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The Journey so Far

SNAPSHOT of the Development of ANP Oncology Prostate Cancer. The Journey so Far. Sheila Kiely C ANP Peri-Operative Directorate. Development of an ANP role for prostate cancer.

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The Journey so Far

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  1. SNAPSHOT of the Development of ANP Oncology Prostate Cancer The Journey so Far Sheila Kiely C ANP Peri-Operative Directorate

  2. Development of an ANP role for prostate cancer • Urology as a medical speciality is continually developing in response to technological advances and there is a move among Urologists to sub-speciality . • Uro-oncology nursing has mirrored this development with the emergence of urological advanced nursing roles following nurses gaining specific urological expertise. • Like with other nursing specialities the role development occurs as a response to local workplace needs (White et al, 2009). • Role development for ANP Oncology Prostate cancer arose as a result of service demand on the Rapid Access Prostate Service

  3. RAPID ACCESS PROSTATE Clinic • Rapid access prostate clinics were developed as part of National Cancer Control Programme (NCCP) to provide a rapid diagnostics for men with a suspicion of prostate cancer. • The service commenced in UHL in Dec 2010 • Out-patients based service that provide men access to • Consultant assessment • TRUS biopsy • Radiological imaging • Service is measured by Key performance indicators

  4. RAPC services need • Service needs analysis • RAPC Services required • Increase access for new patients • Increase access to diagnostics • Imaging • Biopsy procedures • Reduction in the number of return attendances that require surveillance • Solution to increase capacity for new prostate cancer diagnosis • Solution: • An advance Nurse practitioner to autonomously diagnose and treat an episode of care • Order and interpret tests • Prescribe medications • Perform medical procedures

  5. Total number of attendance RAPC 2017, 2018

  6. New cancer diagnosis figures

  7. Number of clinics per month

  8. Treatment choices

  9. Current Service delivery for RAPC UL Out patient based service delivered over two clinics per week • Thursday am • TRUS biopsy clinic • New patient review clinic • Returns patient • New diagnosis • Under PSA surveillance • Newly diagnosed • Decision – making about treatment plan • On active surveillance • Post surgical intervention POCU • Tuesday am • One stop clinic for new patient + prostate biopsy if deemed needed • Patient return to the Thursday clinic for results

  10. Impact of RAPC clinics Impact Increased number of prostate cancer diagnosis Increased number of men living following a prostate cancer diagnosis Increase number of men under PSA surveillance Increased number of men on an Active Surveillance protocol Solution • Service need analysis • Solutions needed to improve efficiency of service • Address the increase number of returns that require follow-up • Improve access for new referrals • Development of an advance Nursing role to manage a specified cohort of prostate cancer patient under stringent protocols • Governance structure to support role • Clinical – Consultant Urologist • Professional – Director of Nursing

  11. Role development • Identify key stakeholders • Having consider the need for the role based on the service need- the role needs professional knowledge , clinical reasoning and clinical judgement at the highest level to safely manage this cohort of prostate cancer patients. • Role is a collaborative process with stakeholders • Benefits to service • Enhance the service having a positive impact on patients and patients family on their experience with the RAPC service

  12. Identify key stakeholders

  13. Clinical Governance- Mr. Garrett Durkan Consultant Urologist Professional Governance- Mr. Declan McNamara DON Peri-Operative directorate ANP Prostatecancer role Vision Ms Carmel Hoey NPDU ANP development Coordinator PSA Surveillance Clinics PSA Surveillance Clinics Active Surveillance Clinics Post RRP & RALP Clinics Management of ED Clinics Survivorship clinics Preparation for discharge TRUS Biopsy Verse TP Biopsy • Stakeholders • Protocol • Virtual V OPD • Stakeholders • Protocol • Virtual V OPD National Guidelines Protocol Protocols Policy/Guidelines • Stakeholders agreement Protocol • Clinical Education • Competencies Protocols Education – seek information from GUH service Referral process for repeat BX and imaging OPD Survivorship Clinical Procedures

  14. Governance structure Clinical Governance Continuous clinical Supervision • Clinical lead Urologist Professional Governance: Code of professional conduct /scope of practice • Director of Nursing Peri-Operative Directorate

  15. Starting with what I can resolve Autonomy - What Gives me Meaning Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base.

  16. Active Surveillance clinic’s for Prostate cancer

  17. Learning’s so far • Start small.

  18. References: • White, T., Crowe, H. and Papps, E., (2009). Defining urology nursing practice roles in Australia and New Zealand. International Journal of Urological Nursing, 3(2), pp.69-77. • Nursing and Midwifery Board of Ireland (2017). Advanced Practice (Nursing) Standards and Requirements. Dublin NMBI.

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