Home Health Nurse Family Health Nurse Family Nurse Practitioner

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Home Health NurseFamily Health NurseFamily
Nurse Practitioner

• ??? ????
• Shannon Tung FNP , PhD

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Outline

• Home health nurse
• Family health nurse
• Family nurse practitioner

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• 1.????(Barthel Index)
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Definition
Preceptor
Roles function
Community
Instructor
Competencies
Hospital
School
Preparation training
(Tung,2007)
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Family health nurse

• Introduction
• Definition
• Role and Function
• Competencies
• Preparation

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Introduction

• Why?
• Family Health Nurse as a generalist community
  nurse working with families was attractive,
  particularly in remote and rural areas, where
  current specialist models are becoming difficult
  to sustain.
• WHO Europe originally established the Family
  Health Nurse project as a two-year pilot project
  with formal evaluation to demonstrate the impact.
  
• In Scottish, two-year pilot was commenced in
  January 2001 .

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Fit the gap

• Family health nurse can facilitate the early
  discharge of people from hospital by providing
  nursing care at home, and they can act as the
  lynchpin between the family and the family health
  physician, substituting for the physician when
  the identified needs are more relevant to nursing
  expertise.
• They give advice on lifestyle and behavioural
  risk factors, as well as assisting families with
  matters concerning health.

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Fit the gap

• Through prompt detection, they can ensure that
  the health problems of families are treated at an
  early stage.
• With their knowledge of public health and social
  issues and other social agencies, they can
  identify the effects of socioeconomic factors on
  a familys health and refer them to the
  appropriate agency.

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Definition

• The Family Health Nurse will help individuals
  and families to cope with illness and chronic
  disability, or during times of stress, by
  spending a large part of their time working in
  patients homes and with their families.
• Family is operationally defined in its broadest
  sense to encompass the notion of a unit which may
  include
• 1.individuals with geographically distant
  relatives
• 2.friends who provide a supportive role in a
  similar way to a family member
• 3.traditional nuclear family with different
  generations being geographically close.

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Role

• Family Health Nurse was expected to be competent
  as, a
• care provider
• decision-maker
• communicator
• community leader
• manager

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Core competencies

• 1. identify and assess the health status and
  health needs of individuals and families within
  the context of their cultures and communities
• 2. make decisions based on ethical principles
• 3. plan, initiate and provide care for families
  within their defined caseload
• 4. promote health in individuals, families and
  communities

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Core competencies

• 5. apply knowledge of a variety of teaching and
  learning strategies with individuals, families
• and communities
• 6. use and evaluate different methods of
  communication
• 7. participate in disease prevention
• 8. coordinate and manage care, including that
  which they have delegated to other people and
  personnel
• 9. systematically document their practice

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Core competencies

• 10. generate, manage and use clinical,
  research-based and statistical information (data)
  for planning care and prioritizing health- and
  illness-related activities
• 11. support and empower individuals and families
  to influence and participate in decisions
• concerning their health
• 12. set standards and evaluate the effectiveness
  of family health nursing activities
• 13. work independently and as members of a team

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Core competencies

• 14. participate in the prioritization of health-
  and illness-related activities
• 15. manage change and act as agents for change
• 16. maintain professional relationships and a
  supportive collegiate role with colleagues and
• 17. display evidence of a commitment to lifelong
  learning and continuing professional development

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Preparation

• Research, Decision-making, and Evaluation in
  Clinical Practice
• Working with Families
• Communication
• Advanced Family Health Nurse Practice

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Preparation
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Scotlands experience

• Delivering services closer to home
• Support and protection of the public
• Caring for older people
• Unscheduled care and planned care
• Anticipatory care, improving health,public health
  and reducing inequalities
• Supported self-care, patient empowerment and
  managing long-term conditions
• Leadership
• eHealth

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Family nurse practitioner

• Introduction
• Definition
• Role and Function
• Competencies
• Preparation

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NP around the world

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NP around the world

• In Us, from 30,000 to 65,000
  (CAN,2001)
• 106,000 NPs, majority primary care,
  (AANP, 2004)
• In Canada, 878 in 2003 to 1,026 in 2005.
• (Canadian
  Institute, 2006)
• In UK, NP is an important resource in primary
  care .
• 
  ( White, 2001)
• In AU, the State Government will spend 5.5
  million to almost double the number of nurse
  practitioners in NSW public hospitals. ( 7160)
  ( NSW, 2006)

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Specialty demographic

• In U.S.
• The average NP is female (95) and 48 yr.
• She has been in practice for 9 years, is a
  family NP (41), and is involved in direct care
  (85.1). 
• The most prevalent clinical specializations are
  family health, adult health(19.5), women's
  health (11.3), and pediatric health (10.9). 
• Acute care (4.5) ,geriatric(1.2),Psych(2.8)
• (AANP,2004)

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What is NP/APN?

• is a registered nurse who has acquired the expert
  knowledge base, complex decision-making skills
  and clinical competencies for expanded practice,
  the characteristics of which are shaped by the
  context and/or country in which s/he is
  credentialed to practice.
• APN- NP,CNM,CRNA, CNS
• A master's degree is recommended for entry
  level.
• (International
  Council of nurses,2003)

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Family Nurse Practitioner

• The population in primary care family practice
  includes newborns, infants, children,
  adolescents, adults, pregnant and postpartum
  women, and older adults.
• The focus of care is the family unit, as well as
  the individuals belonging to the family, however,
  the family chooses to define itself.

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Family Nurse Practitioner

• The family nurse practitioner is a specialist in
  family nursing, in the context of community, with
  broad knowledge and experience with people of all
  ages.
• Family nurse practitioners demonstrate a
  commitment to family-centered care. Family nurse
  practitioners practice primarily in ambulatory
  care settings.

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Nurse Practitioner - NP

• ????????
• ????????????,????????????????????????????????
• (???,2003)

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NP Role
Physician
Nurse Practitioner
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NP role

• NP in US
• Clinician
• Educator
• Coordinator
• Monitor
• Advocate
• Counselor
• Manager
• Mentor
• Researcher

• NP in TW
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• (AANP,2004 ???,2003)

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Competencies

• 1. Management of patient health /illness status
• health promotion/ disease prevention
• 2. The nurse practitioner patient relationship
• Mutual trust, confidentiality
• 3. Teaching-coaching function
• Timing,eliciting, assisting ,providing,coaching
  
• 4. Professional role
• Use scientific research , directs care,
  leadership
• cost-effective health care, policy
• ( AANP, 2003)

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Competencies

• 5. Managing and negotiating health care delivery
  system key member of interdisciplinary team
  through collaborative practice
• 6. Monitoring and ensuring the quality of health
  care practice
• Evidence based approach , follow up to
  evaluate patients outcomes , research to improve
  quality
• 7. cultural competence
• Spiritual competencies (
  AANP, 2003)

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Nature of Practice

• Integration of practice, management, education,
  research
• Higher degree of autonomy
• Case management/continuous care
• Care plan, implementation and evaluation
• ( AANP, 2003)

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Regulations

• 1. Right to diagnose
• 2.Authority to prescribe medication
• 3.Authority to prescribe treatment
• 4.Authority to refer clients to other
  professionals
• 5.Authority to admit patients to hospital
• 6.Legislation to confer and protect the title
  "Nurse
• Practitioner/Advanced Practice Nurse"
• 7.Legislation or some other form of regulatory
  
• mechanism specific to advanced practice
  nurses 8. Officially recognized titles for
  nurses working in
• advanced practice roles

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Core NP skills

• Advanced health assessment
• focused history and physical exam
• Diagnostic reasoning
• Ordering further diagnostic studies
• Treatment plan
• Follow up and evaluation
• (
  Sarter, 2001)

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Competencies and skills

• What else?
• Personal experience ( critical thinking)
• Attitude
• Respect
• Encouraging instead of criticizing

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NP preparation

• Registered Nurse
• Clinical preparation
• Education preparation
• 1.Advanced physical assessment, advanced
  pharmacology and advanced path physiology.
• 2. Theory and clinical course ( 550-600 hours)
• 3. Research and method course
• 5.Decision making or leadership

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Discussion

• Difference among family nurse practitioner,
  family health nurse and home health nurse?
• What are the demands ?
• What we want to be?
• Create a niche?
• Combine the roles?
• Policy and regulation ?

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Outcome evaluation

• Changes to existing primary health care nursing
  services
• Financial costs of the services
• Acceptance of families, patients, employers and
  other related services
• Perceived effectiveness ( health status of the
  families, promotion of equity,, quality of the
  family health care nurse provision)
• Curriculum evaluation

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Reference

• The WHO Europe Family Health Nursing Pilot in
  Scotland 2006Final Report
• Scottish Executive Health Department (2003)
  Evaluating Family Health
• Nursing Through Education and Practice.
• World Health Organisation Europe (2000)
  EUR/00/5019309/1300074 The Family Health Nurse
  context, conceptual framework and curriculum.
  Copenhagen WHO Regional Office for Europe.
• www.aanp.org
• www.healthleadership.com
• www.nonpf.com
• www.acnpweb.org
• www.dea.gov
• www.rn.ca.gov
• www.ncsbn.org
• icn-apnetwork.org
• nhri.org.tw
• www.hatw.org.tw

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• Thanks for your attention
• Henghsin_at_ntcn.edu.tw