Analysis of nurse practitioner programme in india

Mathew Varghese V
MSN(RAK),FHNP (CMC Vellore),CPEPC
Nursing officer
AIIMS Delhi
Analysis of Nurse Practitioner
Programme
1 mathewvmaths@yahoo.co.in

History
 The advanced practice nursing role began to take
shape in the mid-20th century in United States.
 Nurse anesthetists and nurse midwives were
established in the 1940s, followed by psychiatric
nursing in 1954.
 The present day concept of the APRN as a
primary care provider was created in the mid-
1960s
 During the mid 1970s to early 1980s, the
completion of a master's degree became required
in order to become a certified nurse practitioner.

Definition
 According to the American Association of
Nurse Practitioners,
 A nurse practitioner is educated at the masters or
doctoral level to provide "primary, acute, chronic,
and specialty care to patients of all ages and all
walks of life"

What Does a Nurse Practitioner
Do?
 According to the American Association of
Nurse Practitioners (AANP), NPs give
 primary
 acute
 and specialty healthcare services to diverse populations.
 With their advanced clinical training, NPs are
authorized to diagnose illnesses, treat
conditions, and provide evidence-based
health education to their patients.
 NPs assess their patients by examining
medical histories; performing physical
evaluations; and ordering (or performing)
diagnostic tests.4 mathewvmaths@yahoo.co.in

Job profile
 They diagnose patients and develop
individualized treatment plans, follow up on
courses of treatment, collaborate with other
healthcare professionals, and maintain detailed
records.
 NPs must also engage in continuing education
(CE) to keep abreast of technological,
methodological, and other developments in their
field.
 Most importantly, these professionals serve not
only as healthcare providers to patients, but also
as mentors, counselors, researchers, educators,
and consultants.

NP Specializations
Women's Health Nurse Practitioner
 Women’s Health Nurse Practitioners (WHNPs)
account for about 5.8 percent of NPs
 Their primary clinical focus area is obstetrics and
gynecology (OB/GYN).
 WHNPs are educated and skilled in partnering
with women to address their total health needs,
from managing chronic health conditions affecting
women to gender-focused disease prevention
and health promotion.

Adult-Gerontology Nurse
Practitioner
 Gerontological Nurse Practitioners (GNPs) account
for approximately 6 percent of NPs.
 The top practice settings for GNPs include hospital
outpatient clinics and long-term care facilities and
their focus area mainly is primary care.
 They have received advanced education to provide
services that address the health issues that impact
older adults, as well as the resultant cognitive,
physical, psychological and social impairments.
 Their expertise equips them to diagnose, treat and
manage chronic and acute conditions and geriatric
symptoms associated with age and provide
therapeutic interventions or, at times, palliative
treatments and end-of-life care.

Pediatric Nurse Practitioner
 Pediatric Nurse Practitioners (PNPs) account for
about 6 percent of NPs.
 Their primary practice setting is hospital outpatient
facilities, although they can provide care anywhere
from hospitals to physicians’ offices.
 Their clinical focus area is generally primary care.
 Similar to pediatricians, PNPs work autonomously or
with other healthcare providers to serve patients from
infancy through young adulthood.
 The services they provide to their patients include
diagnosing illnesses; prescribing medication and
therapy, in some states; conducting routine check-
ups, well-child exams and childhood immunizations;
ordering patient lab tests; and counseling young
patients and their families on health-related issues.

Family Nurse Practitioner
 Family Nurse Practitioners (FNPs) by far represent
the largest category in the NP population.
 The largest percentage of FNPs work in a private
group practice setting, or conventional doctor’s
offices, but they also work in clinics, schools,
hospitals and private homes.
 Their main clinical focus is primary care. Because
they are working with a diverse patient population,
FNPs are trained to provide a wide range of
healthcare services for every member of the family,
such as conducting exams; performing screening
evaluations and diagnostic tests; treating mild
ailments and serious conditions; promoting healthy
lifestyle habits and preventative care; prescribing
medications; and counseling.
 They also serve as administrators and policymakers.

Neonatal Nurse Practitioner
 Neonatal Nurse Practitioners (NNPs), which form
about 2 percent of the NP population, generally
practice in the hospital inpatient clinic setting,
including neonatal intensive care units (NICU),
delivery rooms, emergency rooms and specialty
clinics.
 NNPs are advanced practice nurses that are trained
in giving care to newborns, particularly those in need
of specialized attention, during the first 28 days of life.
 They serve as the primary caregivers for sick or
premature newborns and assume full responsibility for
their patients.
 They perform numerous duties, from monitoring
specialized equipment and dispensing medications to
performing diagnostic tests and other procedures and10 mathewvmaths@yahoo.co.in

Psychiatric Nurse Practitioner
 Psychiatric Mental Health Nurse Practitioners
(PMHNPs) primarily work in clinical settings such as
private psychiatric practices and in-patient or out-
patient psychiatric/mental health facilities.
 However, they also provide care at domestic violence
shelters, schools, correctional facilities and residential
substance abuse facilities.
 Their primary clinical focus is psychiatric and they
work with a wide range of patients to provide
specialized intensive mental health services.
 PMHNPs are specialists who are certified to assess
and diagnose mental health issues and manage
pharmacotherapeutic and psychotherapeutic
interventions as means of treatment.

Emergency Nurse Practitioners
(ENPs)
 Emergency Nurse Practitioners (ENPs) work in
emergency care settings, which often are complex
and unpredictable, and provide healthcare services
for individuals of all ages either autonomously or
through interdisciplinary collaboration.
 Some of the provided services include health
promotion; disease and injury prevention; assessing,
diagnosing and managing acute episodic and
exacerbations of chronic illnesses; and administering
education or counseling services to patients and their
families. Because of their knowledge and expertise,
ENPs also serve as researchers, advocates and
consultants.


Acute Care Nurse Practitioner
 Acute Care Nurse Practitioners (ACNPs) account for
about 7.7 percent of the NP population and they
typically work within an inpatient setting.
 They are among the medical professionals trained to
provide care for patients experiencing brief yet severe
episodes of injury, illness or trauma, including
respiratory distress and heart attacks.
 This care generally consists of emergency medical
interventions and involves diagnosing and treating
acute medical conditions through an immediate
process.
 ACNPs might be skilled and trained in a specialty
areas specific to a patient population, setting,
condition or disease type.

Sub specialization
 Allergy & immunology NP
 Cardiac NP
 Dermatology NP
 Geriatric NP
 Emergency room NP
 Endocrinology NP
 Holistic NP
 Hospice NP

Sub specialization
 Gastroenterology NP
 Pediatric oncology NP
 Surgical NP
 Neurology NP
 Occupational health NP
 Orthopedics NP
 Pulmonology & respiratory NP
 Sports medicine NP
 Travel NP
 Urology NP

Skills & Personality Traits of
Successful Nurse Practitioners
 The Mayo Clinic (2016) recommends
 NPs be compassionate, self-confident, analytical,
personable, and calm under pressure.
 Since NPs may be confronted with time-sensitive
healthcare issues, they must be able to make good
decisions under duress and show leadership in
uncertain situations.
 Having a strong grasp of math and science
contributes to the day-to-day problem-solving,
analysis, and diagnostic capabilities of NPs.
 Effective NPs also spend much time liaising with
patients, their families, and healthcare professionals,
and therefore are expected to possess excellent
communication skills.
 Other desirable traits include being detail-oriented,
empathetic, and emotionally stable.16 mathewvmaths@yahoo.co.in

NP programmes in India
 Nurse Practitioner in Critical Care (Post
Graduate- Residency Program)
 Critical Care Nurse Practitioner Program is
intended to prepare registered BSc Nurses to
provide advanced nursing care to adults who are
critically ill. The nursing care is focused on
stabilizing patients’ condition, minimizing acute
complications and maximizing restoration of
health. These NPs are required to practice in
tertiary care centers.

Competencies of Nurse
Practitioner in Critical Care
 Patient selection/admission into ICU and
discharge
 Problem identification through appropriate
assessment
 Selection/administration of medication or devices
or therapies
 Patients’ education for use of therapeutics
 Knowledge of interactions of therapeutics, if any
 Evaluation of outcomes and
 Recognition and management of complications
and untoward reactions.


Aim

 The critical care NP program prepares registered
BSc nurses for advanced practice roles as clinical
experts, managers, educators and consultants
leading to M.Sc degree in critical care NP

Objectives
 1. Assume responsibility and accountability to provide
competent care to critically ill patients and appropriate
family care in tertiary care centres
 2. Demonstrate clinical competence / expertise in providing
critical care which includes diagnostic reasoning, complex
monitoring and therapies
 3. Apply theoretical, patho-physiological and
pharmacological principles and evidence base in
implementing therapies / interventions in critical care
 4. Identify the critical conditions and carry out interventions
to stabilize and restore patient’s health and minimize or
manage complications
 5. Collaborate with other health care professionals in the
critical care team, across the continuum of critical care


Standards/Requirements to start
the NP program
 The teaching institution must accept the
accountability for the NP program and its students
and offer the program congruent with the INC
standards.
 The hospital should be a parent tertiary care
centre with a minimum of 500 beds and above
having Medical ICU, Surgical ICU, Cardio/thoracic
ICU and Emergency care unit with a minimum of
10 beds and above in each ICU, to a total of 40-
50 ICU beds in the hospital.
 Recognition for Nurse Practitioner in Critical Care
(Post Graduate – Residency Program) will be
given by Indian Nursing Council (INC) as per the
guidelines laid down by INC21 mathewvmaths@yahoo.co.in

Physical and Learning Resources
at college/Hospital
 One classroom/conference room at the clinical
setting
 Skill lab for simulated learning ( Hospital/college)
 Library and computer facilities with access to
online journals
 E- learning facilities

Staff resources
 Full time faculty qualified NP in the specialty/ MSc
in relevant specialty (1 faculty for every 5
students)
 Professor cum coordinator 1/ Reader / Associate
Professor 1
 The above faculty shall perform dual role or a
senior nurse with MSc qualification employed in
the tertiary centre
 Medical/nursing faculty

Curriculum

Criteria for Admission -
 Applicants must possess a registered B.Sc nurse
with a minimum of one year clinical experience,
preferably in any critical care setting prior to
enrollment.
 Must have undergone the B.Sc in an institution
recognized by the Indian Nursing Council.
 Must have scored not less than 55% aggregate
marks in the B.Sc program.
 Selection must be based on the merit of an
entrance examination and interview held by the
competent authority.
27 mathewvmaths@yahoo.co.in

 Number of candidates: 1 candidate for 5 ICU
beds
 Salary:
 In-service candidates will get regular salary
 Salary for the other candidates as per the salary
structure of the hospital where the course is
conducted

Teaching methods:
 Teaching-theoretical, lab & Clinical can be done
in the following methods and integrated during
clinical posting
 Clinical conference
 Case/clinical presentation
 Nursing rounds
 Clinical seminars
 Journal clubs

Teaching methods:
 Case study/Nursing process
 Advanced health assessment
 Faculty lecture in the clinical area
 Directed reading
 Assignments
 Case study analysis
 Workshops

Assessment
 Formative and Summative
 Seminar
 Written assignments/Term papers
 Case/Clinical presentation
 Nursing process report
 Clinical performance evaluation
 Log book- counter signed by the medical/nursing
faculty preceptor
 Objective Structured Clinical Examination
 Test papers
 Final examination

Comparison of facilities available
in MIMS CON with INC
recommendation
 Recognition –
 INC, KNMC, KUHS& NAAC (National
Assessment and Accreditation Council)
 Physical and Learning Resources at
college/Hospital
 Two class rooms for NP and one seminar room
available in clinical area

Skill lab for simulated learning
( Hospital/college)
 Preclinical Lab:- The college boasts of a well
equipped preclinical lab with various equipment and
manikins for familiarization with nursing skills before
the actual clinical practice in hospital.
Computer Lab:- A well equipped computer lab
intended to impart all the essential computer skill
training fully caters to the requirement of students.
Laboratories in Maternity Nursing, Pediatric
Nursing and Community Health Nursing: - These
laboratories are fully equipped for practical skill
training in the above three specialties. All type of
equipments and manikins are available for hands on
training of students in each of these specialties.

Skill lab for simulated learning
( Hospital/college)
 Basic Science(s) Lab:- Basic science facilities in
Anatomy, Physiology, Biochemistry, Microbiology etc
are available in Allied Medical Sciences Laboratories
and students are exposed to all the necessary
equipment and experiments.
 The Library of College of Nursing is fully equipped
and spacious with an excellent collection of authentic
reference books (5000+ +) and large number of
national and international journals. Spacious reading
hall with plenty of broad band connections for internet
use make the library the heart of this academic
campus. Periodically all the new books are added to
the library to update the knowledge resource. Library
is open from 08:00 a.m. - 08:00 p.m. every day to
enable students and faculty to utilize the facilities to
the maximum.

 E learning facilities are available
 Faculties
 Total No. of permanent faculty-27
 Total Asst. Professors -7
 Associate Professors-0
 Professors -4
 Lectures -16
 No. of Guest and Visiting faculty -10

List of college with NP
State No of institutions
Assam 1
Chattisgarh 1
Karnataka 1
Kerala 7
Madhya Pradesh 2
Maharashtra 3
Uttar Pradesh 2
Uttarakhand 1
Total 18

cp

Organization chart

Questions

References
 Neeraja .K.P.Text book of Nursing
Education.1stEd.NewDelhi:Jaypee Brothers Medical
Publishers Pvt Ltd;2003
 Aggrawal JC. Principles , Methods and Techniques of
Teaching.NewDelhi:Vikas Publishing House Pvt
Ltd;1996
 Sankaranarayanan B, SindhuB.Learning and
teachingnursing.4thEd.New Delhi: Jaypee Brothers
Medical Publishers Pvt Ltd;2012
 Gopichandran .L,Kanniammal .C.Essentials of
Communication ansd
Technology.1stEd.NewDelhi:CBS Publishers and
Distributers Pvt Ltd;2017

Analysis of nurse practitioner programme in india

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