introduction INTRODUCTION: BURDEN OF CHRONIC DISEASES The 3 rd International Conference on Prevention and Management of Chronic Conditions Panel 5: Future Direction for Prevention and Management of Chronic Conditions pm. 27 February 2015 Jariya Wittayasooporn RN; DNS.; Dilp. Board of APPN Introduction The prevalence of chronic noncommunicable diseases mainly from cardiovascular disease, cancer, chronic respiratory disease and diabetes has increased over time. Outline Introduction: Burden of Chronic Diseases Role of APNs in Prevention & Management of Chronic Conditions Capacity Building of APNs through Nurse Residency Training Programs

2 Introduction Nurses is a vital role in prevention and management of these chronic diseases. Today I will focus on role of Advanced Practice Nurses APNs Introduction Thirty-eight million people die each year from NCDs, over 14 million deaths from NCDs occur between the ages of 30-70, of which 85% are in developing countries. Introduction Role of APNs ROLE OF APNS IN PREVENTION & MANAGEMENT OF CHRONIC CONDITIONS This dramatic change contributes significant to disease burden, low and middle income country already bear 86% of the burden of these premature deaths, resulting in cumulative economic losses of US$7 trillion over next 15 years and millions of people trapped in poverty.

3 Role of APNs in Prevention & Management of Chronic Conditions Nurse Residency Training Programs CAPACITY BUILDING OF APN THROUGH NURSE RESIDENCY TRAINING PROGRAMS Long Term nature of chronic disease pose special challenges for health care provider particularly APNs. It is anticipate that the burden of chronic disease will continue to rise in future years and that APNs will challenges to cope with this situation. Capacity Building of APNs Through Residency Training Program Capacity Building Nurse Residency Training Programs USA Thailand Role of APNs in Prevention & Management of Chronic Conditions Evidence Based demonstrate that APNs can improve health outcome of patient with chronic conditions. Thus capacity building of APNs is a crucial significant.

4 What is the capacity building? The UNDP defines capacity building as a longterm continual process of development that involves all stakeholders; including ministries, local authorities, non-governmental organizations, professionals, community members, academics and more. Capacity building CAPACITY BUILD :DEFINITION What is the capacity building? The goal of capacity building is to tackle problems related to policy and methods of development, while considering the potential, limits and needs of the people of the country concerned. The UNDP outlines that capacity building takes place on an individual level, an institutional level and the societal level. [1] What is the capacity building? Capacity building is a name for the familiar concepts of community and workforce development. Capacity building taps into existing abilities of individuals, communities, organisations or systems to increase involvement, decision-making and ownership of issues.

5 The level of capacity building? Societal level the establishment of a more "interactive public administration that learns equally from its actions and from feedback it receives from the population at large." Community capacity building must be used to develop public administrators that are responsive and accountable. The level of capacity building? Individual level requires the development of conditions that allow individual participants to build and enhance knowledge and skills. It also calls for the establishment of conditions that will allow individuals to engage in the "process of learning and adapting to change. The level of capacity building? Capacity building can start from the inside with the individual and then spread through the community and organisational levels to the outer systems level. It may start with outer systems first until it eventually reaches the individual. This presentation focus on individual level of Advanced Practice Nurses through 3 years Nursing Residency Training Program The level of capacity building? Institutional level involve aiding institutions in developing countries. It should not involve creating new institutions, rather modernizing existing institutions and supporting them in forming sound policies, organizational structures, and effective methods of management and revenue control.

6 Nursing Residency Training Programs (NRTPs) in USA Endorsement from large advisory agencies The Joint Commission (2002) and The Carnegie Foundation (Benner, 2010). The Institute of Medicine (IOM, 2010) (Jim Hansen 2013) Capacity building NURSE RESIDENCY TRAINING PROGRAMS IN USA The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) exists to "examine the capacity of the nursing workforce to meet the demand of a reformed health care system...with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system Nurse Residency Training Programs NURSE RESIDENCY TRAINING (NRTPS) IN USA : A CRITICAL PART OF THE FUTURE OF NURSING

7 The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) New nurses are required to use a set of professional competencies that may not have been fully developed during nursing school, an NRTP offers an extended opportunity to reinforce and test core competencies in real-world settings that are both safe and monitored The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) It seek to reconceptualize the role of 21st century nurses and attract and retain wellprepared nurses in the diverse care settings that are a permanent feature of American health care. The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) a targeted set of specific recommendations that the IOM "believes has the potential for greatest impact and can be accomplished within the next decade The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) The competencies of professional nurses are rapidly changing, nursing education must "adopt a framework of continuous, lifelong learning that includes basic education, residency programs, and continuing competence

8 NRPs ACROSS ALL PRACTICE SETTINGS Most NRTPs have emerged in larger hospitals and acute care systems. an area of greatest need. acute care facilities often have larger operational budgets and see the direct financial impact of high turnover rates among new graduate nurses because of a mismanaged transition into practice The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) Recommendation:-Implement NRTPs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses' completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas NRPs ACROSS ALL PRACTICE SETTINGS Nursing and healthcare practice will continue shifting from hospital-based to communitybased settings, requiring nurses to develop greater expertise in chronic illness management, gerontology, and transitional services. The Future of Nursing: Leading Change, Advancing Health. Report (IOM, 2010) The first action steps:- implement them across "all practice settings"; fund them in a sustainable, long-term manner; evaluate and research their effectiveness

9 NRTPs ACROSS ALL PRACTICE SETTINGS A formal NRPs for APNs at the Community Health Center in Connecticut to provide the training and transition support needed to become a competent primary care provider NRPs ACROSS ALL PRACTICE SETTINGS APNs will continue to expand into community based and acquire a greater share of the overall primary healthcare burden. "essential that residency programs outside of acute care setting be developed and evaluated NRTPs for advanced practice nurses as well as for new graduates who begin their careers in nonhospital settings. THE NRTP COLUMN In making the appeal to implement NRTPs, supported by a level of evidence necessary to warrant its implementation currently available is sufficient to guide or motivate implementation NRPs ACROSS ALL PRACTICE SETTINGS NRTPs for newly licensed nurses; the Visiting Nurse Services of New York (homebased nursing), the North Carolina State Health Department (public health nursing), and the Milwaukee, Wisconsin Center for Nursing (public and community health).

10 Rational for Developing NRTPs in Thailand Improving our nursing image similar as other health care provider such as Physician, Dentist and Pharmacist Previous Master s Degree in nursing earn more than 42 credits, different from other discipline (36 Credits) THE NRTP COLUMN Hospitals needs to understand the true costs of such programs, as well as the key ingredients for their success Health care organizations that offer nurse residency programs should evaluate the effectiveness of the residency program in improving the retention of nurses, expanding competencies, and improving patient outcomes Rational for Developing NRTPs in Thailand Need Nursing Residency Training for Master s degree prepare in nursing University Education focus more on Scientist or researcher Provide opportunity for nurses who earn master s degree in nursing already to train more in the program which recognized equally doctoral prepare. Capacity building NURSE RESIDENCY TRAINING PROGRAMS (NRTPS) IN THAILAND

11 Specialty in NRTPs 1. Medical Surgical Nursing Specialty 1.1 Chronic Care and Disability 1.2 Acute and Critical Care 1.3 Oncology Emergency and T Number of APN(Master s Prepare) = 1, Perinatal Nursing =50 2. Community Health Nursing = Medical-Surgical = Pediatric Nursing = Psychiatric Nursing&Mental Health =213 College of APN Aug Specialty in NRTPs 2. Pediatric Nursing 2.1 Chronic Care and Disability 2.2 Acute and Critical Care 2.3 Newborn Care 2.4 Well Child Care and High Risk Group Number of APN(Master s Prepare) = 1, Aging Nursing = Midwifery =24 8. General Nurse Practitioner= Infection Nursing Anaesthetic Nursing 162 College of APN Aug. 2012

12 Nurse Residency Training Program in Thailand: Main Objectives Develop Essential Competency for APN ; Leader in Nursing Service; Faculty Practice Skill in Clinical Practice Evidence Based Practice Leadership/ Change Agent System Thinking & Approach Involvement in Policy Specialty in NRTPs 3. Psychiatric Nursing& Mental Health 2.1 Child & Adolescent 2.2 Adult & Aging 4. Gerontology 4.1 Long Term Care 4.2 Acute and Critically Ill 5. Midwifery Nurse Residency Training Program in Thailand: Main Objectives Improve Nursing Service and Health Outcome of Population Empowerment Leadership/ produce change agents Specialty in NRTPs 6. Community Nursing 6.1 Nurse Practitioner 6.2 School Health 6.3 Health System 7. Infection Nursing 8. Anesthetic Nursing

13 Compare & Contrast Nurse Residency Training Program in Thailand: Main Objective NRTPs An intense practice immersion experience with expert clinical faculty or APN PhD An intense mentored research experience with a faculty investigator with an established funded program of research Improve health of population Evidence-Based Practice/ Transform empirical knowledge, ethic/ code of practice, aesthetic knowledge and personal/tacit knowledge to practice Empirical knowledge: new knowledge research, innovation, technology and intervention Develop system of care for improving quality care and health outcome. Nurse Residency Training Program in Thailand Launched 1 st Cohort in Feb 2014 Medical Surgical Nursing at Ramathibodi School of Nursing Psychiatric Nursing at Chulalongkorn University Expanded 2 nd Cohort in Feb 2015 Pediatric Nursing & Community Health Nursing at Ramathibodi School of Nursing Compare & Contrast NRTPs/Diplomate Board.. Transform Knowledge & Research to Practice Establish innovation of nursing service Change Agent in Nursing Practice/ Nursing Administrator PhD Develop New Knowledge/Theor y/innovation Scientist

14 Change Agents Essential competency: good vision; using power/authority in appropriate way; motivate people and management skill. Leading to change in organization and society in policy and health system Clinical Practice Theory / Research Based Practice Direct Care: Interact with Patient as individual, family or group level focus on system, management, and policy Indirect Care: Teaching/coaching/doing research/ supervise Patients families and staffs NRTPs Structure 3 years ; 92 Credits Core: 9 Credits =135 hours Specialty: 9 Credits =135 hours Nursing Residency 50 Credits =3,000 hours one research publication=24 Credits Evidence Based Transform empirical knowledge, ethic/ code of practice, aesthetic knowledge and personal/tacit knowledge to practice

15 Research 1) Doing research focus on improve quality outcome. 2) Major Advisor from School of Nursing, Coadvisor may be from School of Medicine or APN in practice setting 3) Oral Presentation 4) Publication in Peer review journal (ISI/ TCI,Thai Journal Citation Index) Core Courses 1. Leadership in Complex Healthcare System 3 Credits 2. Evidence-Based Practice 2 Credits 3. Health System, Health Policy, Healthcare Information System 2 Credits 4. Outcome Measurement and Management in Healthcare Delivery System Host of NRTPs School of Nursing : Host University Hospital : Co-host Nurse Residency Training Full Time Training 1 st year: Advanced Practice in specialty 2 nd year: Advanced Practice in popular of interest 3 rd year: Integrated Advance Practice and Research Fellowship

16 Conclusion Although Nurse Residency is a critical part of the future of Nursing, but it is still young and insufficient. Capacity Building of APNs through Nurse Residency Training Programs needs more attention not only at individual level it should be encourage in Institutional level and also Societal level Examination Written Examination Oral Examination Clinical practice Examination Nursing Education/Training and Career Path in Thailand Human resources development CNEU Diplomate, Thai Board of Advanced Practice in Nursing 3 years Residency Training Program/ 4-6 years experience + pass examination 4 months Specialty Training Baccalaureate Program Doctorate Degree in nursing + experience + Master s pass examination degree Credits/ Credits Specialist Nurse Register Nurse

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