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How can the role of a community nurse practitioner support the older person in the rural setting
of new knowledge and expanded perspective2. Campbell’s archetypal journey1,2 reflects the experiences of many NPs and resonated with the two NP authors. Results: Linking The Hero’s Journey1,2 and the NP journey is a novel idea that assisted two NPs to change their perspectives. They realised that within their unique experiences were universal features that closely fitted the mythical journey described by Campbell. This deeper understanding fostered a more objective view of the journey including the painful elements. Recommendations: The idea of relating the NP experience with The Hero’s Journey1 requires further study. Minimal research has occurred within the health care environment using Campbell’s work to explore individuals’ experience of growth and change. Research is planned to determine if Campbell’s myth resonates with the experience of other NPs and this presentation will outline the current findings and ongoing research. http://dx.doi.org/10.1016/j.nurpra.2017.05.081 A Nurse Practitioner candidate : A model for change in aged care Ms Kaye Coates1, Ms Marianne Wallis2, Ms Alison Craswell2, Mrs Amanda Glenwright3 1 Sundale, 2University of Sunshine Coast, 3Central Queensland, Wide Bay, Sunshine Coast PHN Abstract: A Nurse Practitioner Candidate : A Model for Change in Aged Care K COATES Masters Nurse Practitioner Studies1, M WALLIS 2 2 PHD , A CRASWELL PHD , A GLENWRIGHT Masters Health Management 1
Sundale Ltd. Nambour, Australia 2 University of the Sunshine Coast, Sippy Downs, Australia 3 University of the Sunshine Coast, Central Queensland, Wide Bay and Sunshine Coast PHN Cotton Tree, Australia,4 Objective: A Nurse Practitioner Candidate (NPC) working in Aged Care recognised that there were occurrences of relative General Practitioner shortage created by elderly people’s decreased access to timely GP Services. The demands of GP practice meant GP’s could not always attend to Residential Aged Care Facilities (RACF) promptly1,2. In addition, much discussion has centred on the high rates of potentially avoidable RACF residents presenting to Emergency Departments (ED) 3-7.To address part of this issue a NPC was implemented within a Residential Aged Care Facility to determine if an on-site advanced practice nurse could have an effect on reducing the number of unnecessary hospital presentations for residents with increasing healthcare needs whilst simultaneously augmenting GP services with minimal added cost to the health care system. www.npjournal.org
Design: Quasi-experimental pre and post intervention design Method: A NPC and collaborative partners successfully obtained a grant from Department of Social Services to fund the NPC role and research project. A NPC was intentionally chosen as the least confronting change-agent to build inter-disciplinary relationships with GP’s, RACF Nurses and carers as successful collaboration would be crucial to project success. The NPC role commenced the Health Intervention Project for Seniors (HIPS) as one subset of a larger research project. Results: Data analysis of the formal research project has now been undertaken with favourable results including: Decreased number of transfers to ED; those transferred were more appropriate; and shorter Length of Stay was observed compared to pre intervention; The reduction in avoidable transfers equated to cost savings for the health service. Compared to other RACF’s in the health service district Sundale demonstrated a lower average cost per resident transferred. Conclusion: Despite measurable cost savings to the state health service and smaller gains to the local GP service, this model demonstrated no cost advantage to the Residential Facility. http://dx.doi.org/10.1016/j.nurpra.2017.05.082 How can the role of a community nurse practitioner support the older person in the rural setting Ms Danielle Kennedy 1 Northeast Health Wangaratta Abstract: Aim: The aim was to determine the role of a Community Nurse Practitioner in supporting the older person in the community through a review of presentations to the Emergency Department (ED) of a sub-regional Victorian hospital. Method: A Retrospective review of Hospital admission data in relation to patients over the age of 65 in 2016. To include: - number of patients - normal place of residence (Residential aged care facility vs private residence) - presentation diagnosis category - outcome of presentation (treatment; admission; planned follow up; discharge) Results: In 2016, 25% of all ED admissions were from patients over the age of 65; the majority (85%) presenting from a private residence. Within this group of patients, approximately 50% had documented diagnoses such as wound management The Journal for Nurse Practitioners - JNP
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(review; closure etc); cellulitis; dehydration; nausea/vomiting; constipation/diarrhoea; pain and various symptoms of chronic disease. Many of these presentations did not result in an admission. Conclusion: Avoidable ED presentations still remain high at approximately 50% of all ED admissions in the older person population. On review of the numbers and diagnoses, many could have potentially been managed in the community. A Community Nurse Practitioner could provide an alternate model of care, to help reduce unnecessary ED presentations in a collaborative role with other Community services/General Practitioners. They could review the patient in the home environment; coordinate further investigations; treat and provide follow up, without the older person needing to spend time in a busy ED. http://dx.doi.org/10.1016/j.nurpra.2017.05.083 (Impact of) a Nurse Practitioner led Acute Review Clinic of patients discharged from the surgical NICU Ms Amy Barker1, Mrs Kristen James Nunez1 1 The Children’s Hospital at Westmead Abstract: Background: The surgical NICU provides quaternary intensive care to the sickest neonates requiring general and cardiac surgery and complex medical conditions. Following recovery from illness, many newborns cared for in a surgical NICU are medically safe for discharge however require ongoing close surveillance for but not limited to; feeding, weight gain, wound review and pathology assessment. Hospital discharge of the high risk neonate should be supported by well-coordinated care1. Healthy infants have early discharge supported by individualised follow-up programs2, however this service was lacking in the NICU. Without such a service to facilitate this process, newborns experienced longer waiting times to discharge for extended periods of monitoring, or discharge into resource poor community services. Method: A pilot project was initiated for a Nurse Practitioner (NP) led Acute Review Clinic (ARC). The aim was to facilitate early discharge and support continuity of care and transition to the community services following discharge from the NICU. A retrospective chart audit of patients seen in the ARC was performed. Key indictors including primary diagnosis, gestational and corrected age at review, weight, reason for review and rate of readmission were captured. Results: During study period 34 patients were seen by the NP with twelve patients requiring multiple visits. There were 188 saved days of hospitalisation with an estimated financial surplus of $282,000. No patients required e352
The Journal for Nurse Practitioners - JNP
readmissions within 48 hours following discharge, and there were no readmissions to the hospital within 30 days related to NICU discharge. Conclusions: A NP led ARC is a cost-effective and useful service to facilitate at risk newborns into follow up community services. http://dx.doi.org/10.1016/j.nurpra.2017.05.084 Case study: Leading change with reflective practice supervision in an early parenting context Dr Elaine Bennett Abstract: Background: In recognition of the emotional and stressful impact of working with young children and their families, an early parenting not-for-profit service in Western Australia sought to introduce reflective practice supervision (RPS) to support nurses in their practice. Objective: To present a case study of the development of a model of reflective practice supervision with findings following two years of implementation. Design/Method: A case study design using a mixed methods approach was used in the development of the model involving staff. An initial survey was used to raise awareness of supervision and identify specific needs before education was provided on the model for implementation. The evaluation framework included regular data collection and analysis as well as an on-line Experiences in reflective supervision questionnaire (ERSQ) located on the organisation’s intranet via a link to independent University researchers. Interviews with staff were transcribed and thematic analysis undertaken to identify the themes of the participant perceptions of their experience to-date. Findings: The benefits and challenges experienced at different levels of the organisation are presented. Many nurses’ experiences of supervision had been punitive, management driven and solely clinically orientated. Some nurses had never experienced supervision. Overcoming these fears and introducing reflective practice supervision has been part of the implementation journey. Thematic data of practice issues and work place stressors has demonstrated a shift in how staff are being able to use reflective supervision to enhance their practice. Conclusion: This paper provides a stimulus for thoughtful reflection on the expectations that underpin ‘best practice’ principles for RPS and how these might be introduced to support nurses working with families with young children. http://dx.doi.org/10.1016/j.nurpra.2017.05.085 Volume 13, Issue 7, July/August 2017
Sundale Ltd. Nambour, Australia 2 University of the Sunshine Coast, Sippy Downs, Australia 3 University of the Sunshine Coast, Central Queensland, Wide Bay and Sunshine Coast PHN Cotton Tree, Australia,4 Objective: A Nurse Practitioner Candidate (NPC) working in Aged Care recognised that there were occurrences of relative General Practitioner shortage created by elderly people’s decreased access to timely GP Services. The demands of GP practice meant GP’s could not always attend to Residential Aged Care Facilities (RACF) promptly1,2. In addition, much discussion has centred on the high rates of potentially avoidable RACF residents presenting to Emergency Departments (ED) 3-7.To address part of this issue a NPC was implemented within a Residential Aged Care Facility to determine if an on-site advanced practice nurse could have an effect on reducing the number of unnecessary hospital presentations for residents with increasing healthcare needs whilst simultaneously augmenting GP services with minimal added cost to the health care system. www.npjournal.org
Design: Quasi-experimental pre and post intervention design Method: A NPC and collaborative partners successfully obtained a grant from Department of Social Services to fund the NPC role and research project. A NPC was intentionally chosen as the least confronting change-agent to build inter-disciplinary relationships with GP’s, RACF Nurses and carers as successful collaboration would be crucial to project success. The NPC role commenced the Health Intervention Project for Seniors (HIPS) as one subset of a larger research project. Results: Data analysis of the formal research project has now been undertaken with favourable results including: Decreased number of transfers to ED; those transferred were more appropriate; and shorter Length of Stay was observed compared to pre intervention; The reduction in avoidable transfers equated to cost savings for the health service. Compared to other RACF’s in the health service district Sundale demonstrated a lower average cost per resident transferred. Conclusion: Despite measurable cost savings to the state health service and smaller gains to the local GP service, this model demonstrated no cost advantage to the Residential Facility. http://dx.doi.org/10.1016/j.nurpra.2017.05.082 How can the role of a community nurse practitioner support the older person in the rural setting Ms Danielle Kennedy 1 Northeast Health Wangaratta Abstract: Aim: The aim was to determine the role of a Community Nurse Practitioner in supporting the older person in the community through a review of presentations to the Emergency Department (ED) of a sub-regional Victorian hospital. Method: A Retrospective review of Hospital admission data in relation to patients over the age of 65 in 2016. To include: - number of patients - normal place of residence (Residential aged care facility vs private residence) - presentation diagnosis category - outcome of presentation (treatment; admission; planned follow up; discharge) Results: In 2016, 25% of all ED admissions were from patients over the age of 65; the majority (85%) presenting from a private residence. Within this group of patients, approximately 50% had documented diagnoses such as wound management The Journal for Nurse Practitioners - JNP
e351
(review; closure etc); cellulitis; dehydration; nausea/vomiting; constipation/diarrhoea; pain and various symptoms of chronic disease. Many of these presentations did not result in an admission. Conclusion: Avoidable ED presentations still remain high at approximately 50% of all ED admissions in the older person population. On review of the numbers and diagnoses, many could have potentially been managed in the community. A Community Nurse Practitioner could provide an alternate model of care, to help reduce unnecessary ED presentations in a collaborative role with other Community services/General Practitioners. They could review the patient in the home environment; coordinate further investigations; treat and provide follow up, without the older person needing to spend time in a busy ED. http://dx.doi.org/10.1016/j.nurpra.2017.05.083 (Impact of) a Nurse Practitioner led Acute Review Clinic of patients discharged from the surgical NICU Ms Amy Barker1, Mrs Kristen James Nunez1 1 The Children’s Hospital at Westmead Abstract: Background: The surgical NICU provides quaternary intensive care to the sickest neonates requiring general and cardiac surgery and complex medical conditions. Following recovery from illness, many newborns cared for in a surgical NICU are medically safe for discharge however require ongoing close surveillance for but not limited to; feeding, weight gain, wound review and pathology assessment. Hospital discharge of the high risk neonate should be supported by well-coordinated care1. Healthy infants have early discharge supported by individualised follow-up programs2, however this service was lacking in the NICU. Without such a service to facilitate this process, newborns experienced longer waiting times to discharge for extended periods of monitoring, or discharge into resource poor community services. Method: A pilot project was initiated for a Nurse Practitioner (NP) led Acute Review Clinic (ARC). The aim was to facilitate early discharge and support continuity of care and transition to the community services following discharge from the NICU. A retrospective chart audit of patients seen in the ARC was performed. Key indictors including primary diagnosis, gestational and corrected age at review, weight, reason for review and rate of readmission were captured. Results: During study period 34 patients were seen by the NP with twelve patients requiring multiple visits. There were 188 saved days of hospitalisation with an estimated financial surplus of $282,000. No patients required e352
The Journal for Nurse Practitioners - JNP
readmissions within 48 hours following discharge, and there were no readmissions to the hospital within 30 days related to NICU discharge. Conclusions: A NP led ARC is a cost-effective and useful service to facilitate at risk newborns into follow up community services. http://dx.doi.org/10.1016/j.nurpra.2017.05.084 Case study: Leading change with reflective practice supervision in an early parenting context Dr Elaine Bennett Abstract: Background: In recognition of the emotional and stressful impact of working with young children and their families, an early parenting not-for-profit service in Western Australia sought to introduce reflective practice supervision (RPS) to support nurses in their practice. Objective: To present a case study of the development of a model of reflective practice supervision with findings following two years of implementation. Design/Method: A case study design using a mixed methods approach was used in the development of the model involving staff. An initial survey was used to raise awareness of supervision and identify specific needs before education was provided on the model for implementation. The evaluation framework included regular data collection and analysis as well as an on-line Experiences in reflective supervision questionnaire (ERSQ) located on the organisation’s intranet via a link to independent University researchers. Interviews with staff were transcribed and thematic analysis undertaken to identify the themes of the participant perceptions of their experience to-date. Findings: The benefits and challenges experienced at different levels of the organisation are presented. Many nurses’ experiences of supervision had been punitive, management driven and solely clinically orientated. Some nurses had never experienced supervision. Overcoming these fears and introducing reflective practice supervision has been part of the implementation journey. Thematic data of practice issues and work place stressors has demonstrated a shift in how staff are being able to use reflective supervision to enhance their practice. Conclusion: This paper provides a stimulus for thoughtful reflection on the expectations that underpin ‘best practice’ principles for RPS and how these might be introduced to support nurses working with families with young children. http://dx.doi.org/10.1016/j.nurpra.2017.05.085 Volume 13, Issue 7, July/August 2017