|
Nurse Practitioners
in Long-Term Care
What do you do
when your loved one develops a nasty skin rash or a frightening cough,
only to find out the physician at your long-term care facility is unable
to attend until next week? Call the nurse practitioner, if the facility
is lucky enough to have one.
In the year 2000, the Ontario government provided funding for nurse
practitioners to work in 20 pilot projects across the province, of which
service 72 long-term care facilities, four hospitals, five special geriatric
services six community care access centres and four day programs. The
impact was positive not only for residents, but for family caregivers,
for busy physicians, and for the staff in long-term care facilities
who are finding that problems treated at the bedside save time and worry
later on.
Concerned Friends spoke to a nurse practitioner to learn more about
her role in long-term care. Michelle Clifford-Middel was hired as a
consultant by a consortium in Barrie, Ontario: I00F Senior Citizens
Homes Inc, Grove Park Home for Seniors, Senior Encounter Day Program,
VON Alzheimer's Day Program, and the Alzheimer Society of Simcoe County.
She cares for 249 residents in the two long-term care facilities alone,
rotating between the two facilities three half-days per week.
In her first three months, she conducted 483 clinical assessments, treating
common ailments such as eye and ear infections, skin problems, bowel
and bladder problems, and chest colds. Dietary or physiotherapy recommendations
were made to staff. She monitored stable chronic conditions such as
diabetes and high blood pressure. Of the 483 assessments, 13 per cent
were diagnosed with pneumonia or congestive heart disease and were referred
to a physician.
"It is difficult or challenging for physicians to be there as regularly
as they'd like to, or to really investigate these conditions sufficiently,"
Michelle said, adding that early diagnosis and treatment can save someone
a trip to the hospital.
Depression is an often overlooked diagnosis of residents in long-term
care, she said. "I ensure that a comprehensive assessment is done.
If the assessment needs to be conducted over a two-day period due to
the resident's needs, I will block that in."
Assessment of behaviour can lead to important changes that alleviate
problems for residents and staff. "Maybe the dining room is too
stimulating for a person, and the person needs to eat in the quiet,"
Michelle said.
Going through patient records with a pharmacist, Michelle was able to
reduce medication use in one facility from an average of 10.1 pills
per day to 8.9 by discontinuing duplications and following up on blood
pressure medications.
During her first three months, she conducted 25 formal information sessions
on needs identified by staff - from new wound care products, to assessment
skills, infection control, vaccinations, and new technologies that often
accompany residents transferred from hospital.
Perhaps more importantly, she said, is the informal
"just-in-time" teaching she provides to staff. "Whenever
I'm conducting assessments I bring someone with me to explain what I'm
doing, what I'm seeing and hearing, and ask them to participate."
Michelle, who previously nursed in a hospital, in a community health
centre, and in a diabetes and cardiovascular/lifestyle centre, says
she has never been more professionally satisfied since moving to her
new role in long-term care.
The Nurse Practitioners' Association of Ontario is lobbying the Minister
for Long-Term Care to continue funding for hiring nurse practitioners
in long-term care settings. It is also lobbying and educating long-term
care physicians and administrators regarding the benefits of the nurse
practitioner role.
Concerned Friends has supported the concept of nurse practitioners in
long-term care for several years. In addition to Michelle's positive
report, we have received good feedback from facility administrators.
|
