Advanced Nursing Practice in Thailand: An Initiative or Old Wine in the New Bottle! Assistant Professor Nanthaphan Chinlumprasert, Ph.D., R.N. Faculty of Nursing Science, Assumption University of Thailand The Development of APN in Thailand 1974 NP 1988 CCS granted “Nursing Expertise” 1994 NNCT approved CNS in 5 areas 2000 Present NHSR APN Existed NP PCU Advanced Practice Nurse (APN) 1. Nurse - Anesthetist 2. Nurse - Midwife *3. Clinical Nurse Specialist *4. Nurse Practitioner Nurse Practitioner (NP) In 1974 : NP first established to serve people in the remote area and to ease the Physician shortage : 4-month-training Legitimate limitation : No autonomy Not well accepted by NNCT : Work as physician extender Nursing Experts (NE) In 1988 : The Commission of Civil Servant (CCS) has granted the career ladder for promoting experienced nurses to become Nursing Experts : Academic report and experiences were used to consider the promotion : Nursing service system has no distinctive organizational line and scope of practice for Nursing Expert position : No continuous support by Nursing Organization Clinical Nurse Specialist (CNS) In 1994 : The National Nursing Council of Thailand (NNCT) has approved CNS in 5 areas Family Nursing Occupational Health Nursing 1) Community Nursing School Health Nursing 2) Mental Health & Psychiatric Nursing 3) Pediatric Nursing 4) Maternal & Child Nursing 5) Medical – Surgical Nursing Master degree in nursing specialty CNS Certification of CNS granted by NNCT 2000 Present : National Health System Reform (NHSR) National Health System: Is the entire system of the national health that interrelated or interconnected as the holism. It effects to the health of all population including other factors such as individual, environment, economic, social, physical, biological, and the factor of health care system. Principle of NHSR Holistic Participatory Public Policy for Health Equity * Efficiency * Quality * Consumer responsiveness and protection National Health System Health Service System Nursing Service System Health Service System University/Regional Hospital Tertiary Secondary Care Primary Care Self Care, Self Reliance Provincial/General Hospital Health Center, PCU, Com. Hospital Village, CPHC Primary Health Care Equity Efficiency Quality National Health Insurance Policy Universal Coverage Primary Care Focus APN NP Nurses CNS-Com. Nsg Primary Care Unit Nurses CNS Other APNS Secondary level Tertiary level Requirement for APN Certification 1. Master degree in nursing specialty 2. Three years working experiences in the specific area of expertise 3. The curriculum must be approved by NNCT The number of APN in Thailand APN CNS-MCH CNS-Ped. CNS-Med. CNS-Surg. CNS-Psy. CNS-Community Total Thailand (2003) 1 8 9 10 12 9 49 The ratio of APN to nursing population Thailand (2003) U.S. (1996) Total Nurses Population APN APN : Nsg Pop 120,000 2.55 million 49 1:2,449 161,700 persons 1:16 Educational requirement for Master degree in Nursing to meet APN requirement Plan A Total credit hours 42 Cr. 1. General Core Courses 15 Cr. Master core courses 8 Cr. APN core courses 7 Cr. 2. Specific Courses Theory courses Practicum courses 12 Cr. 6 Cr. 6 Cr. 3. Elective Courses 4. Thesis 3 Cr. 12 Cr. Plan B Total credit hours 42 Cr. 15 Cr. 18 Cr. 6 Cr. 1. General Core Courses 2. Specific Courses Theory courses Practicum courses Seminar 9 Cr. 3 Cr. 3. Elective Courses 4. Independent Study 3-6 Cr. 3-6 Cr. Advanced Nursing Practice initiative requires: Initiation/creativity Professional leadership Vision Good governance : Participative management, Public/Private sectors involvement Goal & Strategy Social & Political Movement : Lobbying, Negotiating power Evidence-based policy making : Research utilization Research: Public demands Market driven trend Customer satisfaction Cost effectiveness Job analysis & Evaluation APN-NP positioning Reimbursement/Incentives What did NNCT accomplish? Enactment Nursing and Midwifery Acts B.E. 2528/2540 Advanced educational degree Certified NP, CNS in Master level Set up standard criterion core competency and qualification of APN Standardize primary medical care as a competency in generic nursing program (BNS) Research A study of characteristics of nursing services in Thailand A need survey of Thai people on health care delivery and nursing services A study of nurses’ role in hospitals of the Northern Thailand A study of service efficiency of nursing/midwifery private clinics in Thailand Continuing education policy & enforcement Exercising power & controlling Unity & Quality Assurance Challenging trend : What should nurse leader do? Empowerment Unity Quality Assurance Pursue APN Actual evidence-based decision making and policy setting APN-NP positioning in NHSR/NHIS Public relation / Social movement ↑ Nursing Image⊕ Political movement Useful research/study goals attainment The nursing profession movement can no longer be governed and managed by only opinions and casual intuition of nursing leaders Continually relevant research will provide definite answers for the challenging question … Is APN an initiative or old wine in the new bottle?
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