Clinical Workshops & Symposia

All Clinical Workshops and Symposia are scheduled live during the conference and will allow for attendee engagement through Q&A, polling and discussion forums. 

Wednesday, September 1, 2021
1:45 – 2:30 pm (UTC-4, Atlantic Time)

Clinical Implications of Legal Cannabis for APNs

Dr. Tracy Klein1, Louise Kaplan1

1Washington State University, Vancouver, United States

Background: Nurse Practitioners in the US and Canada may authorize cannabis for medical use. In the US, 8 states permit NPs to sign authorizations, while in Canada national law includes NPs as those who can authorize, though provincial standards may restrict this authority. Variance in both preparation for and implementation of these laws, including parallel access by patients to non-medical cannabis, generates multiple clinical questions for consideration.

Purpose
The purpose of this clinical workshop is to identify and explore key clinical implications of legal cannabis for the APN through active case-based learning and discussion.

Approach
Implications of access to cannabis for APNs and their patients will be presented. Cases for discussion include ethical considerations (i.e. special populations, non-authorized use for medical purposes) as well as screening, consent, monitoring, pharmacologic interactions and harm reduction. The workshop will engage participants in a discussion of their experience and dilemmas as APNs with cannabis issues in practice.

Key Learnings
Participants will learn from presenters, who are APNs and professors in a state with both recreational and medical cannabis and have conducted research regarding medical marijuana. Content includes tools used for monitoring, consent and harm reduction as well as knowledge regarding potential drug-cannabis interactions and cannabis use disorder.

Conclusion
Studies demonstrate discomfort by APNs with their knowledge and practice regarding cannabis. Preparation and discussion of clinically based scenarios can assist APNs in exploring potential areas of clinical concern and relevance.

Significance
APNs are likely to be asked about cannabis and its use. APNs may explore their own concerns and enhance their knowledge through this guided participatory workshop.

Tuesday, August 31, 2021
3:15 – 4:00 pm (UTC-4, Atlantic Time)

ADHD Update on the 2019 American Academy of Pediatrics Guidelines

Susan Van Cleve1,2

1University of Iowa College Of Nursing, Iowa City, United States, 2Pediatrics South, Pittsburgh, United States

Attention Deficit Hyperactivity Disorder (ADHD) is a well-recognized neurodevelopmental disorder that can affect functioning for children, adolescents, and adults in their schools, homes and communities. It is estimated that the ADHD prevalence in children up to aged 18 worldwide is 7.2% (Thomas et al, 2015). In the United States, 9.4% of children 2-17 years have been identified as having an ADHD diagnosis (Ghnadour et al, 2019).

In 2019, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for the assessment and management of ADHD in children and adolescents (Wolraich et al, 2019). This revised guideline identifies evidence based recommendations for how to accurately assess, diagnose, and treat ADHD in children and teens. This presentation will review the guideline and provide recommendations on how to accurately assess, diagnose, and manage ADHD in outpatient practice.  A review of possible comorbid conditions will be examined. Non-pharmacologic interventions will be presented, with an emphasis on behavioral and school management.  Evidence based screening tools will be reviewed highlighting ease of use and interpretation. Pharmacologic interventions will be presented. The presentation will focus on caring for the child with ADHD with a chronic care and family centered perspective. 

Wednesday,  September 1, 2021
1:45 – 2:30 pm (UTC-4, Atlantic Time)

Update On Adolescent Concussion Care: Linking Practice, Education and Research

Dr. Gail Macartney1

1University Of Prince Edward Island, Charlottetown, Canada

Concussion represents a prevalent health care issue affecting many individuals across the life span. The number of visits to the Emergency Department for sport-related concussions has increased by 28% in Alberta and Ontario over the last 5 years. About one-quarter of head injuries are sport-related with the highest proportion of injuries among 10 to 14-year olds. Fortunately, most individuals recover in a timely fashion following a period of cognitive and physical rest. Some individuals, however, have more difficulty returning to normal function. Appropriate concussion management can help facilitate recovery and reduce the risk of second impact syndrome. Implementing evidence-informed care guidelines in clinical practice will support concussion recovery and ensure a safe return to school, work, and physical activities. 

The purpose of this presentation will be to provide an overview of the context of the concussion care challenge. Adolescent concussion care and management will be reviewed. Focused clinical assessment, diagnosis, and management of multidimensional issues affecting an individual’s symptom experience will be highlighted. Symptom-based interventions and evaluative criteria will be discussed. The application of evidence-informed practice guidelines will be highlighted. A retrospective review of symptom trajectory over time will be reviewed from a research perspective. A combination of didactic, interactive, and case-based approaches will be used.

Health care providers will be empowered with the knowledge needed to support the care of this unique group of individuals. Attendees should acquire an up to date understanding of the challenges of concussion care including an easy to use framework for concussion assessment, care and follow-up including resources. Additionally, they will better understand how concussion symptom experience can be tracked over time and linked to their clinical practice, in an empirical way. The application of concussion research will enable attendees to improve concussion value-added outcomes.

Monday, August 30, 2021
12:30 – 1:15 pm (UTC-4, Atlantic Time)

Hormone Replacement during Peri/Menopause and Beyond for Symptoms and Chronic Disease Prevention

Ms. Susan Prendergast1

1Ellithia Healthcare, Edmonton, Canada, 2Dalhousie University, School of Nursing, Halifax, Canada

Background
For many women, especially after 50 years of age, chronic diseases like cardiovascular disease, osteoporosis and memory loss significantly affect their quality of life. Hormone replacement therapy (HRT), an approach used for many years for the treatment of peri/menopausal symptoms and bone protection, has emerged as an excellent preventive measure for women for chronic diseases like CVD and dementia.

Purpose
The purpose of this clinical workshop is to present the latest evidence-based literature around the use of HRT for women in peri/post menopause and beyond, for both symptom management and chronic disease prevention.

Approach
Specific protocols will be presented based in real cases. The participant will leave the workshop with a better understanding of the holistic approach to assessment and management of symptoms of peri/menopause and the prevention of chronic disease.

Monday, August 30, 2021
12:30 – 1:15 pm (UTC-4, Atlantic Time)

Parental Engagement During Cognitive Behavioural Therapy for Childhood Obsessive Compulsive Disorder: Strategies for Nurse Therapists 

Assistant Professor Carrie Bullard1,2, Dr. Susan  Jack2,3,4, Dr.  Ellen  Lipman4,5,7, Dr.  Noam Soreni1,4,5, Dr.  Denise  Bryant-Lukosius2,6

1Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton , Canada, 2School of Nursing, McMaster University  , Hamilton, Canada , 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton , Canada , 4Offord Centre for Children’s Studies, Hamilton, Canada , 5Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, Canada , 6Canadian Centre for Advanced Practice Nursing Research , Hamilton , Canada , 7McMaster Children’s Hospital, Hamilton , Canada

Background
Psychiatric mental health nurses with advanced practice training in psychotherapy are well positioned to deliver specialized treatment for children and their families in Canada. Pediatric obsessive-compulsive disorder (OCD) is a mental health disorder that requires specialized cognitive behavioural therapy (CBT) treatment. Formal inclusion of parents during CBT is particularly important when treating OCD in young children as symptoms directly affect family functioning. However, there is a lack of understanding about parental perspectives of nurses’ roles during CBT and the factors that impact parents’ engagement during therapy.

Purpose
The purpose of this interactive workshop is to increase understanding about parental engagement during CBT for childhood OCD by describing and examining this phenomenon from the perspective of parents and exploring parents’ experiences of nurses’ roles during therapy.

Methods
Data will be presented from an interpretive descriptive study that used semi-structured interviews with parents and a focus group with CBT treatment providers.

Results
To date, 14 interviews have been completed. Data collection and analysis is currently on-going.

Conclusion
Using the results from this study and current evidence based literature, participants will build on their current understanding of parental engagement during mental health treatment for children and their families. Participants will also learn strategies of how nurses can promote and assess parental engagement during CBT treatment.  

Significance
This interactive workshop will inform:
1) nursing practice related to psychotherapy.
2) how parents perceive nursing roles related to CBT
3) the needs for clinical nursing training and the development of nursing education related delivering children’s mental health treatments
4)  a family-centered care approach to treatment design, practice, and evaluation

Tuesday, August 31, 2021
3:15 – 4:00 pm (UTC-4, Atlantic Time)

Abdominal Examination: Overview, Preparation, Technique and the Role of Artificial Intelligence

Mrs. Mitra Rangarajan1, Hanna Hopia2

1Lifebridge Health, Timonium, United States, 2JAFK University, Jyvaskyla, Finland

Purpose of the Workshop
The purpose of the workshop is to underscore the importance of conducting a proper abdominal examination and use artificial intelligence to complement but not compete with the clinician to find an etiology for the presenting symptoms of a patient.

Workshop Methods and Format
Power point presentation and live hands on practice allowing participants to gain the skill set to be able to take a good history, perform the abdominal exam and order the correct diagnostic tests to discern an etiology for the patient’s presenting symptoms. Different case studies will be presented covering the major abdominal organs.

Significance
-Participants will be able to identify the abdominal anatomy including vasculature and abdominal nervous system.
-Learn to organize the differential diagnosis.
-Understand what tests to order.
-Understand the role of artificial intelligence.
-Learn to educate the patient on the diagnosis, treatment and prognosis.}
-Understand the role of precision medicine in diseases affecting the abdominal organs.

Target Audience
Nurse practitioner in active practice, NP students and faculty members.

By the end of the workshop, participants will be able to:
1. Take a good history.
2. Perform an abdominal examination pertinent to the symptoms.
3. Delineate the differential diagnoses.
4. Participants will be able to demonstrate the skill set acquired in mock patient cases.
5. Participants will be provided resources to use during the evaluation of a patient.

Monday, August 30, 2021
1:15 – 2:00 pm (UTC-4, Atlantic Time)

First proposals to Advanced Practice Nursing in Brazil: Experience report

Associate Professor Beatriz Toso1, Dr. Manoel Vieira De Miranda Neto2, Elisabete Paz3

1West Paraná State University, Cascavel, Brazil, 2 Federal University of São Paulo, São Paulo, Brazil, 3Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Background
The symposium presentation intends to reflect about an approximation of Brazilian nurses with advanced nurse practice in primary health care. As a model to increase in number and quality health human resources, this kind of nursing helps to create new possibilities of patients care. Their mainly denomination includes different roles and act places, such as clinical nurse specialists and advanced nurse practitioners.

Purpose
Address the advanced practice nursing, covering the first approaches regarding the theme in Brazil. We focused on educational preparation; a research experiment in a primary care setting about how to insert such role; and the Brazilian Council of Nurses’ actions.

Approach
Theoretical reflection, describing the concept of advanced practice nursing, addressing on priority strategies for its implementation in Brazil. Thus, we included the following three perspectives: educational system, report about the impact on a primary health care setting and a discussion considering the Brazilian Council of Nurses’ actions.

Results
Among the strategies, we highlighted these ones: investment in graduation nursing courses; national strategies adoption for follow-up training at work; addition of practice based on evidences as a guideline for professional nursing actions in primary health care; legislation revision and expansion guiding the practice; and health care system legislation review for advanced practice nursing.

Conclusion
We may understand that the foundations for the adoption construction and formal regulation of the advanced practice nursing are established. Thus, the Brazilian nursing needs to be aware about that and take the decision whether incorporating or not to the profession.

Significance
Advanced practice nurses may improve access to services and reduce waiting time. They should deliver care for a range of patients, including those with minor illnesses and the ones requiring routine follow-up, with high patient satisfaction rate. So, we have been spending efforts to bring this role to Brazil.

Monday, August 30, 2021
5:20 – 6:05 pm (UTC-4, Atlantic Time)

Strengthening the Reach and Impact of Online Advanced Practice Nursing Education

Dr. Karan Kverno1, Dr. Emily  Frosch1, Dr. Tamar Rodney1

1Johns Hopkins University School Of Nursing, Baltimore , United States

Background
Benefits of digital/online education include flexibility for students in when to study and where to live. Challenges include students feeling under-involved and difficulties for faculty in monitoring learning.

Purpose
With grant funding from the State of Maryland Higher Education Commission, we developed one of the first and few entirely online, accelerated, post-graduate psychiatric-mental health NP (PMHNP) programs in the U.S.  The purpose of the program is to develop the psychiatric competencies of primary care NPs so that they can provide comprehensive integrated care to their patients. The purpose of this symposium is to share lessons learned from five years of teaching an online accelerated post-graduate PMHNP program.

Approach
We will discuss our strategies for teaching online, including but not limited to:
 How we set up our online classrooms and orient students to the learning environment, expectations and overarching framework.
How we engage students in learning.
How we use both pre-assignment work reviews and post-assignment remediation processes to ensure optimal learning.
•  How we facilitate and evaluate learning without exams.

Key Learnings
Although we use technology, most of our teaching methods are simple and involve student case write-ups, presentations and discussions, faculty feedback and student-faculty phone and written communication. All of our clinical teaching faculty and instructors have extensive practice experience in our respective interdisciplinary fields.

Conclusion and Significance
Over the last five years, we have made at least yearly modifications to the curriculum, courses, assignments and teaching strategies to maximize student learning. We have found that it is not so much the technology, but the development of strong teacher-student working relationships and repetition of applied clinical reasoning that facilitates rapid learning and consolidation of new competencies. Both student satisfaction surveys and certifying exam outcomes to date suggest that we are meeting personal and professional learning needs.

Monday, August 30, 2021
6:10 – 6:55 pm (UTC-4, Atlantic Time)

Pioneering a Global APRN-led Sustainable & Innovative Clinic Model

Julie Novak1

1NAPNAP National Association of Pediatric Nurse Practitioners, San Diego, United States

Background
The historical basis/social mandate for nursing’s role in health promotion/healthcare delivery is rooted in the work of Florence Nightingale and public health nurses, e.g., Lillian Wald and Lavinia Dock.  Just as Nightingale and public health leaders influenced the British/U.S./global/military health-care delivery systems, mid-1800s through the 20th century, advanced practice registered nurses (APRNs) have designed alternatives to failing healthcare delivery systems.   

Purpose
This workshop features the integrated nurse-led model for sustainability and innovation (INMSI), a road map for developing sustainable clinics, responding to community needs for accessible, quality, value-based healthcare, and expanding clinical sites for inter-professional education. 

Approach
Earliest iteration of the INMSI addressed primary care workforce needs in Virginia.  The model evolved in rural/urban Indiana and Texas with significant clinic development, expansion, and replication resulting in 12 APRN-led clinics in rural/urban primary healthcare, refugee health, Head Start Early Childhood Education, K-12 school systems, college/employee health. INMSI was expanded in California with a NICU Follow up Clinic in 2016, designated as a California Children’s Services High-Risk Infant Follow-up Clinic and used to design a Head Start Health and Wellness Mobile Van.

Results/Conclusion
The 14 INMSI clinics meet the Institute of Healthcare Improvement Quadruple Aim goals of better healthcare and access; better population health and patient experience; lower cost; joy in work for healthcare providers.  Each clinic demonstrates mission integration of practice/education/research, achieving sustainability through diverse financial portfolios.  INMSI was further developed in Cape Town, South Africa and rural Xochimilco, Mexico.

Reach
Over 40,000 patients cared for in the 14 clinics. For further dissemination online, six modules were created including: Relationship-based Communication/Partnership; Cultural Proficiency/Humility; Developing a Business/Reimbursement Plan; Clinic Design/Implementation/Expansion/Replication; Building a Mosaic of Financial/Community Support, and Grants/Grant Writing.

Wednesday, September 1, 2021
2:45 pm – 3:30 pm (UTC-4, Atlantic Time)

Nurse Practitioner-Led Clinics in Ontario: A Tool Box for Creating Accessible Patient-Centred Primary Care Teams 

Jennifer Clement2, Mrs. Sue Tobin1, Mrs. Stephanie Skopyk3

1Ingersoll Nurse Practitioner-led Clinic, Ingersoll, Canada, 2Sudbury District Nurse Practitioner Clinics, Sudbury , Canada, 3Nurse Practitioner -Led Clinic CMHA Durham , Oshawa, Canada

Background
Nurse Practitioner-Led Clinics (NPLCs) are innovative, interdisciplinary primary care teams where Nurse Practitioners (NPs) are the most responsible provider (MRP) for over 100,000 patients at 25 sites in Ontario, Canada.  NPLCs demonstrate access and quality outcomes that exceed those of other primary care models.   NPLCs are located in urban, rural, remote, and marginalized communities and address diverse health issues including wellness care, chronic disease management, mental health care, addiction treatment and palliative care.  They are salary-based, fiscally sustainable and responsible models of care that can be tailored to meet geographic or patient population needs.

Purpose
To provide participants with  foundational knowledge to develop NPLCs in their communities

Methods and Approach
NP Leaders from 3 NPLCs including the first NPLC developed in Ontario, will take participants through an interactive step by step process of establishing an NPLC.  The NP Leaders will share their experiences working in rural,remote, urban and marginalized communities.

Key Learnings or Results
Participants will increase their knowledge on the value of clinical nursing leadership, learn how to develop an NPLC, design their interdisciplinary team based on their population attributes, collect data on NPLC “value added” care, and learn about challenges faced by NPLCs relating to the delivery of primary care in a historically medical model/fee for service health care system.

Conclusion
The Ontario NPLC model can be duplicated and modified in order to meet patient and community needs.   Placing an NP in a dual leadership/practicing NP role reflects a high level of clinical accountability, ensuring a nursing focus is maintained in day to day practice, while remaining fiscally responsible.

Significance
Nurse Practitioners are having a greater impact on patient care delivery systems and patient outcomes.   Lack of access to primary care has a significant health and financial impact in many countries around the world. 

Wednesday, September 1, 2021
12:45 pm – 1:30 pm (UTC-4, Atlantic Time)

Advanced Practice Nursing Roles, Regulation, Education and Practice:  Results and Implications of a Global Study

Dr. Kathy Wheeler1, Dr. Minna Miller2, Dr. Elissa Ladd3, Dr. Joyce Pulcini4

1University of Kentucky College of Nursing, 2University of British Columbia, 3MGH Institute of Health Professions, 4George Washington University School of Nursing

Background:  A year-long global study was conducted in order to update Nurse Practitioner/Advanced Practice Nurse (NP/APN) information from around the world.  This survey was developed by the Health Policy Subgroup of the International Council of Nurses Nurse Practitioner/Advanced Practice Nursing Network (ICN NP/APNN) and launched at the 10th ICN NP/APNN Conference in Rotterdam in 2018.  A similar study was completed 10 years earlier, developed by the ICN NP/APNN Education/Practice Subgroup.

Purpose:  The study was conducted in order to understand the most recent state of practice, education, regulation and certification of NPs/APNs around the world.  Certification questions were added to the survey in order to understand this comparatively new NP/APN regulatory issue.

Methods:   After securing Institutional Review Board (IRB) approval from the University of Kentucky this descriptive study was performed initially through an electronic questionnaire made available via a link to a Research Electronic Data Capture (REDCap) survey.  When firewall issues precluded some regions of the world from responding the IRB approval was amended, the deadline was extended and the survey was made available via word document submission.  The sample was stratified according to each country and/or administrative region who responded to the survey. 

Results:  The study yielded global information on NP/APN practice, education, regulation and certification.  Over 30 countries/regions provided data on how respective countries/regions approached advanced practice.

Conclusion:  The NP/APN role has continued to proliferate around the world, with some countries/regions developing highly structured practice, education, regulatory and certification processes.  However, numerous barriers continue to plague role development in many parts of the world.

Significance:  In order to advance a profession that has been found to be helpful towards the achievement of Sustainable Development Goals, including universal health coverage, it is critical to understand practice, education, regulatory and certification practices in order to provide direction and resources.

Tuesday, August 31, 2021
11:30 am – 12:15 pm (UTC-4, Atlantic Time)

The role of national research centers in advanced practice nursing role development: the CCAPNR experience

Dr. Ruth Martin-Misener1, Dr. Denise  Bryant-Lukosius2, Josette Roussel3, Dr. Manuela Eicher4, Dr. Krista Jokiniemi5, Dr.  Nancy Carter2, Dr. Faith Donald6, Dr. Kelley Kilpatrick7, Dr. Joan Tranmer8, Dr.  Jennifer Rayner9, Dr. Diana Sherifali2, Dr. Erin Ziegler6, Linda Brousseau2, Dr.  Andrea Carson1

1School Of Nursing, Dalhousie University, Halifax, Canada, 2School of Nursing, McMaster University, Hamilton, Canada, 3Canadian Nurses Association, Ottawa, Canada, 4University of Lausanne, Lausanne, Switzerland, 5Department of Nursing Sciences, University of Eastern Finland, Kuopio, Finland, 6School of Nursing, Ryerson University, Toronto, Canada, 7Ingram School of Nursing, McGill University, Montreal, Canada, 8School of Nursing, Queens University, Kingston, Canada, 9Alliance for Healthier Communities, Toronto, Canada

Background
The Canadian Center for Advanced Practice Nursing Research (CCAPNR) was established on the foundation of Dr. Alba DiCenso’s nationally funded Research Chair (2001-2011) focused on capacity-building in advanced practice nursing (APN) research. CCAPNR’s mission is to conduct research, translate knowledge, and mentor the next generation of APN scientists. The role of research centers in furthering APN role development within and across countries has not been examined.   

Purpose
To explore opportunities and challenges associated with developing and sustaining a national research enterprise to support APN role development and future directions.  

Methods or Approach
Panelists will present perspectives on the role of national research centers in advancing APN research. Dr. Denise Bryant-Lukosius will present on the evolution of CCAPNR identifying achievements, challenges, and a vision for a preferred future. Ms. Josette Roussel will discuss the changing context of nursing in Canadian healthcare and implications for APN research on policy development and advancing the role of APNs. Dr. Manuela Eicher will share the Switzerland experience in collaborating with CCAPNR faculty to promote APN role development. Dr. Krista Jokiniemi will describe her experience as a post doctoral fellow from Finland with CCAPNR.  Dr. Ruth Martin-Misener will facilitate interactive discussion examining international collaboration and translating the CCAPNR model to other countries as a strategy to stimulate research (and promote global development of APN roles.

Key Learnings or Results
Participants will learn from panelists and each other about the potential benefits and challenges of national research centers focussed on APN and transferability of the CCAPNR experience to their own countries. 

Conclusion
National research centers can increase APN research and knowledge translation. Evaluating their mission and goals to remain relevant to changing healthcare contexts is essential.

Significance (Impact and Reach)
Interactive discussion may lead to development of APN research centers in other countries and/or cross-country collaborations.

Tuesday, August 31, 2021
11:30 am – 12:15 pm (UTC-4, Atlantic Time)

Implementing Nurse Practitioner as Most Responsible Provider in a Mental Health Facility: Advancing Practice

Julie Earle1, Karima Velji1, Andra Duff-Woskosky1

1Ontario Shores Centre For Mental Health Sciences, Whitby , Canada

Ontario Shores Centre for Mental Health Sciences is continually striving to advance nursing practice and provide excellence, innovation, safety and recovery to our patient population. With these principles guiding practice, we developed the first ever Nurse Practitioner (NP) as Most Responsible Provide (MRP) role in an inpatient Mental Health Hospital.

The development of the NP as MRP role took significant planning and consideration. Specific attention to the Mental Health Act tenants was required. Key Stakeholders were involved, including the senior management team and physician and psychiatry partners to make this role implementation successful. Due to the patient complexity, both medical and psychiatric, and need for the comprehensive and holistic approach of the NP, the role was initiated on an inpatient dementia unit.

Since the implementation of the NP role, patients receive comprehensive assessment on admission. There has been a 100% increase in the use of non-pharmacological interventions for treatment of agitation/aggression. Alternate Level of Care (ALC) rates have decreased by 44%. Length of stay has decreased, with over 80% of patients being discharged within the 59 day care pathway. Readmission rate is less than 5%. Overall, patient and family satisfaction has increased. Lastly, the nonclinical domains of NP practice have been utilized to encourage the frontline staff to work to full scope of practice.

This presentation will focus on how the first ever NP as MRP role was implemented successfully in an inpatient setting. Attention will be given to principles of change management, legal implications of different health acts, operationalization and sustainability of the role to provide excellence, innovation and patient and recovery focused care. Through use of power point and interactive discussion with the Vice President, Director and NP, this presentation will help advance the advance practice nursing role.

 

Tuesday, August 31, 2021
4:15 pm – 5:00 pm (UTC-4, Atlantic Time)

Outcomes of Pain Management Clinical Nurse Specialists within the Three Spheres of Impact

Lydia Booher1

1Cleveland Clinic, Cleveland, United States

Background
The impact of the pain management Clinical Nurse Specialist (CNS) ranges from micro to macro level in a healthcare system within three spheres of impact: patient/family, nursing and systems. Clinical Nurse Specialists are unique in their ability to be experts in a specialty such as pain management, and possess skills such as leadership, collaboration, consultation, quality improvement, evidence-based practice and systems thinking. As advanced practice nurses, CNSs are also able to diagnose, treat and prescribe, and impact outcomes at the patient/family, nursing and system levels.

Purpose
The purpose of the symposium is to describe the impact and value of Pain Management CNSs in patient/family, nursing and system spheres to improve outcomes through consultation, collaboration, education, leadership, and research and quality improvement.

Method
The role of the pain management CNSs in each sphere of impact will be discussed with examples.
Identify complex patients and create individualized holistic plan of care; educate patient and family; communicate plan of care with other team members; assess learning needs of nurses, provide education; create quality improvement projects; evaluate impact of the project;  create care pathways that increase quality, efficiency and decrease cost at the system level. 

Key Learnings/Results
Outcomes: Increased engagement and patient satisfaction; minimize patient suffering; decrease length of stay; measure nursing knowledge before and after education, and outcomes after implementing quality improvement projects. Improved workflow at the system level.    

Conclusion
While the attributes of critical thinking, creativity,collaboration, consultation, education, leadership and systems thinking is not unique to the CNS role, having the autonomy to impact outcomes as APNs within the three spheres clearly sets the CNS role apart from other APNs and nursing roles.

Significance:
The audience will:
 Appreciate the unique value and effectiveness of the pain management CNS role ranging from micro to macro levels within a healthcare system.

Tuesday, August 31, 2021
4:15 pm – 5:00 pm (UTC-4, Atlantic Time)

Understanding NP Workforce Patterns: Developing a Standardized Tool for Data Collection

Dr. Tammy O’Rourke1, Dr.  Els Duff2, Dr.  Tracey  Rickards3, NP Sharon Hamilton3, Dr.  Esther Sangster-Gormley4, Dr.  Denise Bryant-Lukosius6, Dr. Ruth Martin-Misener5

1Athabasca University, Athabasca, Canada, 2University of Manitoba, Winnipeg, Canada, 3University of New Brunswick, Fredericton, Canada, 4University of Victoria, Victoria, Canada, 5Dalhousie, Halifax, Canada, 6McMaster University, Hamilton, Canada

Background
Nurse practitioner (NP) practice in Canada has changed considerably and continuously over the past 50 years and there is growing interest in several countries to increase utilization of this role.  Understanding changes in NP practice and emerging utilization trends is an important component of ongoing research.  Additionally, significant variances exist in the way that we currently collect NP workforce data. No single comprehensive data source for conducting NP focused research exists. There is a need to develop and utilize survey instruments responsive to these changes.

Purpose
To describe the development of an NP practice pattern survey and engage participants in discussion about the relevance of the survey items.

Methods
During this symposium, four presenters, each from a different Canadian province, will discuss their experience with developing and administering an NP practice pattern survey and their collaboration to develop a new comprehensive NP practice pattern survey. The audience will be asked to provide feedback on new and or changed components of the survey and to engage in discussion about the international relevance of this data collection tool.

Results
A new, more comprehensive, yet concise NP practice pattern survey was developed to more effectively reflect the current context within which NPs work.  A total of 236 items were reviewed, several items were removed from the survey, and new sections were added. The new tool has a total of 127 items. 

Conclusion
National and international collaborations among researchers to improve the evaluation of NP workforce practice patterns is needed.

Significance
A standardized NPWD (Nurse Practitioner Workforce Data) collection tool can be used to inform NP workforce planning and evaluation and program curricular improvements to meet the current and future educational needs of NP graduates.  

Monday, August 30, 2021
12:30 – 1:15 pm (UTC-4, Atlantic Time)

What Have Happened in the APN Development and Implementation in Latin American countries?

Consuelo Ceron, Ms Sivlia Cassiani2

1Universidad De Los Andes, Santiago, Chile, 2Pan American Health Organization, Washington, United States of America

Background
Human Resources play a key role in the achievement of Universal Health. The PAHO/WHO Resolution CD 52 urges Member States to support PHC based health systems and increase the number of health professionals for PHC such as APN. However, APN in Latin American countries (LAC) is not well known. PAHO/WHO have organized webinars, documents and summits to encourage the implementation of APN in LAC and have published a document about expanding the role of nurses in PHC and an action plan in 2018. This publication was the most accessed document in PAHO in 2018-2019.

Purpose
To (1) show the progress made by 6 LAC in the development and implementation of APN; (2) analyze barriers and opportunities; and (3) visualize new strategies to advance in the APN implementation.

Methods or Approach
National nursing leaders of LAC will present the advances reached following the strategies and action plan suggested by PAHO through the summits, webinars and 2018 document.

Key Learnings or Results
6 countries (Brazil, Chile, Colombia, Costa Rica, Mexico and Uruguay) have made significant progress in APN development since 2013. In general, the main difficulties are problems in differentiation between RN and APN; absence of legal framework that allows the extend role development of APN; to engage nurses themselves in the initiative and to establish labor market and salaries. As opportunities: the network collaboration established among leaders of each countries and the discussion of the expansion of the role of nurses in PHC and their competencies.

Conclusion
Collaborative networks and support/experience of developed countries are key for APN development and implementation. It seems appropriate to strengthen collaboration south-south and revisit national goals and action plans to move forward in the APN implementation in the LAC.