background initial steps€¦ · nz role definition the specialty clinical nurse is a registered...
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Wendy BrysonWorking Group Chair CSANZ 2018
What a journey…
Background Increasing evidence that nurses working in advanced roles are
very effective and improve patient outcomes
However in NZ, pathways from RN into advanced roles are inconsistent and influenced by the geographic location, health care environment, leadership and nurses themselves
If Cardiac nurses are to develop a sustainable NZ model we need to unite and work together
Initial Steps 2014 CSANZ CVN meeting
Advanced nursing practice presentation Defining specialty/specialist practice What is advanced cardiac nursing in NZ?
CSANZ Affiliate AGM Proposal Volunteer working group set up Support/Endorsement by CSANZ committee Email to nursing affiliates seeking support/mandate Progress updates at annual NZ meeting
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Working Party Julie Chirnside (Chch) Jo Scott (Chch) Jo-Ann Downie (Taranaki) Steph Madenholt-Titley (Akld) Sarah Cheeseman (Nelson) Kathy Patrick (Timaru) Andy MacLachlan (Middlemore) Helen McGrinder (Akld) Dean Kinloch (Palm North) Wendy Bryson (BOP) chair Naila Rahman (Hutt) on leave
Real issues… Interpretation/understanding
Plethora of nursing titles, roles and scopes of practice Further confusion by expanded/extended practice terminology
Isolation/vulnerability/ constant restructuring Proposed competencies for RN prescribing Acknowledgement inconsistent nationally
Levels of RN practice defined by PDRP, together with competencies/skills specific to DHB and location of practice eg CCU, Cardiothoracic ward, etc
Advanced Practice Nurse "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”.
International Council of Nurses
The NZ National Programmes Working Party defineAdvanced Nursing Practice as:
“Reflecting a range of highly developed clinical skills and judgements acquired through a combination of nursing experience and postgraduate education.
…advanced nursing practice requires the application of advanced nursing knowledge, with practitioners drawing not only on their own clinical experience, but also on the experience and research of the profession as a whole”.
2014
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NZ Role definition The Specialty Clinical Nurse is a registered nurse who has
become highly proficient in a clinical setting. This is a designated senior nurse position
“The Clinical Nurse Specialist is a registered nurse, who uses advanced specialised clinical knowledge to practice within a defined specialty or specialties”….
Working group focus
Establish NZ Cardiac Nursing Framework
Define Advanced Cardiac Nursing Practice Competencies
2 levels of practice, CNS and Specialty Nurse
Clinical Skills
Knowledge
d) Those RNs who the NCNZ has awarded the Cardiac Nurse Practitioner scope of practice
b) Those RNs who provide routine care for patients with specialised cardiac care needs
a) All RNs who care for patients with cardiac care needs
c) Those RNs who provide care for patients with increasingly complex, unpredictable specialised cardiac care need, and provide expert support to others members of the healthcare team
Fig 1. Cardiac Nursing Levels of Clinical Practice (Adapted from Benner, 1982)
NZCN Framework Purpose and UseDescribes the knowledge and skills of practice in Cardiac nursing roles. It will benefit patients, nurses and health providers by:
1. Standardising Cardiac nursing role expectations nationally
2. Establishing a resource that may be used in the development of career pathways and job descriptions
3. Articulating role behaviours and capabilities
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Framework Purpose and Use (cont)
4. Providing a framework for PG Cardiac nursing programmes
5. Providing a platform for nurse-led Cardiac care
6. Clarifying the scope of Cardiac nursing roles to administrators, consumers and other health care professionals
Link existing CN competencies
NZ CN Framework
? Secondary Prevention
Genetic
Congenital
Cardiac Invasive Nursing
NZ Regulatory Requirements:
NZ National Nursing Consortium
Progress in past year Draft document out for comment to all CSANZ Affiliate
nurses (Sept 2017)
Feedback collated, Draft 7 evolved…
Consultation with National nursing advisors and PG academic providers
March 2018 endorsement by CSANZ (NZ)
Draft journal articles in progress for dissemination
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Thank You Generic Competencies1. Leadership
2. Physiology / Pathophysiology
3. Assessment
4. Diagnostics
5. Health Education
7.3 AssessmentGeneric competency
Demonstrates ability to:• Undertake an objective assessment of the cardiac patient
using a systematic approach.• Utilise appropriate risk-assessment tools. • Undertake focused physical examination of the cardiac
system using a systematic approach:a) General appearanceb) Exam extremities examined for cyanosis, clubbing, pallor
and oedemac) Measure blood pressure, heart rate, respiratory rate,
height, weight (BMI) and pulse oximetryd) Measurement and estimation of jugular venous pressuree) Inspect and palpate precordiumf) Auscultate heart (minimum apical area) and lungsg) Inspect and palpate of arms and legsh) Recognise abnormal physical assessment findings and
responds appropriately.i) Identify specific cardiac risk factors based on the
patient’s history and physical examination.
Demonstrates ability to:• Perform a complete or focused physical examination. Identifies and
interprets normal and abnormal findings as appropriate to patient presentation.
• Request and/or performs screening and diagnostic investigations, interprets results and assumes responsibility for follow-up
• Rationalise reasons for investigations and plan of care based on assessment findings
• Synthesise health assessment information using clinical reasoning to identify health risks and states of health/wellness.
• Formulate differential diagnoses through the integration of patient information and evidence informed practice.
Able to:• Communicate history and physical examination findings
effectively in oral and written form.
Able to:• Communicate with patients about health assessment findings including
outcomes and collaborates to establish ongoing plan of care.
Specialty Cardiac Nurse Cardiac CNS Generic Competencies1. Leadership
2. Physiology / Pathophysiology
3. Assessment
4. Diagnostics
5. Health Education
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7.4 Diagnostics / ProceduresDefined:
12 Lead ECG and interpretation2 Lead ECG and in Invasive cardiac investigations Pacing/ICD ETT DC Cardioversion
7.4 Diagnostics / Procedures7.4 Generic
CompetencySpecialty Cardiac Nurse Cardiac CNS
12 Lead ECG and interpretation
Able to:• Initiate and undertake a 12 Lead ECG • Complete ECG and rhythm interpretation
workshop/course • Seek timely review of all 12 Lead ECGs by
clinical staff
Demonstrate:• Telemetry set-up including patient education
Able to:• Discuss indications and procedure for
requesting inpatient telemetry
Able to: • Discuss the role of the 12 Lead ECG in patient
assessment and diagnosis, including limitations.• Evaluate the impact of intervention on the ECG and
suggests alternatives.• Expert assessment of ECG /arrhythmias and
demonstrate appropriate intervention.
Generic Competencies1. Leadership
2. Physiology / Pathophysiology
3. Assessment
4. Diagnostics
5. Health Education
7.5 Health Education / Cardiac rehabilitation / Risk Modification
Generic Competency Specialty Cardiac Nurse Cardiac CNS
Risk
profile/assessment
Demonstrate an understanding of:
• The importance of an accurate patient assessment
targeting specific cardiac risk factors to offer referral
for appropriate cardiac rehabilitation/prevention
support.
Able to:
• Utilise interactive communication and counselling
processes with both patients and their families and
agree on a treatment plan and patient goal setting
using shared care principles.
Demonstrate an understanding of:
• The importance of identifying patients requiring additional
support for their cardiac recovery.
Able to:
• Communicate lifestyle intervention (s) at an appropriate
level for the patient, assist with setting clear and realistic
goals and negotiates appropriate interventions.
Healthy Eating
support
(Cont)
Demonstrate an understanding of:
• Role and impact of diet on CVD progression and risk
factor management and the principles of weight
management.
Able to:
• Calculate body mass index and offer tailored advice
on current guidelines and recommendations for
healthy body weight and secondary prevention.
Demonstrate an understanding of:
• Effective behaviour change strategies and target goals for
CVD modification.
Able to:
• Offer behavioural interventions to promote adherence and
self-management skills and support patients to make sense
of dietary information to apply it to their particular
circumstances.
• Ensure realistic goals for change, measure and report
outcomes.
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Aspects of Cardiac Care1. Acute Cardiac Care
2. Chronic Cardiac Care
Aspects of care outline the competencies associated with nursing care of patients with specific cardiac conditions and will be applicable based on individually defined role responsibilities.
Aspects of Cardiac CareAcute Cardiac Care Chronic Cardiac Care
a) Coronary Ischaemia
b) Arrhythmias
c) Decompensated HF (Coronary Care)
d) Cardiac Surgery
8.1 Acute Cardiac CareAspect of care Specialty Cardiac Nurse Cardiac CNS
A) Coronary Ischaemia
Demonstrates understanding of:• Appropriate and timely treatment of cardiac
ischaemia.• Appropriate patient placement and judgement
of acuity: liaises with senior nursing line management.
Able to • Accurately assess patient’s chest pain/
ischaemic symptoms• Safely interpret and hemodynamically monitor
patients.• Display critical thinking/risk assessment and
follow through actions.
Demonstrates:• Expertise in haemodynamic monitoring and
interpretation.
Able to:• Anticipate and respond appropriately to rapid
changes in patient condition.• Able to work autonomously, assess workloads and
prioritise needs.
Aspects of Cardiac CareAcute Cardiac Care Chronic Cardiac Care
a) Coronary Ischaemia
b) Arrhythmias
c) Decompensated HF (Coronary Care)
d) Cardiac Surgery
a) Heart Failure
b) Ischaemic Heart Disease
c) Palliative Care
d) Arrhythmia management
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8.2 Chronic Heart DiseaseAspect of care Specialty Cardiac Nurse Cardiac CNS
A) Heart failure Able to:• Monitor and review response to treatment.• Recognise progression of HF signs and
symptoms and take appropriate action• Encourage patient to maximise self-
management strategies to make lifestyle changes.
Able to:• Assess, monitor and manage progression of chronic
cardiac disease including pharmacological therapy and selection for device therapy such as CRT, and suitability for cardiac transplant.
• Support patient to maximise self-management strategies to make lifestyle changes.
• Request laboratory tests and diagnostic studies in collaboration with cardiologists, to enable comprehensive assessment and monitoring of condition.
B) Ischaemicheart disease
Demonstrates an understanding • And facilitates secondary prevention including
medication adherence and lifestyle interventions.
Able to:• Facilitate/initiate pharmacological treatment and
lifestyle modification and monitors response
Thank You
