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Home Health Nurse Family Health Nurse Family Nurse Practitioner

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Title: Home Health Nurse Family Health Nurse Family Nurse Practitioner


1
Home Health NurseFamily Health NurseFamily
Nurse Practitioner
  • ??? ????
  • Shannon Tung FNP , PhD

2
Outline
  • Home health nurse
  • Family health nurse
  • Family nurse practitioner

3
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5
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6
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9
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10
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  • 2.????(Karnofsky Scale)

11
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12
????(Barthel Index)
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  • 61??90??????
  • 91??99??????
  • 100??????
  •            

13
????(Karnofsky Sacle)
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14
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15
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    Groups)?????

16
Definition
Preceptor
Roles function
Community
Instructor
Competencies
Hospital
School
Preparation training
(Tung,2007)
17
Family health nurse
  • Introduction
  • Definition
  • Role and Function
  • Competencies
  • Preparation

18
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 .

19
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.

20
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.

21
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.

22
Role
  • Family Health Nurse was expected to be competent
    as, a
  • care provider
  • decision-maker
  • communicator
  • community leader
  • manager

23
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26
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

27
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

28
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

29
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

30
Preparation
  • Research, Decision-making, and Evaluation in
    Clinical Practice
  • Working with Families
  • Communication
  • Advanced Family Health Nurse Practice

31
Preparation
32
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

33
Family nurse practitioner
  • Introduction
  • Definition
  • Role and Function
  • Competencies
  • Preparation

34
NP around the world

35
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)

36
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)

37
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38
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)

39
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.

40
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.

41
Nurse Practitioner - NP
  • ????????
  • ????????????,????????????????????????????????
  • (???,2003)

42
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43
NP Role
Physician
Nurse Practitioner
44
NP role
  • NP in US
  • Clinician
  • Educator
  • Coordinator
  • Monitor
  • Advocate
  • Counselor
  • Manager
  • Mentor
  • Researcher
  • NP in TW
  • ???????
  • ?????
  • ????????
  • ?????????
  • (AANP,2004 ???,2003)

45
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)

46
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)

47
Nature of Practice
  • Integration of practice, management, education,
    research
  • Higher degree of autonomy
  • Case management/continuous care
  • Care plan, implementation and evaluation
  • ( AANP, 2003)

48
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

49
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)

50
Competencies and skills
  • What else?
  • Personal experience ( critical thinking)
  • Attitude
  • Respect
  • Encouraging instead of criticizing

51
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

52
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 ?

53
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

54
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

55
  • Thanks for your attention
  • Henghsin_at_ntcn.edu.tw
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