Discuss critically how Advanced Clinical Practitioners can integrate theory and evidence to lead change in clinical practice
The present assignment will analyze the role of Advanced Clinical Practitioners (ACP) in the launch and implementation of of Bespoke Long Covid-19 Rehabilitation service in a community setting based on the drivers for the services, including NHS long term plans, NICE guidelines, etc. The developed service will be examined using four pillars of Advanced Clinical Practitioners, leadership, research, education, and management (Kitsell, 2017). The management and leadership issues in the service development will be discussed along with the theories, models, and evidence involved in the development, management, and improvement of quality of the proposed service and plan. The assignment will also shed light on barriers in the way of service improvement. The service improvement of this assignment will be focusing on introduction of a Bespoke Long Coivd-29 Rehabilitation service in a community setting based on the recommendations of National Health Services (NHS) England. The service aims to provide multidisciplinary assessment and intervention to covid-19 patients in their homes. The purpose of the service improvement is to combine the primary and secondary care of the patients within community ways of assessment to provide equal and quicker rehabilitation to all patients.
Drivers for the service improvement
The studies have reported that the patients of covid-19 are showing symptoms after being discharged from the hospitals and clinics in United Kingdom (Gerrigues et al. 2020). Symptoms such as shortness of breath and increased mental stress was reported by covid-19 survivor post-discharge. It is proposed by the health practitioners that rehabilitation services should be planned for the covid-19 survivors, to assess their symptoms accurately and reduce the likelihood of their return (Halpin et al. 2020). National Health Service England adapts various initiatives and policies to enhance the quality of healthcare and implement such service improvements (Craig, 2018).
The NHS Long Term Plan (2019a) constitutes a care plan which seeks to provide rehabilitation services to the patients after they discharge from the hospitals. It also asserts that rehabilitation service that is community based, should be available to the patients (CSP, 2018). The NHS guidelines and policies in Long Term Plan, vows to provide quality care to patients and act in the interest of the patients. Similarly, the Charted Society of Physiotherapy (2020), proposed guidelines on Long covid (unable to fully recover from the covid-19 symptoms, despite passage of several weeks). It provides standard for physiotherapist, who will deliver rehabilitation as a part of multi-disciplinary healthcare team. The CSP opined that physiotherapy is key practice in coronavirus pandemic, and necessity of community rehabilitation should be emphasized. However, the NHS has limited resources and show little progress in the matter (CSP, 2020). Nevertheless, they continuously seek to provide rehabilitations services in accordance to the place and time.
NHS England published NHS Five Years Forward View (2014), with an aim to articulate a future plan, which identifies the required changes in the healthcare system, along with defining the nature of the change or service improvement and pathways to achieve it. The service improvement to deliver rehabilitation services to covid survivors at their home, can be mapped out using guidelines in NHS Five Years Forward View. Some general practitioners are sceptical in implementing the suggested policies, as they fear it has limited academic literature to clearly define role and responsibility of GP in healthcare service improvement (Humphrey & Cleaver, 2018). In order to implement the Five Years Forward View, NHS established Sustainability and Transformational Plans or programmes in 2016, by joining forces with the local authorities. In STPs guidelines local healthcare leaders are supposed to cover healthcare problems related to quality improvement, efficiency in healthcare services etc. (King’s Fund, 2017). It gives authorization to local healthcare leaders and professionals to identify the changes required to deliver quality care and run healthcare services in more co-ordinated manner. It represented a new approach to providing health, but the local authorities are under immense pressure, and in some localities the meaningful involvement of local bodies is limited to none (King’s Fund, 2017). Likewise, Birmingham Community Healthcare (BCHC) proposed a ‘Fit for 2022’ program with a perspective and ambition to make the present services in align with the NHS Long Term Plan, to establish to provide safe, quality and holistic care to the members of the community (NHS Foundation Trust, 2020).
The drivers which are mentioned above can play a significant in implementing the proposed care plan and providing clarity for General Practitioners regarding their role and responsibilities.
Role of Advanced Clinical Practitioners
The role of Advanced Clinical Practitioners (ACP) will be very crucial in the introduction and implementation of proposed service improvement. The shortage in NHS workforce and increased healthcare demands led to the introduction of Advnaced Clinical Practitioners (ACP) role in healthcare setting, who expanded and utilized the nursing skills to provide services in areas specified for doctors (Imison et al, 2016). Advanced Clinical Practitioners belong to different professional background such as, pharmacy, nursing, healthcare sciences, therapy, or midwifery (Phipps & Setchfield, 2019). That is, they all possess different skill set and have different progress rates, which are dependent upon their acquired expertise. ACPs can demonstrate their expertise in diagnosis, professional judgment, therapies, consultation, critical thinking, leadership, and advanced clinical decision-making. The Health Education England, NHS Improvement, and NHS England (2017) collaborated to develop a National Framework for Advance Clinical Practice to clarify the role and responsibilities of ACP. The NHS (2017) pointed out that advanced clinical practitioners should have standard skills and capabilities to provide care to the patients. The practice of ACP should be based upon four pillars of clinical practice, leadership and management, education, and research. The clinical practice involves compliance with ethical codes set out by NHS (2019), NMC (2018), and NICE (2012), understanding of responsibilities, autonomy, and limitation of competence, self-awareness and critical reflection, effective communication, decision-making, integrated and holistic care, and evidence-based clinical judgment, assessment, diagnosis and intervention. Leadership and management involves active participation in relationship building, and teamwork, encouraging the team members, acting as role model, evaluating role of self and team, and measuring effectiveness of the service, active involvement in peer review to guide own and others’ practice, formulating and implementing strategies, seek feedback, and modify practice according to unique needs of the service and patients. The education pillar demands the assessment and development of the present learning, strive for self-initiated learning, contribution to team and organizational education, identification of learning gaps and formulation of strategies to fill these gaps, and to act as educator, role model, supervisor, and coach to develop competencies in a team. The last pillar of advance clinical practice is research, which involves engaging, promoting, and adhering to evidence-based practice in service improvement, evaluating clinical practice based on standard, valid, and reliable sources to increase capability and productivity, adopt critical approach to identify gaps in evidences and conduct further reteaches, and establish link between clinical practice and evidence-based practice to have better outcomes.
Based on the guidelines, framework, and defined roles of advanced clinical practitioners by NHS, their role will be very extensive and crucial in implementation of Bespoke Long Coivd-29 Rehabilitation service in a community setting. ACPs will test their individual skills of nursing, therapeutics, and diagnosing in the multidisciplinary team. They will work in collaborative manner to deliver face to face one stop care to covid-19 patients by using their expertise, evidence-based learning, leadership and management skills, and advance clinical practice. The rehabilitation plan aims to protect covid-19 patients from crowded areas and provide services them at their homes. ACPs will visit the patient home and will provide him assessment and intervention through primary and secondary care. They will also strive to enhance experience and outcome for the patients by providing innovative care for their complex problem (Azam, 2019). The focus of the service improvement is to provide equal and quick interventions to all patients. Moreover, ACPs will also critically reflect on their practice to find out the shortcomings and improve their practice using reliable evidence from research. The role of ACP in Bespoke Long Coivd-29 Rehabilitation service will be to provide patient-centred and high-quality care to coivd-19 patients, who have been shocked by the pandemic.
The studies conducted on the role of ACPs in emergency and critical situation have provided several benefits. The induction of ACPs into advance clinical practice is proved to be cost-effective and time saving, has reduced patient stay in the care facilities, mortality rates and has improved satisfaction of the patients (Woo et al, 2007; Hooks & Walker, 2020). It has also enhanced continuity of the care, improved diagnosing and intervention, and has laid positive impacts on patients and healthcare staff and juniors (Williams, 2017; Halliday et al, 2018; Mckeag & Fenton, 2017; Pearce & Breen, 2018). The use of ACPs for introduction and implementation of Bespoke Long Coivd-29 Rehabilitation service will be beneficial to improve NHS services, patient outcomes, and practice of healthcare workers.
References
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