Unlocking the Danish advanced practice nurse s role: Cultivating a path for global partnership Lauren Holton, RN, MSN, FNP Dr. Kathleen Flaherty, PhD, CNS, RN Dr. Lora Wyss, PhD, CNS, RN
Objectives Describe the components of a Danish-American crosscultural advance practice nurse research study. Analyze the findings according to emerging themes and the Neuman s System s model concept of reconstitution. Formulate keys to future transcultural APN collaborations. 10/28/2015 2
Denmark 10/28/2015 3
Values and the Danish Social Democracy State Free schools, higher education, medical care and expansive social security Educational Aid (SU): Danish students enrolled in a higher education course are entitled to a number of monthly grants corresponding to the prescribed duration of the chosen study, plus 12 months. 10/28/2015 4
Denmark cont. Large public sector: 1/3 of the workforce is working in the government services (doctors, nurses, professors, and teachers are all government employees. Highest Income Tax rate in the World (43-63%, progressively). Social-democratic values-the rich pay the most tax. Cradle to the grave protection. Universal benefits and services. Centralized pension guaranteed by the government. 10/28/2015 5
Roles and Status Men and women are considered equal Independent women: one of the worlds highest employment rates for women (79.1% of women work) Femine values based on relationship Quality of life: work as a means to gain leisure time (37 hours work-week, 5 weeks vacation as minimum) The Law of Jante 10/28/2015 6
The Danish Healthcare System Hospital care is mainly provided by hospitals owned and run by the five regional governments. There are few private hospital providers, and they account for less than 1% of hospital beds. Denmark spends about 10 percent of the Gross Domestic Product on health care (US spends nearly 17%). There is 1 doctor for every 294 persons in Denmark. As for nurses, there are 63,929 as of 2013. Entry into nursing practice is a bachelor s degree. At minimum there are 594 master s and/or candidate prepared nurses and 130 PhD nurses. 10/28/2015 7
Malone-Lillebaelt Nursing Denmark to U.S. 3 week exchange Exchange Clinical placements in the hospitals, public health and the community (Free Clinics) Classroom placement with upper level nursing students: Community, Cultural, Critical Care, Pediatric, and Psychiatric Nursing. U.S. to Denmark 2-3 week exchange Clinical placements in the hospitals and community Classroom placement with other international students: Care of the Chronically Ill Person 10/28/2015 8
Malone University Research Project MSN APRN Research Project Pilot 3 semesters Neuman Systems Model Intervention for prevention Reconstitution 10/28/2015 9
Study Design Qualitative phenomenological design Sampling obtained via convenience and snowball techniques Permission was granted by Malone University Human Research Committee/IRB Nurses who were trained and worked in Denmark in advanced roles as determined by objective educational and career criteria. 10/28/2015 10
Interviews Six participants interviewed between January and April 2015; five interviews were conducted by primary investigator Interviews lasted between 30 and 60 minutes each Interviews were recorded and transcribed by the primary investigator Participants had the choice of using Skype or FaceTime for the interviews. Two of the five interviews were conducted using FaceTime ; three were conducted using Skype 10/28/2015 11
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Reconstitution Neuman described reconstitution as beginning after treatment (intervention for prevention) of a stressor reaction and the return and maintenance of system stability/wellness. Complete reconstitution may return the system to the level of wellness prior to illness, or may stabilize the system to a higher or lower level of wellness. 10/28/2015 13
Responses of Danish APNs that may indicate the process of reconstitution in patient care I would reconstruct something that went down and now it has to be built up again It s like reorganization and or readjustment to the current structure... (Ida, 2015) We identify the problem, set goals, interact and do the reconciliation, (Cecilie, 2015) I think, if I understand correctly, reconstitution is when you are able to obtain your normal life again. It is when you are able to manage your stress in a competent way, (Emma, 2015). 10/28/2015 14
Responses of Danish APNs that may indicate the process of reconstitution in patient carecont. Anna (2015) states, You can ask yourself, why are some people able to handle the stress factors, regardless of how big they (the stressors) are and why some cannot? I think that is a big part of it. They are able to balance it. They are able to manage it....you have to work with families whenever you work with chronically ill patients, because it involves rehabilitation, health promotion and other areas. Without the interventions one won t get better, (Ida, 2015). 10/28/2015 15
Participant Demographics Participant Age Range Gender Primary Language Years in Practice Emma 56-60 years Female Danish 30 years Anna 56-60 years Female Danish 38 years Cecilie 36-40 years Female Danish 18 years Sarah 51-55 years Female Danish 26 years Ida 56-60 years Female Danish 39 years Julie 46-50 years Female Danish 25 years 10/28/2015 16
Themes Roles Theoretical Constructs Healthcare System Education DANISH NURSING CULTURE Global Influences Family Unit APN Theory Selection for Practice 10/28/2015 17
Theoretical Constructs Mary Scheel, Lehman Florence Nightingale Wright, Leahey, Janice Morse Patricia Benner, Virginia Henderson, Jean Watson Kari Martinsen Canada United States Denmark Norway England 10/28/2015 18
Theoretical Constructs we really need to discuss different theoretical settings and different theoretical people so we can get more awareness of the theory that is behind the nursing, (Cecilie, 2015). Sometimes when you read the American theorists, it can be difficult to find the words describing some of the theories and some theorists. So I think that when we have different languages we have to work really closely with the theorists to understand them when it is not our own language. But that wouldn t keep me away from reading them, because you can learn something from nearly everyone, (Ida, 2015). 10/28/2015 19
APN When we are talking about advanced nurses, what do you exactly mean by that word?...i think I define it (advanced practice nurse) as the nurse that is special and has been in the nursing clinical part for a long time. Therefore they are advanced nurses, but in the clinical part. You can also see advanced nurses within education, but then they are educators and that is different for me. But I don t know what your focus is Advanced or expert, (Anna, 2015)? The reason why I asked is because I am a little bit, not confused, but you know. I don t know what exactly you mean by advanced nurses or what you think about it (the term and definition). In a way participating in your study is awkward, because we are leaders in education and not in the clinical model, (Emma, 2015). 10/28/2015 20
APN The Modified Advanced Practice Role Delineation Tool ) Domains of Advanced Practice Nursing 1. Direct Comprehensive Care 2. Support of Systems 3. Research 4. Education Defined Activities Obtain patient history, assess psychosocial factors, interpret assessment data, provide care according to a specific specialty, communicate the plan of care, educate patients and families, document care provided, consulting other healthcare members regarding patient care, collaboration of other services, make decisions based upon ethical circumstances, efficiently move the patient Consult with others, plan strategically, quality improvement, contribute to and consult and collaborate with others, leadership, mentor, advocate, spokesperson for nursing and assessing, developing, implementing and evaluation. Support generation of knowledge, integrate research findings into clinical practice Educator and/or clinical preceptor, identify learning needs, informal educator to staff, research for professional development, clinical investigation, monitor and improve quality, identify potential funding 5. Publication and Professional Leadership Serve as a resource and consultant, disseminate nursing knowledge, represent nursing (professional nursing image and collaboration with other healthcare providers) 10/28/2015 Modified from Mick & Ackerman, 2000, p. 217-218; Chang et al., 2010, p. 2325 21
APN Participant Cecilie Sarah Ida Anna Julie Emma Degree(s); Title Nomenclature Master's Degree Education, Clinical Nursing; Clinical Counselor Master's/Candidate Degree; Team Leader Master's Degree Health Science, PhD Student; Senior Professor Master's Degree Public Management/Organization; Dean Nursing Education PhD Student; Senior Lecturer Master's Degree Nursing Science, Educational Management; Quality Control Leader 10/28/2015 22
Conclusion/Discussion Theories are heavily utilized in the Danish nursing culture. Danish Nursing is frequently influenced by international nursing theories; thus cultural considerations and understanding are important. 10/28/2015 23
Conclusion/Discussion Participants and their reported roles were included within the title of Advanced Practice Nurses according to the definition as adopted by the International Council of Nurses. Danes may define advanced practice nurses as those nurses who are advanced at the bedside and who exhibit expert skills. Findings of this study support previous research indicating the lack of congruency and standardization of the terminology and role delineation for advanced practice nurses internationally. Further exploration needed. 10/28/2015 24
Questions? Overall, findings from this study give a glimpse into the Danish advanced practice nursing culture, contributing to the understanding and methods used in Scandanavia. This is a necessary step in attempting to cultivate a path for global standardization of the profession. 10/28/2015 25
References Available upon request. 10/28/2015 26