1. Advanced Practice & Clinical Assessment Where are we today? Linda McKee Cardiothoracic Nurse Practitioner Western Infirmary, Glasgow

2. History Development of advanced nursing practice in UK – fragmented and poorly documented. Early experimental appointments were made due to a shortage of junior doctors. Advanced practice roles however have continued to evolve.

3. History Many differing titles, roles and remits Often leading to confusion within the profession, allied professions and the public.

4. History UKCC(1994) defined Advanced Practice as: “ adjusting the boundaries for the development of future practice, pioneering and developing new roles responsive to the changing needs and with advancing clinical practice, research and education enrich professional practice as a whole”

5. Advanced Practice of the Past Little formal education On the job training Often by medical colleagues Based on others perceptions of what was required.

6. Developments Formal training programmes introduced for advanced practice – university linked qualifications. NMC have acknowledged the need for advanced practice to be officially recognised as a qualification on the register

7. NMC Registration Discussions ongoing between the NMC, Department of Health and educational institutions to clarify educational and legal requirements for Advanced Practice registration. Advanced Practice registration should be a reality by August 2006.

8. Clinical Assessment Clinical Assessment

9. What is involved? Includes history taking, physical examination and patient management. Further training explores specialist skills such as advanced cardiac, abdominal, respiratory and neurological assessment.

10. Ongoing Professional Development Work place practice is also essential to help reinforce newly acquired expertise. Support from medical peers in relation to practice.

11. Course 15 week course One week intense top to toe clinical examination tutorial Weekly clinical examination practice sessions Case study with 2 OSCE stations

12. Benefits to Patient Access to immediate examination, review and possible intervention. Builds relationship of trust with Advanced Practice Nurse. Increased patient satisfaction More holistic care to the patient.

13. Benefits to Nurse Ability to systematically examine patient and identify potential problems. Ability to deliver or initiate immediate care. Increased autonomy. Actual practice instead of advised practice.

14. Awareness Limitations of professional/personal experience and competence. When to make an appropriate referral. The need for ongoing clinical practice development.

15. The Future Changes to cardiothoracic medical staffing and training. Increasing emphasis on advanced practice roles within cardiothoracic surgery departments. Further development of additional specialised practice i. e. surgeons assistants.

16. Challenges for the Future Continuing development of clinical skills Ensuring standards for best practice Clear guidelines for advanced practice roles. Research and audit.

17. A Familiar Situation ??

18. Information www.pduk.net www.etu.sgul.ac.uk/cso/index.htm http://omeweb2.ucdavis.edu/doctoring/doctoring http://medicine.ucsd.edu/clinicalmed/links.html http://echt.chm.msu.edu/videolect/viewvideos.htm