Clinical Nurse Educator Role in Swan Hill Hospital

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Executive Summary

Cardiovascular diseases (CVDs) are a considerable bother for healthcare authorities in Australia. CVDs are accountable for 14% of the total burden of diseases resulting in $10.4 billion of healthcare expenses (AIHW, 2019). CVDs are more prevalent in distant areas of the country due to decreased access to healthcare services. Swan Hill area in Victoria is an explicit illustration of the situation since its population experiences considerable difficulties in receiving appropriate heart care services. The matter may be significantly improved by the introduction of a clinical nurse educator (CNE) role in Swan Hill Primary Health Medical Centre (PHMC). The most efficient way to implement the project is by using the PEPPA framework.

The potential stakeholders of the advanced practice nursing program include all patients of the PHMC, hospital personnel, including management, the community of the area, the public health sector, and the Australian Heart Foundation. A thorough analysis of the present model of care is the lack of CVD awareness and prevention program. A CNE can lead the modernisation of the current model to include the best evidence-based practices.

The primary concern of the program should be health promotion and early detection of heart issues, better access to critical cardiac care, improved services, and system performance enhancement (Victoria State Government, n.d.). Therefore, the new model should include spreading awareness about the importance of heart health using visual aid on hospital grounds, promoting a healthy lifestyle, and arranging home visits and online consultations to patients living in remote areas. A CNE should utilise Roger’s diffusion of innovation theory (DOI) to create a coherent implementation plan for the new model of care.

Introduction

Cardiovascular diseases (CVDs) are a major concern for the Australian healthcare system due to the high rate of morbidity and mortality from its complications. According to the Australian Institution of Health and Welfare (AIHW, 2019), 1.2 million Australians aged 18 and above have one or more heart-related conditions. Heart conditions account for 14% of the total burden of diseases and $10.4 billion of yearly expenditures attributed by the Australian health system (AIHW, 2019). One of the reasons for the increased amount of adverse events is low access to qualified healthcare services in rural areas.

The matter may be addressed by introducing advanced nursing practice in remote areas. The present paper proposes the introduction of a clinical nurse educator (CNE) role in Swan Hill hospital to reduce the number of CVD complications in the area.

Importance of Advanced Nursing Practice

Health care reformation has led to an increased need for advanced practice nurses (APNs). According to Bryant-Lukosius and DiCenso (2004), such professionals focus on meeting the needs of patients by “maximising the use of nursing knowledge and skills and improving the delivery of nursing and health care services” (p. 11). In other words, APNs offer flexibility to the healthcare system by contributing to various areas of care provision, which is vital for improving the cost-efficiency of the matter (Gardner, Duffield, Doubrovsky, & Adams, 2016).

Even though the definition of advanced nursing practice is ambiguous, the impact of the issue is well known and highly valued among health care authorities around the globe. According to Woo, Lee, and Tam (2017), the introduction of advanced nursing practice in hospitals is associated with a decreased time of consultation, treatment, and waiting in emergency care. Moreover, multiple studies confirm improvements in patient satisfaction, cost-efficiency, and mortality rates (Woo et al., 2017). Therefore, APNs may positively affect patient outcomes in remote areas.

PEPPA framework Overview

There are many barriers to the successful introduction of APNs in healthcare institutions. One of such issues may be the lack of a systematic approach to the matter. PEPPA framework is a participatory, evidence-based, patient-centred process for APN role development, implementation, and evaluation (Bryant-Lukosius & DiCenso, 2004).

This guideline proposes nine steps to successfully advance nursing program initiation, including the definition of the patient population, identifying stakeholders, determining the need for a new model of care, identifying the priority of problems, description of a new model of care, planning the initiation process, implementing the plan, evaluating the outcomes, and long-term monitoring (Bryant-Lukosius & DiCenso, 2004). This framework promotes an increased understanding of how to organise an optimal advanced nursing practice in any part of the world.

Identifying Population

The identified population for the present proposal is the adult population in Swan Hill and associated areas suffering from CVD complications. According to Worthington (2018), people living in remote areas are 90% more likely to die from heart diseases in comparison with their counterparts living in the city. The matter may be associated with the lack of health care services in rural areas due to inefficient models of care. Indeed, Indigenous people in Central Australia who develop heart failure are 20 years younger than the general population on average (Worthington, 2018).

As another confirmation of the matter, the report by Rural Health Outreach Fund (RHOF, 2017) notes a high rate of CVD complications in various parts of Victoria, including Swan Hill. Even though the overall prevalence of heart diseases in the area is medium (Heart Foundation, 2011), Swan Hill is considered a CVD hotspot due to a significant gap in care provision to the population (RHOF, 2017). Therefore, the introduction of advanced nursing practice in the area may positively affect the situation.

It is vital to consider all the characteristics of the population before planning the implementation of the project. According to the Australian Bureau of Statistics (ABS, 2016), Swan Hill is a rural town in Victoria, Australia, with a population of 10,905 at an average age of 39. The area has an increased number of citizens above 60 in comparison to the Australian average (ABS, 2016), which may be associated with decreased mobility of the population and increased risk of CVD (Heart Foundation, n.d.).

Healthcare services in the area are provided by Swan Hill Primary Health Medical Centre (PHMC), which is a 143-bed hospital with 630 staff members (Swan Hill District Health, n.d.). The PHMC provides a wide range of services, including medical and surgical care, obstetrics, aged care, community and primary health, renal dialysis, and chemotherapy (Swan Hill District Health, n.d.). The hospital offers a wide variety of patient-centred health promotion programs for children adults.

However, there are no CVD awareness and prevention programs, which may be the reason for the high prevalence of heart disease. Additionally, there are no APN programs established in the hospital, which may be associated with reduced effectiveness of services (Woo et al., 2017). In short, the population of Swan Hill is at high risk of CVD complications due to the inefficient model of care.

Stakeholders

The potential stakeholders of the advanced practice program are numerous. The purpose of the proposed project is to improve patient outcomes and the quality of care; therefore, the primary beneficiaries of the matter are patients of Swan Hill PHMC. In particular, patients with a high risk of CVD, including obesity, low mobility, depression, diabetes, and high cholesterol, will receive additional services that will reduce potential morbidity and mortality. Moreover, the introduction of the CNE role will help the nursing staff to receive further education and acquire additional qualifications.

The decreased prevalence of CVD complications will improve the social and family well-being of the community. Additionally, the hospital will enhance its reputation resulting in increased patient trust and personnel retention. In short, the APN program will positively affect hospital staff, its patients, and the Swan Hill community altogether.

Other groups of stakeholders include hospital authorities, the public health sector, and the Australian Heart Foundation. Hospital authorities will need to finance the project and hire appropriate personal. They are to evaluate the financial feasibility of the proposal and make a final decision on whether a CNE role should be introduced in the PHMC. The Australian Heart Foundation is expected to provide the required methodology for the prevention of heart diseases. Additionally, the public health sector will be affected since the project is associated with a decreased probability of danger to the population. In brief, the project will have an influence on diverse stakeholders.

Determining a Need for a New Model of Care

The identified population needs the introduction of a new model of care for a variety of reasons. The patients and their families need adequate information about the importance of CVD prevention strategies to reduce morbidity and mortality from the conditions.

The matter is especially relevant for Swan Hill are since many families live far from the medical facilities and experience mobility problems. The Heart Association of Australia expresses a deep concern in the matter and is ready to provide support in resolving the issue (Heart Association, n.d.). Victoria State Government (n.d.) also identifies the promotion of healthy living and improvement of detection of the early stages of heart disease as the top priority for the development of healthcare services. All these matters may be modifying the existing model of care in Swan Hill PHMC.

The new model of care should include CVD prevention programs that can be fostered by a CNE. CNEs are devoted to teaching nurses the best quality evidence-based practice that can improve patient outcomes in all types of healthcare facilities. The minimal education requirement for the role is a bachelor’s degree in nursing; however, a Master’s of Science in Nursing degree with a specialisation in teaching is recommended (Brennan & Olson, 2018).

CNEs are also required to have considerable experience in primary care to be able to appreciate the problems of front-line care providers. The high expectation for the role is associated with the working spectrum of the professionals. CNEs provide training to nurses with varying level of education and experience. They are to be able to develop appropriate educational programs for any nurse regardless of his or her rank (Brennan, & Olson, 2018). Along with teaching and care program development, CNEs are to advocate for the programs’ implementation. Therefore, the introduction of a CNE role in the PHMC is projected to be an effective strategy to elaborate a CVD awareness and prevention program.

A CNE can use the information and support of the Australian Heart Association and create evidence-based prevention and awareness projects that would reduce the number of patients with CVD. Currently, the hospital does not use guidelines and tools provided by the Heart Association to decrease the prevalence of CBD in Swan Hill. The utilisation of absolute risk calculators and risk charts can help the nurses learn how to assess the risk of heart diseases.

Additionally, there is no sign of using effective patient education that can help the population to improve their quality of life by managing the risk factors of CVD. The lack of teaching programs for patients may be associated with the absence of adequate training among front-line employees. A CNE can collaborate with doctors, nurse leaders, managers, and other hospital personnel to address this problem.

Identifying Priority Problems

The strategic problems are clearly articulated by the local authorities. Victoria State Government (n.d.) identifies four priorities for the provision of care to CVD patients: health promotion and early detection of heart issues, better access to critical cardiac care, improved services, and system performance enhancement. Consequently, the new model of care should aim at spreading awareness about risk factors of CVD and encourage early reporting of heart-related problems.

The modification should focus on maximising the response to time-critical events, meaning that a person surviving an acute event can depend on a rapid and effective response from both members of the community and the health system (Victoria State Government, n.d.). The change is to promote the implementation of the best evidence-based practices to ensure patient satisfaction, safety, and cost-efficiency. Finally, a systematic multi-disciplinary cross-organisational approach is required to provide a seamless transition between all stages of care. These four problems should be considered as the top priority for the new model of care.

The introduction of a CNE role will help to translate the identified priorities into practice. A new CVD awareness and prevention program is to prioritise care provision to patients with increased risk of heart-related problems. Additionally, the program should consider reaching out to remote populations with phone calls or personal nurse visits to assess their hearts’ health. In other words, the patients under the focus of the change in the model of care are older citizens, the Aboriginal population, smokers, people with high cholesterol, high blood pressure, diabetes, low activity level, unhealthy diet, and signs of depression and social isolation (Heart Association, n.d.). These patients are to be provided with the best available service and a smooth transition between specialists and organisations.

Defining a New Model of Care

A new model of care is to elaborate a patient-centred, evidence-based, and cost-efficient health promotion program that addresses the problem of an increased occurrence of CVD in the Swan Hill area. The new model should feature efficient strategies of health promotion to patients with a high probability of CVD complication. These strategies include a screening of all patients for hypertension and absolute risk assessment (Heart Association, n.d.), spreading awareness about the importance of heart health using visual aid on hospital grounds, promoting a healthy lifestyle, and arranging home visits and online consultations to patients living in remote areas.

The new model of care is supported by evidence from the Australian Heart Association (n.d.) and other research findings. For instance, Yu, Malik, and Hu (2018) state that healthcare professionals are to be proficient in basic nutritional knowledge to promote a sustainable pattern of healthy eating. Southwell et al. (2018) encourage the use of online promotion consultations to decrease the chance of adverse cardiac events. Carey, Muntner, Bosworth, and Whelton (2018) also identifies the promotion of adherence to a healthy lifestyle as a primary strategy of reducing the prevalence of high blood pressure. A CNE can coordinate all the efforts described above.

A professional in the newly introduced role of CNE is to elaborate the best health promotion program with adequate support of recent evidence. First, the CNE is expected to conduct a thorough literature review and analysis concerning the most effective practices that improve heart health in Australia and abroad. Second, the CNE is to create a coherent implementation plan with an explicit financial statement that considers all the possible expenditures of the newly introduced program. Third, the conclusions made from the literature review and the elaborated plan are to be presented and negotiated with the hospital management.

Fourth, CNE is expected to lead the introduction of the new practice and provide necessary information and training to the medical staff. Fifth, the CNE will evaluate the new process of care provision and provide a list of further modifications if they are needed. After completing the project, the CNE may start elaborating on new initiatives to ensure the best quality service and improved patient outcomes. The competencies discussed above provide a thorough explanation of the CNE role in the new model of care.

Implementation Plan

Theoretical Framework

The process of implementation of practice changes can be facilitated by adopting a relevant change theory that can help to save time and resources (Batras, Duff, & Smith, 2014). For the present modification of the model of care, it is appropriate to use Roger’s diffusion of innovation (DOI) theory (Lien & Jiang, 2017). According to DOI, there are four steps to efficient adoption of new processes: awareness, decision to adopt or reject, initial use, and continuous use (Lien & Jiang, 2017).

The utilisation of the theory has been proved beneficial for various health promotion practices. For instance, according to Lien & Jiang (2017), an intervention that used DOI as a framework for implementation was successful in reducing the prevalence of tobacco smoking in Australia by 40%. Therefore, the theory may be used to create an action plan for introducing a new role.

Action Plan

As stated above, there will be four steps that will lead to the effective implementation of the role. First, awareness about the current state of CVD prevalence in Swan Hill will be spread together with the information about how the introduction of a CNE role can help to improve the matter. Second, the stakeholders should make a decision of the newly introduced role will be beneficial to the identified vulnerable population. Third, care providers will be encouraged to test the new model of care and accumulate feedback about their experience. Finally, needed modification of the initial model will be made, and the practice will be adopted and accepted as the new standard. The proposed four steps are expected to lead to improved patient outcomes and satisfaction.

Conclusion

CVD prevalence in Australia remains high in rural areas due to the low accessibility of healthcare services. One of the primary reasons for the situation is the lack of qualified front-line medical personnel. The matter can be improved by introducing CNE roles in primary care settings. CNEs are to elaborate, advocate, and implement educational programs for the nursing staff. These programs help to ensure the best patient by implementing the best evidence-based practices.

References

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Worthington, Brett. (2018). Isolation, low incomes and lack of services result in more deaths from heart disease in regional Australia. ABC News. Web.

Woo, B., Lee, J., & Tam, W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1). Web.

Yu, E., Malik, V. S., & Hu, F. B. (2018). Cardiovascular disease prevention by diet modification. Journal of the American College of Cardiology, 72(8), 914–926. Web.

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