QUEEN S NURSING INSTITUTE OF SCOTLAND FINAL PROJECT REPORT

Transcription

1 QUEEN S NURSING INSTITUTE OF SCOTLAND FINAL PROJECT REPORT Development of a Virtual Learning Resource to Support Advanced Nurse Practitioners Working in Remote and Rural Islands within NHS Orkney.

2 Project Team: Caitrian Guthrie Senior Lecturer (Professional Development) School of Nursing and Midwifery Robert Gordon University, Aberdeen Lynne Croy Community Nursing Team Manager NHS Orkney Steve O Brien Director of Academic Programmes/Associate Head of School School of Nursing and Midwifery Robert Gordon University Aberdeen. Acknowledgements The project team would like to acknowledge the financial support provided by QNIS and to thank them for their ongoing support throughout the project. We would also like to thank the advanced nurse practitioners from NHS Orkney for their invaluable contributions to the project, particularly for their guidance on content.

3 Executive Summary Project The project represents a collaboration between NHS Orkney and the School of Nursing and Midwifery, Robert Gordon University, Aberdeen. It is part of a wider collaborative project between the two organisations aimed at developing a work based educational initiative to prepare community nurses in Orkney to undertake new roles within island communities. Aim To produce a virtual learning resource to support the continuing professional development of advanced nurse practitioners with a special interest in remote and rural primary healthcare. Process Individual and group interviews were held with key stakeholders in NHS Orkney to determine the needs of both the organisation and the individual advanced practitioners. Based on these identified needs, a virtual learning resource was developed. Further individual interviews were held with the advanced practitioners to ensure that the resource was appropriate and amendments were made based on the outcome of this evaluation. The resource was developed jointly by staff from NHS Orkney and the School of Nursing and Midwifery, Robert Gordon University, with external support in relation to the e-learning technology and clinical skills filming. Key Outcomes development of a customised virtual resource for advanced practitioners working in remote and rural island settings within NHS Orkney development of a range of problem based learning scenarios covering healthcare across the lifespan and across the potential healthcare needs of a remote island community production of clinical skills video clips based on the identified continuing professional development needs of advanced practitioners working on remote and rural islands in Orkney compilation of a digital repository which allows access to contemporary research/literature; relevant web sites; recommended readings; NHS protocols and guidelines. Conclusions Whilst it is not claimed that online learning completely meets the continuing professional development needs of advanced practitioners working with remote and rural island communities, it would appear that this learning resource has the potential to contribute significantly to their learning. The learning resource should be viewed as a dynamic and evolving entity that will require regular review and updating. The resource has been developed and customised in response to the educational needs of a specific group of advanced practitioners employed by NHS Orkney. Its use with other advanced practitioners and those working in different remote and rural contexts may require further development. Implications for Practice Effective use of the learning resource will allow practitioners access to up-to-date, contemporary material relating to practice. In order to ensure the resource retains its currency, organisations will require to identify a key individual to take responsibility for the maintenance and updating of the included material. What Next? A number of Scottish health boards have expressed an interest in using the resource. This will require further development work to be undertaken.

4 PROJECT REPORT Introduction The project involves the development of a virtual learning resource to support the role of advanced nurse practitioners working in isolation on remote and rural islands in Orkney. It is anticipated that the learning resource produced will be a valuable commodity for the increasing number of community nurses undertaking advanced and expanded roles within remote and rural contexts throughout Scotland. Background NHS Orkney workforce planning had identified a need to prepare a number of suitably qualified and experienced community nurses to work as advanced nurse practitioners with a special Interest in remote and rural primary healthcare. The need for this role emerged from national policy drivers, which support the need for healthcare services designed around community needs and with a focus on health improvement and wellness, and a local need to create a sustainable and safe model of service delivery for remote and rural island communities. NHS Orkney undertook a very detailed analysis of its primary care service delivery to these island communities and recognised that the current model, based around General Practitioner services, is no longer financially viable or professionally appropriate. Demographic changes, along with an increase in long term conditions, were identified within this analysis and it is clear that services delivered using the current care module fail to respond adequately to changing healthcare demands. It is believed that an advanced nurse practitioner with a special interest in remote and rural primary healthcare can provide an alternative model of service delivery which would ensure future sustainability. The change means that some island communities will no longer have 24 hour GP cover and healthcare services will be maintained by an advanced nurse practitioner. This will result in a more sustainable primary care service for patients living on remote and rural islands in Orkney. The nurse practitioners providing the new service will have a greater public health focus, with increased health outcomes for the population. Options for service redesign are currently in the public consultation and appraisal process but there is no doubt that a change in service delivery is required as the current model is unsustainable in terms of both economic and human resources. Professional and public consultation has taken place with regard to the change in service. NHS Orkney had employed four advanced nurse practitioners with the required knowledge and skills to provide the new service. NHS Orkney also currently employs District Nurses and experienced community staff nurses who could be prepared to undertake the role of advanced nurse practitioners in the future. The practitioners fulfilling this advanced role will be the sole healthcare practitioner on the island but will have the support of a wider interdisciplinary team. The overall project, undertaken as a collaborative initiative between NHS Orkney and the School of Nursing and Midwifery, RGU, of which this development was one element, aimed to provide the underpinning educational knowledge and clinical expertise to enable practitioners to fulfil this new and innovative advanced practice role whilst, at the same time, meeting the healthcare needs of island communities. In the pilot phase of the project, four practitioners are participating in the necessary continuing educational and clinical preparation, whilst concurrently undertaking their new roles. These practitioners come from varied clinical backgrounds but all have extensive clinical experience. Only

5 one of the appointed nurses, however, has expertise working in a remote and rural island context. QNIS project funding was obtained for the development of a virtual learning resource to support the ongoing continuing professional development of advanced nurse practitioners working in isolation in remote and rural locations. These nurses have undertaken the educational courses required to enable them to fulfil the role of an advanced nurse practitioner. However, it is suggested that, in order to maintain the high levels of decision making and clinical judgement essential for working at this level of practice, nurses need the opportunity to consolidate and practise skills which, although essential, may not always be used on a routine basis. Advanced nurse practitioners working in isolation in remote and rural locations have to demonstrate a breadth of clinical judgement and expertise not required by other practitioners working in less remote settings. They are working with clients across the age span and with a wide range of healthcare needs. The virtual learning resource will allow them to consolidate and develop their skills within a safe environment. This virtual environment had been customised to suit the learning needs of practitioners working within a remote and rural context. Staff accessing the virtual learning environment have been offered the opportunity to use their work as credit towards a work based educational module at Masters level. Aim To produce a virtual learning resource to support the continuing professional development of advanced nurse practitioners with a special interest in remote and rural primary healthcare. Initially, this resource has been tailored to meet the specific needs of NHS Orkney but it is envisaged that the resource will be applicable across a range of remote and rural healthcare settings. Objectives development of a customised virtual resource for advanced practitioners working in remote and rural island settings within NHS Orkney development of a range of problem based learning scenarios covering healthcare across the lifespan and across the potential healthcare needs of a remote island community. These focus on advanced decision making and clinical judgement skills. production of clinical skills video clips based on the identified continuing professional development needs of advanced practitioners working on remote and rural islands in Orkney compilation of a digital repository which allows access to contemporary research/literature; relevant web sites; recommended readings; NHS protocols and guidelines. Project Implementation Initial planning took place based on discussion with NHS Orkney community nurse leads. At this stage in the process, no appointments had been made to the advanced practice roles within NHS Orkney. This identified three main areas for development, that is, problem based clinical learning scenarios, video clips of clinical skills and a digital repository. A variety of clinical learning scenarios were developed across a range of clinical settings. These settings reflect the contexts within which the advanced nurse practitioners will be delivering care and include the following:

6 Home Setting elderly patient with increasing breathlessness middle aged man with chest pain confused elderly patient lady with multiple sclerosis who has developed swollen leg Healthcare Setting child with rash asthmatic child young female with acute abdominal pain menopausal woman with headache baby with fever External Community Setting young adult hiker with head injury middle aged man, fallen, smelling of alcohol diabetic collapse depressed patient who is at potential risk of suicide minor road traffic accident These were developed as interactive learning scenarios, with a focus on the practitioner s clinical judgement and decision making skills. A PowerPoint presentation, with voiceover, introducing the concept of clinical judgement and decision making was also included, along with further recommended reading. At this stage in the process, four advanced nurse practitioners were appointed by NHS Orkney and consultation took place with these individuals with regard to the potential content of the clinical skill videos and the digital repository. The project team had anticipated that the videos would concentrate on reinforcing and reviewing the advanced clinical assessment and examination skills required of a nurse practitioner at this level. However, the nurses interviewed felt very confident in these skills and indicated that their concerns were around more basic nursing skills that they were not required to use on an everyday basis. All of the nurses also expressed concerns about dealing with acute coronary syndromes and with breathless patients, and this was taken into account when developing the library of video clips and the digital repository. The focus for the video clips is very much on the maintenance of clinical skills. However, what emerged from the practitioner interviews was the need for a one stop virtual resource that would give them access to up-to-date material immediately. The practitioners were confident that they could access research and literature effectively but the range and scope of their roles meant that this could be very time consuming. They identified three distinct nursing roles that they undertook in practice - public health nurse, emergency nurse practitioner, and community nurse - and also felt that they fulfilled a very important social care role within their island communities. The digital repository has been developed to support the advanced practitioners in undertaking these roles and has been arranged under a number of key themes. These are: Advanced Practice Clinical Skills examination and assessment cardiac

7 respiratory acute abdomen long term conditions management wound management immunisations [NB These were the areas of clinical practice identified as being most valuable to these particular practitioners. It is acknowledged that different nurses will have different needs and that the resource may need to be amended accordingly for use with other groups of practitioners]. Protocols and guidelines Competency/capability frameworks Useful general resources Initially, it was intended to host the resource on the University s virtual learning environment. However, this was problematic in terms of access and maintenance. The possibility for hosting on NHS Orkney s intranet was then explored but this did not appear to be a feasible option. A decision was taken, therefore, to offer the resource in CD format. Whilst this has obvious benefits in terms of accessibility, it does mean that updating and maintenance of the resource will be more difficult. A disclaimer has been added to the resource indicating that it is current only at time of production. NHS Orkney will have access to the files containing the resource materials so that these can be updated as, and when, required. Ongoing evaluation of the resource will take place as part of the wider collaborative project remit. There have been issues around the retention of the initially appointed advanced nurse practitioners within the health board, with two of the appointed nurses having moved to different posts. One of these nurses was particularly instrumental and valuable to the evaluation process and provided very useful feedback on the resource which has been used to amend and further develop the content. What we have learned and what we would do differently NHS Orkney has been going through a transitional phase, both in terms of management structure and service delivery, and this has, at times, had implications for the project progression. One member of the initial project team was seconded to another management role almost immediately on commencement of the work and the remaining community nurse leader has also changed role. The continuing commitment of that individual to the project, despite her move into a different post, is to be commended. The main lesson learned was not to make assumptions about what practitioners want. The project team had definite ideas about the content of the virtual learning resource which, when they consulted with the advanced nurse practitioners who would be using it, transpired to be very different from those of the practitioners. It was not possible to interview the nurses prior to project commencement as they had not been appointed but, had it been possible, valuable time might have been saved and the content more accurately planned from the outset. Conclusion The project has resulted in the development of a virtual learning resource, available to practitioners in CD format. Whilst originally devised for use within NHS Orkney, the material contained in the resource has the potential to be used by any advanced nurse practitioner working in a remote and rural community setting. However, the resource has been developed and customised in response to the educational needs of a specific group

8 of advanced practitioners employed by NHS Orkney. Its use with other advanced practitioners and those working in different remote and rural contexts may require further development. Whilst it is not claimed that online learning completely meets the continuing professional development needs of advanced practitioners working with remote and rural island communities, it would appear that this learning resource has the potential to contribute significantly to their learning. The learning resource should be viewed as a dynamic and evolving entity that will require regular review and updating. Dissemination Plan The project work was disseminated nationally in a key note speaker presentation at the Scottish Clinical Skills Network 2009 annual conference in Glasgow. This has resulted in interest from the NHS Education for Scotland Remote and Rural Healthcare Education Alliance and this group have requested to be kept informed of any future developments. In addition, the proposed work was presented at the NHS Education for Scotland Out of Hours Unscheduled Care 2008 national conference and has continued to be promoted within the Out of Hours Unscheduled Care context. A number of health boards with remote and rural communities have expressed a wish to discuss the use of the resource within their health board area. Future Development There is definite potential for the resource to be further developed to meet the needs of a range of advanced nurse practitioners working in remote and rural community settings. Although it has been customised to suit NHS Orkney, there is also the potential for it to be tailored to suit other health boards with remote and rural healthcare needs. However, this will require identified and appropriate individuals within the University and health boards to take this forward and will have ongoing resource implications for the organisations involved.