Becoming an Advanced Healthcare Practitioner PDF
Preview Becoming an Advanced Healthcare Practitioner
We dedicate this book to our students. Manyfrom the past are already advanced practitioners, and those with whom we work currently,carrythe seedsof future advanced practice. ForButterworthHeinemann: CommissioningEditor:HeidiAllen ProjectDevelopmentEditor:Robert Edwards ProjectManager:JoannahDuncan DesignDirection:GeorgeAjayi IllustrationManager:BruceHogarth BUTIERWORTH-HEINEMANN AnimprintofElsevierSciencelimited ©2003,ElsevierScienceLimited.Allrightsreserved. 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Firstpublished2003 ISBN0750654414 BritishLibraryCataloguingin PublicationData Acataloguerecordforthisbookisavailablefrom the BritishLibrary LibraryofCongressCatalogingin PublicationData Acatalogrecordforthisbookisavailablefrom theLibraryof Congress Notice Medicalknowledgeisconstantlychanging.Standardsafety precautionsmustbe followed,butasnewresearchandclinical experiencebroadenourknowledge,changesintreatmentanddrug therapymaybecomenecessaryorappropriate.Readersareadvisedto check the mostcurrentproductinformationprovidedbythe manufacturerofeachdrugtobeadministeredtoverifythe recommendeddose, the methodanddurationofadministration,and contraindications.Itisthe responsibilityofthepractitioner,relyingon experienceandknowledgeofthepatient,todeterminedosagesand thebesttreatmentforeachindividualpatient.Neitherthe Publisher northeauthors/editors/contributorsassumesanyliabilityforany injuryand/ordamagetopersonsorpropertyarisingfrom this publication. The Publisher _ yoursourceforbooks, journalsandmultimedia inthehealthsciences www.elsevierhealth.com The Publisher's policy isto use papermanufactured fromsustainableforests Printedinthe UK Foreword 'Thegreatthinginthisworldisnotsomuchwherewe One of the challenges of skills utilization has are but in what direction we are moving' (Oliver been finding ways to use, define and regulate WendellHolmes) 'advanced' practice. There are several reasons Ithas beenenlighteningto write the foreword why this is so: it is difficult to functionally forthisvisionarybookwhichtakes the readeron define the exact level of practice which stops ajourney alongthe pathto advancedpracticein, being 'ordinary' andbecomes advanced: educa explaining, en route, what advanced practice is tion may not have kept up with the needs of and why, in today's challenging health care practice, so that practitioners learn from experi world,itisimportant. ence and in-service professional development, Theauthorsaredrawnfrom differentrehabilita and none of this is regulated: or there may be tiontherapy areas, bringing a fresh perspective to turf wars, over who 'owns' particular pieces of theissuesofadvancedpracticeandstartby reflect practice. These are difficultissues,butthisbook ingonthe driversfor changein the currenthealth tackles themall in apracticalway, usingworked carearena.Theeconomicimperativeinmostcoun examples to show different routes to advanced tries is to keep costs down while continuing to practice, likely obstacles and ways of overcom meetgrowing demand, often resulting in changes ing them. The book acknowledges that in many tothe structure of the health system. Because of waysthetitle ofadvancedpractitionercannotbe this,thereisa needfor professionalswho are able given, it has to be taken, and this readiness for toworkwithinever-changinghealthcare systems practice is acquired not only through formal aswellas a growing interest in the links between learning. The reflective practitioner is one who education, provider performance and quality of can look at their own quality of practice, and care. These challenges provide an apt backdrop consider to what extent it is evidence based, againstwhich to consider the potential contribu how theory can be applied to it, and whether tionsofadvancedhealthcare practitioners. theycanteachothers. Human resources in health care are central to Havinga level of self-awarenesswhichresults delivering health services, and yet the World in increased motivation to improve knowledge Health Report 2000 noted that determining and andskills, andputtheseintopracticeto improve achievingthe 'right' mix ofhealth personnel is a quality of care, is the cornerstone of empower major challenge for most health systems. The ment as a practitioner. With self-efficacy comes knowledge and skills that staff have, and the inner power to make decisions comfortably, to waysin whichtheyare managedsothattheycan take calculated risks and to tackle the unex use them effectively and efficiently, affects not pected in everyday practice. This is the sustain onlythe satisfaction of health care practitioners, able professional development for which all buteven morecrucially,determinesthe qualityof those involved in humanresources development carethey provide. are seeking. It is not easily taught, but it is encouragingtofind itdiscussedin this bookinall work for describing and measuring health, to its dimensions. define activity and participation. Hocking notes Over the past few years, there has been a that in using this framework practitioners will growing debate about the role of health in the have tohave the skills and knowledge to measure development of societies. Work done by WHO healthoutcomesinanindividualisedway,over the has shown that a healthy population is a pre long term - skills she identifies with advanced requisite for growth, rather than an expensive practice.Toachievethisgoal,shesuggeststhatpro optionfor developingcountries. Healthypeople, fessionals must increasingly work together, each supported by a functioning health sector, can withauniquecontribution. ensure that their societies develop, and sustain This is the new world of health care. Such an theirdevelopment. For this reason, loss ofhealth approach- teamwork using the skills of a range isalossnotonlytothe personbutalso tofamilies of professionals, and measuring health and not and societies. only illness in a population - is vital both to Improving the health of an individual, or the developing countries struggling to improve populationas awhole,does notmeanonly reduc health conditions despite severe financial and ing prematuredeathduetodiseaseandinjury,but human resources limitations, and to industrial also aboutmaximizingthe capacityofindividuals countriesworkingto providefair andresponsive to live a full lifein society.Healthis the ability to healthservicesin atimeofchangingexpectations live life to its full potential, and to realise this amongtheirpopulations,andwithlimitedfinan potential,rehabilitationtherapistshaveakey role. cial resources. In Chapter 8 of this book, Clare Hocking dis The journey is only beginning, but this book cusses the advanced occupational practice skills providesanessentialmaptoallserioustravellers. neededby healthcarepractitionersinordertohelp I commendittoallthoselookingto advancetheir people follow their occupations, and thus lead a practice. fulfilling and productivelife.Sheuses the WHO's International Classification of Functioning Disability OrvillAdams andHealth,whichisacommoninternationalframe- WHO,C;eneva,2003 Preface The impetus for writing this text came firstly give you several ways in which you could fromnumerous recent government publications, examine the needs of your own place of work particularly in theUKandthe USA.These papers whileat thesametimeputtingyourserviceinto emphasizethe needfor healthprofessionalstobe a wider context. These are skills that an collaborative, innovative, evidence-based and advanced practitioner needs to acquire and to creative in developing new, integrated areas of be sensitive about. practice. The concept of a highly qualified, Our own professional development has gone advanced practitionerandspecialist,whocan act through many stages, becoming honed often as,and is, officially recognized as a consultant is through trial and error but also through deliber an important feature of the government direc ate planningand further study. Now, in different tives,especiallyin the UK.Webecamechallenged ways, we have reached a stage where we can and inspired by the notion of developing a map operateon expertknowledge,supportedthrough thatcould guide an early-career healthcare prac lifelong learning, until we hit the nextbig learn titionertobecomean advancedpractitioner,who ingcurve. Given the fast rate at whichall aspects couldeffectivelyfillaconsultantpositionatsome of health-care are changing, we believed that it latertime. wouldbe helpful to provide you with a guide as Our second source of inspiration came from an early-careerpractitionerso thatyoucan accel ourownexperienceas clinicians, managersand erate the process ofbecoming an advanced prac educators of undergraduate and postgraduate titioner. This notion follows the same line of students. Betweenus, we have worked as clini thinkingthatisadvocatedin teachingclinical rea cians and/or educators in seven countries, soningin orderto enhancethe processofmoving where we had to adapt to different concepts of from novice to expert. Processes like these take a health and culture, in the delivery of services considerable amount of time-often many (public and private) and the education of years-sothe sooneryou are awareofyourcareer healthcare professionals.Also, we have worked paththebetteryou can planandfollow yourown with students who have come to our programs map. from many countries and cultures. Each one We also bring our own perspective on, and had a different slant on healthcare. These per beliefabout,healthcareprofessionals.Deliberately, spectives stemmed from each country having we have not referred to themas allied despite the other priorities and needs. Furthermore, each factthatmanydocumentsdo. Webelievethatthe profession had developed slightly differently, term allied suggests dependency, and this is not so there were many diverse ways of working compatible with the notionof autonomy thatwe and interpretingpractice. There are few univer are advocating. However, we accept that in saltruths and yet there are some commonprin some contexts, the term allied refers to the ciples and processes. The chapters in this text operational relationship of the allied health professional groups to each other and to that of relatetomanyotherhealthprofessionals,suchas medicine. dieticians, dental hygienists, nurses, medical All the chapters in this text were written by technologists, psychologists, physicians, and experiencedandadvancedhealthcareprofession pharmacists. als. These authors come from Australia, Canada, Figure1.1is ourmap.Itrepresents thecontext New Zealand, the UK and the USA. They repre ofhealthcarepracticefrom the perspectiveof the sent a rich diversity of experiences from cultural practitioner.Itisrepeatedas akey for eachchap andprofessionalperspectivesthatincludehealth ter. We invite you to use the figure and the text promotion,medicaleducation,occupationalther reflectively, as a guide for developing your own apy and physiotherapy and speech-language careerplan, and adding your ownquestions and therapy/pathology. As this text is published in ideas. Weseethis text asaworkingmaptowhich the UK, we have used UK spelling, with some you can constantly return at different stages in modifications. However, we have used both UK your career as.well as using it for different pur and North American terms to describe profes poses suchas workingwithand supervisingstu sionals, depending on their country of origin dents or for developing your role as a mentor. It and/or the literature being cited. Thus, North can also be used as a plan for a department to American physical therapists and their publica progress to becoming more scholarly and tionshavenotbeenturnedintophysiotherapists, research-focused. Wehope that youwillfind the or vice versa. We have also kept references to text valuable, and that collectively we have speech and language therapists or pathologists, inspired you to learnmore and to add your own depending on their countries of origin. The insights and scholarship as you move along in majority of the references we have cited, and yourcareer. examples we have used are about occupational therapists, physio/physical therapists, and GillianBrown,SusanA. Esdaile,SusanE.Ryan speech-languagepathologists, therapists. But we 2003 have also included examples and references that Contributors AuldeenAlsop, MPhil, BA,DipCOT,SROT, HelenM. Madill,PhD, Discipline Leader for Occupational Therapy Professor and Graduate Programs Coordinator Sheffield Hallam University, School of Health Centre for Health Promotion Studies, University andSocialCare, Sheffield, England,UK ofAlberta,Edmonton,Canada Gillian Brown,MSc,DipCOT,SROT, Maralynne D. Mitcham, PhD, DipCOT, OTR/L HeadOccupational Therapist, Barking Havering FAOTA, and Redbridge NHS Trust, and Senior Lecturer, Professor and Director, Occupational Therapy UniversityofEastLondon,London,England,UK Educational Program, Department of Rehabilitation Sciences, College of Health SusanA.Esdaile,PhD, MAPS,AccOT,OTR,SROT, Professions, Medical University of South Professor, Department of Occupational Therapy, Carolina,Charleston,SC,USA Eugene Applebaum College of Pharmacy and HealthSciences,Wayne State University, Detroit, Gwilym Wyn Roberts, MA DipCOT SROTAMICPD, Michigan,USA Head of Department, Department of Occupa tional TherapyEducation, School of HealthCare JoyHiggs, PhD,MPHEd,GradDipPhty,BSc,Professor, Studies,UniversityofWalesCollegeofMedicine, School of Physiotherapy, Director, Centre for Cardiff,Wales,UK ProfessionalEducationAdvancement, Faculty of Health Sciences, University of Sydney, NSW, LindaM. Roth, PhD, Australia Associate Professor and Education Coordinator, Department of Family Medicine, Faculty of ClareHocking,MHSc(OT), Medicine, Wayne State University, Detroit, Principal Lecturer, School of Occupational Michigan, USA Therapy Auckland University of Technology, Auckland,NewZealand Susan E. Ryan, MS, BAppSc, OTR, SROT, AccOT, Professor, School of Occupational Therapy, VivienHollis,PhD, MSc,TDip,COT,OT(C), UniversityCollege,Cork, Ireland ProfessorandChair, DepartmentofOccupational Therapy, Faculty of Rehabilitation Medicine, M. Clare Taylor, PhD, DipCOT, SROT,BA(Hans), MA UniversityofAlberta,Edmonton,Alberta, Canada (Dist), PrincipalLecturer, OccupationalTherapySubject LindyMcAllister, PhD,MABSpThy, Group, School of Health and Social Sciences CourseCoordinator Speech Pathology, School of CoventryUniversity,England,UK Community Health, Charles Sturt University, Albury,NSW,Australia Acknowledgements Wewouldliketo expressourgratitudeto thecol We are pleasedthatwewere able to includesug leagueslistedbelowfor reviewingearlierchapter gestions from people representing several health drafts and providing us with valuable feedback. professionsandfrom early-careerpractitioners. Barbara HooperMS, OTRjL MaryE.WilcoxBSc(Pharm),BA, DipJ DianeHamiltonOTR NiallFitzpatrickDip COT, SROT IdaCaniniOTR PetraJ. Klompenhouwer-MeijerMS, OTR,SROT c. Jennie AriailPhD StephanieFadeBSc(Hons),SRD KarenFronMPT ToddWolneyMT(ASCP) 1 Appreciating the big picture: you are part of it! The socio-political influences on health practice in the public and private sphere Susan E. Ryan, Susan A. Esdaile and Gillian Brown Figure1.1 Thepractitioner's perspectiveofthecontextofhealthcarepractice: individualqualities neededandkeyaspectsofprofessionaldevelopment tobecome anadvancedpractitioner Chapter outline Wehaveseparated this chapterintotwopartsthat examinethe major influenceson healthcarein thepublicand the privatesphere. The first partlooks atthe presentchallengestohealthcareprofessionals,includ ing, in particular, the definitions and role requirements of the newly createdpositionof the advanced practitioner. The reasons for the cre ation of this role are outlined in subsequent sections that look at the factors drivinghealthcare changes, the changinghealthcare scenarios 2 Becoming an advanced healthcarepractitioner and the consequentneedfor differentways of working. Thesefactors are coupled with the recognition that other forms of knowledge and different capabilities are required. Ways of maintaining professional standardsthatwillsupportthesechangeswithvariousregulationsare contrasted between professions and between countries. International and globalissuesthatimpacton practicein the various countries rep resented in this book are discussed and implications are suggested. The factors shapingthe privatesphereoftheindividualandhoweach practitionerworksin thischangingclimateare featured in threeways: howtoshapeideas,howtomanagepower,andhowtoorganizetimeto avoid stress. The chapter concludeswitha summary. Keywords Advanced practice,vision, leadership, power structures Anticipated As a result of reading this chapterwe anticipate that you willbe able outcomes to: • appreciate the complex breadth of factors that impact on national and local healthcare services • understand theneedfor visionand leadership from advancedprac titioners • realize the implications for altered service structures that the pro posedchangeswill generate • formulate strategiesto progressyourcareer-pathtowardsbecoming an advanced practitioner. Perspectives on the Healthcare practitioners are being challenged on several different big picture fronts. Manygovernmentsin developedcountriesare demandingfun damental re-organizations of all aspects of their healthcare. This includes all levels ofeducation, the diversification and distributionof healthprograms,otherwaysofworkingwithpatients/clients and the promotion of particular forms of research. Various commissions have been set up in different countries to examine national requirements and many of these reports are referenced in this book. At the same time, evolutionary changes are being generated from within health professions as anatural resultofthe developingmaturityofsome rel atively young professions. Research capabilities and study findings are also contributingto practice changes. Some challenges often seem contradictory. Certain changes appear tosuggestthathealthcarepractitionersshouldworkat lowertechnical levels to formulated patterns of practice. At the opposite end of this continuumisthe advancedpractitioner,anewcareerrole thatisbeing carved out that has a different combination of skills and knowledge. This role is thefocus of thisbook. Called variously by other titles such as consultant therapist and nurse specialist, the definition of an advanced practitioner remains cloudy and is developing. You can become part of this development andthisbookwillgiveyouways to follow andideasto use. Figure1.1 illustrates multiple and overlapping layers that we believe constitute thecrucialpartsthatwilldevelop this role. Centredbypersonalqual-
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