Advanced Nurse Practitioner, Candidate, University Hospital

University Hospital Kerry is the second largest of the Health Service Executive –South’s seven acute hospitals. The hospital provides acute general hospital services to the population of Co. Kerry (139,616) and additionally to a proportion of the populations of West Limerick and North Cork.

The hospital has 275 acute general beds; 50 Acute Psychiatric beds, 46 elderly continuing care beds and an Annual Budget of approximately 70 million. The hospital treats over 20,000 inpatients per annum and approximately 41,0000 patients attend the Outpatients Department Accident and Emergency attendances are over 34.000 annually.

University Hospital Kerry range and scope of services provided.

 Emergency Medicine.

 Ear nose and Throat Services.

 General Medicine including Medicine of the Elderly& Endocrinology.

 General Surgery.

 Endoscopy.

 Adult Intensive Care.

 Coronary Care/High Dependency

 Gynaecology (inc.Colposcopy,menorrhagia, Fertility and Urodynamics)

 Obstetrics.

 Orthopaedics.

 Paediatrics including Special Care Baby Unit.

 Audiology.

 Palliative Care

 Psychiatry

 Radiography, including C.T. Scanning Service

 Renal Dialysis Satellite Unit.

Dementia is a syndrome which causes progressive deterioration in peoples’ functional capability and behaviour, causing dramatic effects on memory, ability to communicate, mood and personality (Cahill et al., 2012) .

As per the Dementia Model of Care (MoC) (2023) there are over 64,000 people currently living with Dementia in Ireland. The Dementia MoC (2023) sets out an arrange of targets and a series of practice recommendations to advance the assessment, diagnosis, treatment, care and support of anyone with suspected Dementia. The model is informed by the work and outputs of the diagnostic and post diagnostic projects led by the National Dementia Office between 2017-2019 and by an expert Advisory group and consultations with key stakeholders.

There are four key elements to the Dementia Model of Care.

These include:

1) A diagnostic model which includes pathways to diagnosis and guidance on assessment for clinicians.

2) Guidance on disclosure, drawing on national and international best practice.

3) Care planning and guidance on personalised care planning processes that are inclusive of the person with dementia and their supporter/carer.

4) Post-diagnostic treatment and support. The model is underpinned by a series of five core principles – citizenship, person-centred approaches, integration, personal-outcomes and timeliness. These are revisited at each point of the care pathway.

In line with the Dementia MoC (2023) there is a significant programme of reform underway in Services for Older Persons and Chronic Disease by the strategic direction set out under Slaintecare (2017), the Enhanced Community Care (ECC) business case (2019), HSE Corporate Plan (2020), National Service Plan (2021) and the National Clinical Programmes.

The ECC is focused on the transformation of community care with an emphasis on establishing Community Health Networks and Specialist Community Teams working within Ambulatory Community Hubs. These plan and organise services for a defined population, enable integrated care to be implemented, shifting the focus away from acute hospitals towards a new model of specialist care in the community. The redesign of services allows new pathways to be developed between hospitals, community services, primary care, health & wellbeing and voluntary sectors to develop new networks of care for Older People and people with chronic diseases.

A new Memory Assessment and Support Service has been funded through the National Dementia Office (NDO) and thus far has recruited a cANP in Dementia with plans for a 1 WTE Consultant to support the acute and community service. Currently, all geriatricians (4 WTE) are providing a dementia service with one dedicated cognitive clinic a week. A consult based service is also provided for complex delirium and patients with dementia as per the acute medicine programme. The ANP role will extend across the breadth of acute services providing diagnosis, post diagnostic support and education of carers and staff.

The purpose of the post is to improve patient experience in relation to assessment and diagnosis of dementia and offer support post diagnosis. The memory service includes a post-diagnostic support service for people diagnosed with dementia through the following:

• Comprehensive Geriatric Assessment (CGA).

• Synthesis and interpretation of assessment information.

• Timely use of diagnostic investigations to inform clinical decision making.

• Medication review.

• Therapeutic interventions: pharmacological and non-pharmacological.

• A virtual clinic and telephone support service.

• Monitoring of dementia symptoms and response to therapies.

• Referrals to community supports and multidisciplinary supports in the acute service.

• Patient and family education and information.

Our guiding principles are to work in partnership with patients and other healthcare providers across the continuum of care to:

• Deliver high quality, safe, timely and equitable patient care by developing and ensuring sustainable clinical services to meet the needs of our population.

• Deliver integrated services across the SSWHG Hospitals, with clear lines of responsibility, accountability and authority, whilst maintaining individual hospital site integrity.

• Continue to develop and improve our clinical services supported by education, research and innovation, in partnership with University College Cork, Munster Technological University and other academic partners.

• Recruit, retain and develop highly-skilled multidisciplinary teams through support, engagement and empowerment.

We are committed to ensuring that our patients are at the centre of all service design, development and delivery. Over the five years of the strategy we will further develop our services, both clinical and organisational based around seven key themes: Quality and Patient Safety; Patient Access; Governance and Integration; Skilled Caring Staff; Education Research and Innovation; eHealth and Infrastructure. These will be our key areas of focus to enable us to meet the future needs of our patients.

Purpose of Post

The advanced practice service is provided by nurses who practice at a higher level of capability as independent, autonomous and expert advanced practitioners. The overall purpose of the service is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level. This involves undertaking and documenting complete episodes of patient care, which includes comprehensively assessing, diagnosing, planning, treating and discharging patients in accordance with collaboratively agreed local policies, procedures, protocols and guidelines and/or service level agreements/ memoranda of understanding.

The cANP (Dementia) demonstrates advanced clinical and theoretical knowledge, critical thinking, clinical leadership, and complex decision-making abilities.

The cANP (Dementia) practices in accordance with the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI 2014), the Scope of Nursing and Midwifery Practice Framework (NMBI 2015), Advanced Practice (Nursing)

Standards and Requirements (NMBI 2017), and the Values for Nurses and Midwives in Ireland (Department of Health 2016).

The cANP (Dementia) service provides clinical leadership and professional scholarship in the delivery of optimal nursing services and informs the development of evidence-based health policy at local, regional and national levels.

The cANP (Dementia) contributes to nursing research that shapes and advances nursing practice, education and health care policy at local, national and international levels.

Informal Enquiries