From Novice to Expert: The Journey
A Vision for the Patient’s Health Home and Team Based Care
Presented to: CFPNA September 27, 2014
Presented by: Treena Klassen Palliser PCN Executive Director
What does dialectics mean???
Logical and reasoned argument to arrive at “truth”
(Socrates, a long time ago).
Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Team Based Care / Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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Palliser PCN - Background
Received approval of its initial Business Plan in August 2006.
VISION: Our commitment is to work collaboratively to develop and
implement primary care delivery models aimed at improving access,
quality of care and satisfaction for both patient and health care
providers.
During this time over 93% of local Family Physicians have joined the PCN
and the vast majority of these physicians have an RN working with
them in their clinics.
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PCN Geographical Region
Crescent Heights Family Medical Clinic
Oyen Medical Clinic
Carry Drive Clinic
Dr. Augustine
Dr. Correia
Dr. Duke
Dr. Durand
Dr. Harrison
Dr. Keshvara
Bassano Medical Clinic
Dr. Mastel
Dr. Prince
Dr. F. Rinaldi
Dr. Saujani
Brooks Medical Clinic
Dr. Viljoen
Newell Medical Clinic
Dr. Wong
Health Matters Medical Clinic
Centennial Medical Clinic
HealthWorx Medical Clinic
South Shore Medical Clinic
Brooks Hospital:
Meiring & Kriel Family Practice
Primacy Medical Clinic (Dr. Filanti)
- Family Medical Maternity Clinic
- Immigrant Clinic
Riverside Medical Clinc
Sage Family Clinic
Bow Island Medical Clinic
Southlands Medical Clinic
The Avenues (Dr. Thorogood)
The Ridge (Dr. Mohanraj)
MHRH: - Family Medical Maternity Clinic
Foremost Medical Clinic
Novice to Expert
Differences between the experienced nurse and the novice
Takes into account increments in skill performance based on experience as
well as education.
Lets apply this model to primary care and then utilize this framework for
assessing how to best help ourselves and each other to become effective team
members in the Health Home.
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Lets define family practice care skills
Acute
• Typically work amongst
nursing colleagues
• Typically have an identified
task to complete
• Work comes to you (patients
are admitted to your unit)
• Typically have substantial
amounts of policy / procedure
to follow
Family Practice
• Often work without other
nurses around
• Often the “task” is unclear
• Often have to seek work
(patients may be used to only
coming to see the doctor)
• Often have very limited policy
and procedure to follow
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Level I: Novice
•
No experience with the situations
•
Rules to guide action in respect to different attributes
•
Inability to use discretionary judgment
•
Context-free rules to guide task performance
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Level II: Advanced Beginner
•
Able to note (or have pointed out by a mentor) recurrent meaningful
situational components (aspects).
•
Aspect recognition is dependent on prior experience in actual
situations.
•
Can formulate guidelines on aspects, however all aspects are
considered equally important.
•
Not able to take in information from context as must focus on
remembering the rules.
•
These nurses need help in setting priorities and benefit from being
backed up by a competent level nurse to ensure that important patient
needs do not go unattended.
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Level III: Competent
•
Typified by the nurse who has been on the job two to three years.
•
The nurse begins to see his or her actions in terms of long-range goals
or plans.
•
The nurse is consciously aware of these plans, and the goal or plan
dictates which attributes and aspects of the current and contemplated
future situation are to be considered most important and which can be
ignored.
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Level IV: Proficient
•
Nurse perceives situations as wholes, rather than in terms of aspects
and performance is guided by maxims.
•
Experience teaches the proficient nurse what typical events to expect in
a given situation and how to modify plans in response to these events.
•
Nurse can recognize when the expected normal picture does not
present itself --- thus improving his/her decision making.
•
Nurse has a deep understanding of situation so can determine which
maxims to apply.
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Level V: Expert
•
Enormous background of experience.
•
Has an intuitive grasp of the situation.
•
Zeros in on the accurate region of the problem without wasteful
consideration of a large range of unfruitful possible problem situations.
•
Has a vision of what is possible.
•
Is able to offer ways of understanding and avenues of acceptance.
•
Through the nurses own ability to face and cope with the problem, the
patient can come to sense that the problem is approachable and
manageable.
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Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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The Medical Home
Described by the College of Family Physicians of Canada as:
“The home base for the continuous interaction between patients and their
personal family physicians, who are the most responsible providers
(MRPs) of their medical care. It is where a team or network of caregivers,
including nurses, physician assistants, and other health professionals –
located in the same physical site or linked virtually from different practice
sites throughout the local or extended community – work together with the
patient’s personal family physician to provide and coordinate a
comprehensive range of medical and health care services required by
each person”.
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Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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RNs in Collaborative Family Practice
Discrepancies among professional organizations, front-line RNs, leaders
and health policy decision-makers related to the theory and the reality
in primary care, with the identity of RNs needing to be enhanced
(Kennedy, 2014)
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What is the RN role in Family Practice?
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Nursing in primary care
Well baby checks and immunizations
(certification)
Cervical smears (certification).
Wound care
Dx. Tests such as spirometry
Assisting with minor surgical procedures
Giving injections
Providing adult immunizations
Triaging
Administering nebulizers
Suture/staple removal
Counselling
General health screening
Mental health screening
Patient education
Health promotion
Enabling patients to improve their own health
and well-being
Managing continuous quality improvement
Managing recall registries/EMR
standardization
Assessing social determinants of health
Prevent and close gaps in care
Case Management and care coordination
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Explicit Palliser PCN RN Role
Priority is comprehensive and complex care focusing on the following services:
Disease Management: Diabetes, hypertension & other cardiovascular disease
(CHF, atrial fibrillation, peripheral artery disease), blood pressure management,
dyslipidemia, obesity, COPD/asthma, chronic digestive disorders (celiac
disease), chronic pain (non cancer pain), and osteoporosis
Complex Care: Those with co-morbidities, ill defined illness, complex socioeconomic status
Disease Screening: Metabolic syndrome, dyslipidemia, diabetes, kidney disease,
anemia, thyroid, dementia, depression, alcohol use, hearing and vision
investigation
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Explict Objectives (2)
Disease Prevention: Education on smoking cessation, immunization,
healthy nutrition and exercise.
Health Maintenance: Socioeconomic issues as they pertain to medication
and health aids, palliative and end of life care.
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Family Practice Nurse Art: Implicit RN
Objectives
•
Sell the nursing service
•
Office practice improvement
•
Share their knowledge with their colleagues
•
Support each other through positivity
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Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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Family Practice Success Stories
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Some Physician Stories
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•
•
•
•
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The PCN has been a boom to my practice! It allows a much greater
quality of service & allows in house provision & coordination for much
of their chronic disease management
Patients are better educated
Patients want to see the nurse instead of me
The nurse knows more about diabetes then I ever will
I would have to retire if I didn't have PCN help
I couldn’t have opened my panel without the nurse
If government funding went away I would definitely pay for the nurse
out of my pocket …. She makes my life better
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Some Patient Stories
•
•
•
•
•
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•
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Most of the time there is very little wait time for appointments -, most of all I appreciate the
follow-up
Excellent care - very professional
Very pleased with the care, results are important but how they are relayed with suggestions
from the nurse makes a big difference as it helps to motivate
Love the time she spends explaining and makes me feel very much at ease about things
involving my health
I have received excellent care and can see the doctor quicker if I have a problem
Having a PCN Registered Nurse is one of the best ideas healthcare has come up with. It
has helped me a lot.
I would not have improved my health if it were not for her suggestions and willingness to
problem solve
Excellent care & knowledge
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Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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Family Practice Challenges
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How can management help?
•
Education
•
Public reflection
•
Change management
•
Scope definition
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How can you help? (Transformative
Learning)
1. Critical reflection of self-behavior
2. Identification of values or assumptions underlying the behavior
3. Changes in underlying values or assumptions
4. Change in the behavior.
•
(Heorhiadi et al., 2014)
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Agenda
1. Treena Klassen RN, BN, ASMH, MEd
2. Palliser PCN
3. Concepts of:
– Novice to expert journey
– Health Home
– RNs and Collaborative Family Practice
4.
5.
6.
7.
Family Practice Success Stories
Family Practice Challenges
Support through Public Reflection
Lifelong Learning in Family Practice
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What one “skill” is imperative in Family
Practice Nursing?
•
Critical Thinking.
•
Knowledge acquisition alone is insufficient for practitioners to function
in complex clinical environments (Papp et al., 2014).
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Homework
What is one thing you can do next week to increase the profile of nurses in
team based care and/or in supporting the development of the Health
Home?
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Next Steps
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As a group:
–
Improved research in primary care, particularly in the areas of specific
provider characteristics and process of working together.
– Ensure you have a voice at the political, educational and planning tables
(CFPNA)
•
As individuals:
– Lifelong learning in Family Practice Nursing
– Ensure the public knows what you do. Always be a role model for your
profession.
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Conclusion
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