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CHAPTER I
Introduction Who doesnt remember running to the school nurses office with a nosebleed or ear ache? But how many among us have gone to a nurse-managed clinic for our adult health care? In this era of experimentation in health delivery, the nurse-led clinic is part of the conversation about how best to medically serve us, particularly the poor and uninsured populations. Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in a wide diversity of practice areas with a different scope of practice and level of prescriber authority in each. Many nurses provide care within the ordering scope of physicians, and this traditional role has come to shape the historic public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing. The shortage of primary care physicians who care for adults (in internal medicine and family medicine) is projected to reach 35,000 to 44,000 by 2025. The worlds population is growing, many people got sick and diseases nowadays continue to evolve and that
CHAPTER II
Review of Related Literature A clinic where the nurse has his or her own patient case load. This involves an increase in the autonomy of the nursing role, with the ability to admit and discharge patients from the clinic, or to refer on to other more appropriate healthcare colleagues. This power to refer to others is often highly variable between clinics, but can include referrals to professionals allied to medicine, such as dietician, physiotherapists, and social work teams, through to medical teams or consultants. Nurse-led clinics were first established in the United Kingdom and the United States in the 1980s in the primary care setting to improve continuity of care after patient discharge while attempting to contain costs. The differentiation between a nurse-led clinic and other forms of clinics such as physician clinics or hospital clinics lies in the fact that nurse-led clinics are run independently by nurses and that their focus is more holistic, preventive and educative rather than therapeutic or medicinal. The major interventions in
HEALTH CARE DELIVERY SYSTEM in the PHILIPPINES The Philippine health care system has rapidly evolved with many challenges through time. Health service delivery was devolved to the Local Government Units (LGUs) in 1991, and for many reasons, it has not completely surmounted the fragmentation issue. Health human resource struggles with the problems of underemployment, scarcity and skewed distribution. There is a strong involvement of the private sector comprising 50% of
Nurses in the Philippines Nursing is the nations largest health care profession, with 2.6 million registered nurses (RNs), and many more needed in the future. Nurses are the largest single component of any hospital staff, the primary provider of hospital patient care and they deliver most of the nations nursing home care. Nurses work in a variety of other settings. Nursing has become the preferred course of a growing number of college enrollees. The CHEDs Policy, Planning, Research and Information Office sees almost half a million or 497,000 students taking the nursing course in the school year 2008-2009 (manilatimes.com). While many countries in the world are experiencing nursing shortage, the Philippines appear to have an oversupply of nurses. The Officer-in-Charge of the Professional Regulation
has disclosed that the oversupply of nurses is fast becoming the countrys problem
(Melencio 2008). Some newly licensed nurses would volunteer to work in the hospitals if only to get the needed experience and training. There are varying reports about the repercussions of nurses volunteers work. The PNA claims that volunteer nurses are being exploited (Balagtas 2008) by requiring volunteers to pay a fee at the same time availing of the volunteers professional services. On the other hand, the Department of
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Scope of Nursing Practice ARTICLE VI Nursing Practice Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;
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Core competencies Within the three spheres of CNS practice, Sparacino (2005) identified seven core competencies: 1. Direct clinical practice includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.
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Although these core competencies have been described in the literature they are not validated through a review process that is objective and decisive. They are the opinion of some within the profession. A set of core competencies has now been described and validated through a consensus process (2008) that clearly defines the spheres of influence, the synergy model and the competencies as defined by Sparacino (2005). These core competencies are now expected to be used in all educational programs and will be revised in the coming years in order to be maintained as current and reflective of practice.
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The Role of Nurse Practitioner-Led Clinics 1. Provide comprehensive family health care services through an inter-professional team of nurse practitioners, registered nurses, a range of other health care
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management and self-care programs, as well as strengthen linkages with existing programs (e.g. the Ontario Diabetes Strategy) as well as the integrated cancer screening programs; 5. Provide patient-centered care where the patient is a key member of the team and uses information and support to make informed decisions on how to manage his/her self-care needs; 6. Create linkages with other health care organizations at the community level in order to meet the needs of the specific community; 7. Use information technology as the backbone of system integration, linking patient records across different health care settings giving providers timely access to test results and other important data; and 8. Evolve through continuous quality improvement processes, evidence-based practice and flexibility for innovation and responsiveness to local community and provider concerns.
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Research Design The study will utilize a qualitative, non-experimental design. It is an exploratory study aim to determine the perception of registered nurses on nurseled clinic. Exploratory research is a flexible research design that provides an opportunity that examines all aspects of the problem is needed. Qualitative, since it will focus on the perception of registered nurses and thus subjective data will be collected.
The Sample The target participants will be thirty respondents. Ten of them will be registered nurses who works as a nurse in any institution/hospital in Metro Manila, other ten
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Study Setting The study will be conducted in the institution were in the respondents are employed, for those who are working and for unemployed nurses, basically in their home setting.
Data Gathering The inductive descriptive method of investigation was employed in the conduct of the study. Respondents were contracted either by telephone calls, personal approach or written letters informing them about the scope of the study. Interview will be mainly utilized in data gathering of the study. A brief biographical data well be extracted from the respondents before the start of the actual interview. Guide questions will be posted by the researcher to the respondents and they will be encouraged to express their views as freely as possible with use of examples, reflections, descriptions and clarifications on the subject matter. The length of interview per respondents will vary from 20-30 minutes.