Expert Patient Programme, Bath and NE Somerset PCT
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Key issues: APN Role
The event then considered some of the key issues in more detail, namely:
APN Role
Relationships
APN Role
What are the key skills and competencies of the Advanced Primary Nurse?
This group saw the key skills and competencies as follows
- Physical assessment & history taking – including mental health, chronic disease, gait and balance assessment, falls assessment, chest examination
- Pharmacological knowledge – for medication reviews
- Communication skills – this was felt particularly important within the collaborative relationship with GPs, acute trusts and community services feedback and relaying information on condition to professionals, patients and families.
- Holistic approach
Click here to view diagram
- Diagnosis – decision based on physical model
- Treatment – particularly around working in complex settings such as home, acute and primary care
- Proactive monitoring for early intervention
- Reflection and learning
- Risk assessment
- Education to cares/family for prevention
- Monitoring
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How do they compare with those of existing nursing roles?
This group could identify these skills in other nursing roles, but crucially not within the same role.
- Physical assessment – similar skills in nurse practitioners/practice nurses/first contact
- History taking – nurse practitioners/first contact
- Pharmacological knowledge – Nurse Practitioners
- Communication – across all agencies, APN in depth communications
- Holistic approach – District nursing
- Decision making – Nurse Practitioner/first contact
- Proactive monitoring – Health Visitors and Older Peoples Practitioners but not as in depth as APN (with no advanced assessment skills)
- EOL planning – specialist nurses such as Macmillan and Older Peoples Practitioners
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What are the skills and competencies that make this model different?
- Specialist older peoples competencies. It was felt the logical conclusion for APN role is almost same as a Nurse Practitioner for Older People
- Caseload presented by person who queried database
- Look at epidemiology
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If you were starting the project again without the support of United/Evercare, what resources or tools would help you to establish an APN type role?
- Need to identify appropriate criteria – 2 or more admissions in the last year has undoubtedly identified the vulnerable population but a more sophisticated approach could help target need with even greater accuracy this could include:
- Use of chronic disease registers
- Social risk factors
- Epidemiology
- Improved understanding of existing services e.g. intermediate care
- Improved use of change of condition tools
- Protocols for liaison with GPs
- Making use of and accepting a range of assessment tools (Social Services, Intermediate care, APN)
- Teams pulling together to provide 24hr nursing care – intermediate care, district nursing, APNs, practice nurses, rehab.
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