Taking care to a new level
PATIENTS BENEFIT FROM ADVANCED NURSING INITIATIVE?

Advanced Practice Nurses Sue DeVries (left) and Alexandra Papadopoulos are taking a leadership role in providing comprehensive care for vascular surgery patients.

“It’s all about continuity of care,” notes Sue DeVries, describing the objectives of the Advanced Practice Nurse (APN) initiative at Peter Munk Cardiac Centre’s Division of Vascular Surgery.

DeVries is one of two APNs currently working in vascular care, along with Alexandra Papadopoulos. Together, they play a leadership role in providing comprehensive care for vascular surgery patients – a level of care that is beyond the traditional scope of the staff nurse.

“Advanced practice nurses work under a unique set of medical directives developed and supported by the hospital,” explains Linda Belford, the APN Practice Leader. “Medical directives enable an expanded scope of practice to maximize efficiency and autonomy. With this expanded scope of practice, APNs collaborate with the interprofessional team to ensure our patients are provided with the best care possible.”

An expanded clinical role
The APN’s expanded role includes increased clinical responsibilities, such as orderingmedications and diagnostic testing, arranging for consultations with in-hospital specialists and other health professionals, and being proactive in patient evaluation and treatment planning.

Naturally, this expanded role is matched by an expanded level of training. “To become an APN you need a Master’s Degree in Nursing, as well as further training in the provision of advanced care,” explains Alexandra Papadopoulos. “This includes training in medications, diagnostics, and patient evaluation and management. We also have special training in our particular area, which is vascular care.”

With this expertise, the Centre’s APNs play a lead role in a multidisciplinary team that includes physiotherapists, occupational therapists, social workers, clinical nurses, pharmacists and others. Their role is 80 per cent clinical with the rest designated to activities directed toward advancing the nursing profession, as well as the enhancement of patient care.

“Since the Peter Munk Cardiac Centre is a designated Centre of Excellence in Vascular Care, it’s a very busy environment, and our patients have very complicated needs,” notes DeVries, who, in addition to being an APN, is currently President of the Canadian Chapter of the Society for Vascular Nursing. “We work very closely as a team with our physician colleagues throughout each day. Each of us is assigned specific patients and our expanded role allows us to provide the very detailed holistic care our patients need.

“The patients and families know us; we know them, and their particular needs or challenges. We can network with internal resources as needed, such as speech language pathology, or infectious diseases. We can follow each patient and help guide their progress – not only while they are in the hospital, but even after they leave.”

This is part of the continuity of care that DeVries believes is a guiding principle behind the APN initiative.

Care beyond the hospital
Both DeVries and Papadopoulos are intimately involved in discharge planning and coordinating the care that each patient may require in the community. And that care can be complicated. “Discharge planning for someone following vascular surgery can involve a lot of complex care,” says DeVries. “You might be dealing with physical frailty, mobility impairment, limb loss, wound care, pain management, and more.”

“It can be especially challenging in situations, as with some elderly patients, where family and social support may be lacking,” adds Papadopoulos.

As Linda Belford points out, it’s not just patients and family who might need support. “One of the most important roles of the APNs it to link with professional care providers in the community, particularly those who don’t have the resources or expertise to provide the complex care that many of our vascular surgery patients may require,” she says.

As such, the APNs ensure that all relevant community care providers, from family physicians to rehab professionals and visiting nurses have their phone numbers – as do patients when they leave the Centre.

“Just the other day I had a call from a nurse at a retreat on behalf of one of our recent patients,” recalls DeVries. “She wanted to discuss if his symptoms were consistent with recovery from surgery.”

Although the APN role is not new to University Health Network, the APN vascular surgery initiative at the Peter Munk Cardiac Centre is – DeVries has been involved since January of last year and Papadopoulos joined a few months later– but everyone involved believes it is already having a positive impact.

Next steps include a working group to examine the implementation of the APN initiative and officially evaluate its effectiveness. “A future possibility may be to consider having more APN coverage in the ambulatory clinic to optimize continuity,” says Belford.

In the meantime, the focus will remain on continuity of care, and the Peter Munk Cardiac Centre’s ongoing mandate to strive towards excellence in patient care.

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