Longstanding Role of Advanced Clinical Practice in Healthcare Management

Introduction

Advanced clinical practice responsibilities have existed in the healthcare sector for years. Their roles include managing clinical care in partnership with individuals, families and carers. They should analyse and synthesis complex problems in different settings, allowing innovative solutions and improving people’s experiences and enhanced outcomes. These roles play a key part in strategic workforce planning. They refer to a level of exercise characterized by high autonomy and complex decision-making. The decisions made at this level are underpinned by a master’s level award that involves the four pillars of clinical practice: clinical practice, education, research, leadership, and management. At the master’s level, the nurses should demonstrate their ability to make decisions and to work autonomously in all four pillars. The advanced practitioners have master-level education, and they can map to Health Education England’s (2017) Multi-professional Framework for Advanced Clinical Practice in England (Lawler et al., 2020). In this reflection, I will cover the four pillars of clinical leadership and management, research, and education.

The learner’s needs are within the four pillars of advanced clinical practices and they include improving the clinical assessment skills, formulation of diagnosis and initiating and implementing. The second need is education and the learner will focus on learning about culture and diversity to finding out how culture and diversity can be introduced in diabetes education programmes. This will allow the learner to work with minority group African and Caribbean that have poor access to healthcare. Educational and clinical development improves patient care, and the practitioner moves to person-cantered care, increasing engagement, autonomy, and connection. At the end of the advanced level, I should be able to translate the research into practice and provide evidence-based care (Evans et al., 2020a). Acquisition of the skills and competencies in the field is essential for professional nurses to work independently and professionally.

The other needs are research to understand how Sodium-glucose Cotransporter- 2 (SGLT2) is used for heart failure and finally identifying the needs for change. Research is essential because it allows the clinical practitioner to add to the body of knowledge and understand treatment of some illness. Finally, the learner plans to reflect on leadership and management to focus on innovation and change management, I will use the leadership and management styles to introduce changes on how to manage the minority groups. With leadership skills, one can think critically and make decisions that are essential to the practice’s success; a practitioner should provide guidance that requires interpersonal and motivational strategies. The clinical pillars cover the clinical assessment, the education pillars, leadership and management and research.

All these areas are essential for a clinical officer at an advanced stage to execute their mandate independently. These learning objectives are crucial because it enhances the learner’s competence and skills in advanced learning and would make the practitioner independent decision-maker. A nurse should employ the skills related to decision-making, quality assessment, assertiveness, critical thinking, and accurate patient assessment. A practitioner should also have practical communication skills: this helps successful collaboration with other members. A practitioner should also be precise, communicate effectively, listen actively, and give patients feedback (Heyns et al., 2017). Therefore, in this reflection, I will evaluate my educational and practice development concerning the four pillars of advanced training. Reflection is essential to understand professionalism and how far one has acquired knowledge and skills. This reflection is based on Rolfe’s reflective model around three questions of what? so what? And now what?

Clinical Pillars

What? I interacted with a female patient who had signs of polyuria and through assessment and history taking, it was established that the family had a history of type-2 diabetes. But after the analysis and lab assessment, it was established that the patient does not have type-2 diabetes but urinary Tract infection (UTI). My role was to alleviate the current situation the patient is facing, she is uncomfortable and I am supposed to help her, I told her this problem is treated with antibiotics. I also have a problem assessing patient’s overall health and treating any associated illness (Heyns et al., 2017). Therefore, in clinical pillar I have identified that I had some limitations, I failed to educate and explain to her that drinking a lot of water can increase the frequency of passing out urine.

I should interact with patient, I also want to improve on the formulation of diagnosis and initiate and implement the treatment (Gloster and Leigh, 2021). The rationale is to help me objectively identify the unique needs and the concerns of individual patient and their concerns and also the potential barriers to their care that may hinder compliance (Nikitara et al., 2019). The role of a nurse is to facilitate care for patients with diabetes and eliminate the barriers to recovery.

So, what? I have learned to widened my thought process and educate the patients, I also want to improve my clinical assessment skills. Achieving competence in this skill will assure patient safety and also improve the patient’s health outcomes from my ACP role. These skills are crucial in the development and the delivery and also taking an increased practice capability and capacity. It also supports the staff, the patient, and advanced practitioners with the self-awareness to evaluate and address their learning needs (Evans et al., 2020b). Assessment is a systematic technique of collecting data that identifies the client’s strengths or weaknesses and the physiological status, knowledge, motivation, support system, and coping mechanism (Wallis et al., 2022). Clinical assessment in nursing depends on the ability to collect and interpret relevant data subjectively and objectively (Price and Reichert, 2017). Therefore, acquiring knowledge and skills in patient assessment is a priority, and the learner will focus on it in the clinical pillars.

I want to be competent and confident when dealing with patients. By spending more time with patients with acute illnesses, I will concentrate on being effective and efficient in in-patient assessment because it is the background of nursing practice. This is my priority because assessment is the foundation of care planning and providing sufficient medication or treatment. Clinical assessment involves my ability to interact with the patient, assess the symptoms, and diagnose the situation (Diamond-Fox, 2021). The correct assessment would result in the proper treatment plan and improve the patient’s recovery.

Additionally, I want to master all nursing processes, such as diagnosis, intervention, and evaluation. A nurse should be able to assess the patient, formulate the diagnosis, and initiate and implement the treatment plan (NHS, 2020). Based on the assessment, I should identify the appropriate diagnosis and recommend and implement the treatment plan (Ajibade, 2021). The objective is to work autonomously and make independent decisions that improve the patient’s health.

Now what? To improve in this area, I will be seeing patients with acute illnesses under supervision. The plan is to see ten patients presenting with a critical condition and having complex symptoms daily. I will use structure and tools in line with ACP methods also specific to my clinical area of practice (Gloster and Leigh, 2021). At the advanced level, the practitioner should have gained the experiences and credentials essential to developing a responsive, flexible workforce and meeting the changing workforce and population needs. I will use assessment tool such as OPQRST ICE mnemonic to assess the characteristics of the patient’s symptoms. The tool will help me evaluate if I have improved on clinical assessment.

I will deploy the ACD structure relevant to my specialization, General Practice Nursing, on type 2 diabetes. Success in the plan requires the supervision of the senior practitioner, practice assessor, and personal tutor (HHE, 2021). Workplace-based oversight is critical in achieving the competencies and capabilities needed to become a safe and effective ACP (Fothergil et al., 2022). Because the interaction with the patient is new, I will need supervision to evaluate my capabilities and give guidelines. I should also be able to recognize my mistake and prepared to recognize potential faults.

Educational Pillar

What? I work in a general practice and in a culturally diverse environment in Greater London. In this area, most of the patients are from Africa and Caribbean origin and another ethnic minority. The population is significantly affected by diabetes type 2 and it is poor controlled, the group is also at high risk of factors that increase the chances of type 2 diabetes. These groups are also academically challenged and they learn in a unique way, the challenge is to engage with them and educate on health and lifestyles that reduces the prevalence of type-2 diabetes. My objective is to find out ways of integrating culture and diversity in education such that I can engage with people from Africa and Caribbean region and help them manage diabetes type 2.

In my practice, I have discovered the existence of inequalities in health and access to diabetes healthcare provision among the ethnic minority group. The ACP places an emphasis on provision of patient-centred care, but there has been a little consideration on the specific cultural barriers that prevent members of ethnic minority groups from accessing effective diabetes care (Alloh et al., 2021). Some of the challenges are cultural and it increases the potential for diabetic diseases and most of the minority groups have been ignored and consequently, it increases the disease prevalence.

So, what? Educating the population on healthy eating and lifestyle would reduce the spread of the disease and this is only possible if I have knowledge on culture and diversity. With healthy eating and active lifestyles for Diabetes (HEAL-D) in Africa and Caribbean communities being offered to these groups of patients across the country (Goff et al., 2018). I want to establish a way I can educate the group in their own way so that they can understand the specific information to their dietary needs. The black British forms the second largest ethnic minority population in UK and almost 4% of the population identify themselves as black British. Poor access to diabetes healthcare is a major issue for the minority ethnic groups in UK and it explains the reasons for high rates of diabetes type 2 and it is important for a general nurse practitioner to educate them on healthy lifestyle (Golf et al., 2020). Therefore, learning styles and education.

Acquiring knowledge of diversity and inclusivity is imperative for an advanced clinical practitioner because it applies to my area of specialization, and because I am working with different people, I should understand different cultures and diversity issues (Solanas et al., 2021). My focus is to understand culture and diversity and how this can be applied when dealing with type 2 diabetes, the role of a clinical practitioner also involves healthcare education on prevention and treatment (Solanas et al., 2021). The knowledge of culture and diversity would be essential to interact with and engage people from different backgrounds and educate them about diabetes type-2.

Knowledge of culture and diversity is imperative for clinical practitioners because it helps in provoking thoughts and knowing the causes of differences and how culture affects people’s views and attitudes (Anton-Solanas et al., 2022). Knowing personality utility and understanding one’s culture influences communication and increases relationships. The practitioner will know how to handle the patients and communicate to them on factors that cause diabetes and control mechanisms. Cultural and diversity awareness will facilitate communication between the healthcare provider and the patient, which is crucial in in-service delivery.

Effective communication will lead to quality service delivery, and my focus is to take advantage of the training opportunities that would allow me to participate with different groups. In my development plan, I propose to attend Educator training with a specific ethnic minority group (Taylor et al., 2021). Through training, I will theoretically acquire skills and apply them in my clinical practice by interacting and engaging with different clients with diabetes.

Now what? I will achieve the objective by completing the education training in culture and diversity. Diversity and inclusion are essential in advanced practitioners, and they should seek to actively promote diversity and inclusion in the workforce and practice (Poillucci and Page, 2019). A practitioner should ensure there is no discrimination in the form of age, race, gender, religion, or ethnicity. The practitioner acts as a role model for the rest and helps eliminate barriers and focus on achieving diversity and inclusivity (Kaihlanen et al., 2019). Promoting a learning culture in the medical profession is essential for growth and professionalism: learning is a continuous process and core for the practice (Pirhofer et al., 2022). Advanced approach and consultants’ role utilize the education that is important for themselves and their profession.

In this pillar, I will undertake my essential learning in developing professional progress and lifelong learning. It is crucial to regularly review the learning and development to reflect on the achievement and the areas of improvement (Pirhofer et al., 2022). I plan to offer group sessions on a one-to-one basis about foods in the Afro-Caribbean and tailor the specific diet to meet the particular group’s needs. I will also attend the Educator training to enhance my skills and knowledge.

I will undertake this learning objective using Kinesthetics learning style, which suggest the use of physical active role. Kinesthetic learners are hands-on and thrive through engagement, this method is important and effective because it involves physical repetition of task that build muscle memory. This style also involves engagement with the participation that helps the participants to focus on their training and it combines verbal and written instructions (Ginting, 2017). The practitioner develops the culture and diversity competencies through projects such as visiting the communities and the clinical sites, identifying the core curriculum components, and evaluating the existing didactic and clinical learning experience (Taylor et al., 2021). Because of this, my development plan involves interacting directly with a different group of people in sessions. Engagement with people allows the practitioner to understand cultural diversity better and design the plan to integrate into the learning program.

I will evaluate my learning and understanding of cultural diversity using the social learning theory. The social theory suggests that learning is effective within the social context and it is facilitated through modelling, observational learning and imitation (Bonatti, 2018). I will learn about culture and diversity in classroom and also interact with the African and Caribbean communities. Using the Kinesthetic method and social learning theory would be beneficial for community because it allows easier interaction and the learner understand their culture and communication styles. The limitation with this mode is that it requires one to sit for long and have stronger interactions with the community and when education community on tasks that require visual demonstration would be challenging.

Research Pillar

What? In my practice I never understood why SGLT2is used for heart failure, it has confused me for years and even in my current level I do not know why and how it is being used. This is the challenging part for me and my objective is to uncover what underpins the use of SGLT-2 for Heart Failure. This research is aimed at understanding why SGLT-2 is used in heart failure and to find out the type of SGLT-2, which is most appropriate to each clinical condition.

There are different types of SGLT2 inhibitors that are used in clinical practices and each has specific function. Thus, my plan is to find the specific subtype that is suitable for heart failure management. At this level, the practitioner should convert the research into practice, which leads to developing policies and guidelines and disseminating results (Ferrira et al., 2022). Diabetes is a severe health problem that affects a vast population, and in my field, I should be able to use the research to understand the different types, causes, symptoms, and treatments.

So, what now? In advanced Clinical Practice, research is fundamental. It covers analysis and the ability to critically appraise and utilize the research practice, evaluate the practice and service delivery and monitor the impact. At the ACP level, the approach is mainly grounded on evidence-based practices, which are the cornerstone of healthcare development (Mortimore et al., 2021). The learner should have research skills and the ability to conduct a survey on the subject and provide a solution. An advanced practitioner must embed a research culture in health and social care (Mortimore et al., 2021). One should be active in data collection, supporting individual engagement, and demonstrating ethical standards during the research.

The multi-professional framework suggests that healthcare professionals in advanced clinical practice should engage in research activities and adhere to the best research rules (Ferrira et al., 2022). The practice should always be guided by evidence-based approaches developed and applied to improve quality, productivity and safety and ensure value for money (Pol-Castaneda et al., 2020). Advanced Clinical Practitioners should actively identify the possible need for further research that strengthens the best practice evidence (Casey and O’Connor, 2021). The study incorporates the educator, leader, innovator, and contributor to research activity and application for funding.

Research is part of advanced nursing because it contributes new knowledge in the field; the clinical practitioner only applies the existing knowledge, and therefore, to be effective, research is critical (Neto et al., 2018). The process of scientific inquiry is systematic and based on achieving a sound and scientific base of information that requires repeated surveys that contribute to understanding the issues of different types of patients (Salem, 2019). The research will help address the critical issues in clinical practice and promote advanced nursing practices.

An advanced clinical practitioner develops knowledge and capabilities by researching a specific study area. For example, in my plan, I want to understand better SGLT-2, the inhibitors class of prescription medicines the FDA approves for use by adults with type 2 diabetes. As a general nurse specializing in type 2 diabetes, I should have vast knowledge and skills in all the causes of the problem and the treatment (Salem, 2019). I should be able to offer the patients the most appropriate treatment depending on their condition, and I can also give the right dose depending on the magnitude of the problem and the age.

Now what? I will apply the research skills acquired at my master’s level to find solutions to the current problems facing clinical practitioners. I have also understood the importance of ethical research in most clinical research; it involves the collection of specimens from people (Larkin et al., 2017). This action requires consent from the concerned people, voluntary participation, and, most importantly, privacy and individual data protection. In any research that I conduct, I will ensure that personal details are not used when used; they should be kept anonymous (Zolkefli, 2021). It is unethical to reveal research participants’ names, addresses, emails, telephone numbers, and locations of credit card numbers.

My research will be based systematic literature review that examines the secondary published reports and journal articles. The systematic literature review follows the following steps: Framing the research question, identifying the relevant work, assessing the quality of the studies, summarizing the evidence and interpreting the findings. The research formulates the topic as, how does SGLT-2 used in Heart Failure? The next step was to search for the relevant articles from medical databases such as PubMed, EMBASE, and Cochrane Library and online materials. The evaluation of the journal articles focused the title, the abstract, research methods and main findings (O’Connor, 2020). The research identified two journal articles, Lam et al. (2019) available at https://www.ahajournals.org/doi/10.1161/JAHA.119.013389. And Kurczynski et al. (2022) available at https://doi.org/10.3390/jcdd9070225. These articles were analysed using content analysis and the finding is that SGLT-2 inhibitors are potential effective class of drugs in the prevention of HF for patients with type 2 diabetes.

Research in nursing should be quality and there are factors that constitute a good research, a good research includes systematic planning and setting time-based and realistic objectives. The research has a clear and a specific title, then the research objectives and aims and a precise method of data collection (Gadalla, 2021). A good research should also be replicable, reproducible and transparent, replicability means the researcher can test the research findings. Reproducible means the researcher can achieve similar results with the same data and analysis method. Transparent means the results are written in a transparent way and it is available to other researchers.

Advanced clinical practitioners can maximize the opportunities for research and innovation to positively impact the care experience and improve patient satisfaction and families (Lehane et al., 2018). It also promotes using knowledge in policymaking and nursing action (Moore, 2018). I will use National Institute for Head and Care Excellence (NICE) guidelines to implement the research findings. Using the research findings, I will provide practical support to the type-2 diabetes patients by administering SGLT-2. I also advice on the use and adoption of new technologies.

Management and Leadership Pillar

What? Being a general nurse, I have encountered different people with diverse needs, I have also noted that the minority group have poor access to healthcare services because of lack of data for poorly controlled type 2 diabetes. The managers and the current leadership are using outdated and ineffective methods of addressing the challenges facing the minority group. These methods have not resulted in anything positive and instead the Africans and Caribbean continue to suffer. There is need for change in the in the healthcare for patients with type-2 diabetes and particularly towards the minority group. The issue here is to change ways of addressing the needs of the minority group to increase access to healthcare.

So, what now? Leadership and management are critical at the ACP level because it allows personal leadership and others; the clinician should integrate transformational leadership (Lamb et al., 2018). The practitioner looks across the practice and services and develops professional boundaries that identify and share the good practices (Hecke et al., 2019). Advanced practitioners should display team leadership, resilience, and determination in managing complex and unpredictable circumstances (Heinen et al., 2019). Advanced practitioners also develop practical leadership skills through educational routes, formal courses, reflective practice, coaching, and mentorship.

There is need to change the management structure and leadership style in the clinical practice and the management of type 2 diabetes. The skills and expertise include proactively identifying areas that need changes and building solid relationships with others (Gifford et al., 2018). The practitioner also acts as a role model by demonstrating the values and creating an organizational culture in place of work. It is imperative to use innovation and new method of management style that would increase the minority groups’ access to quality healthcare.

Now what? In this area, the National Health Service (NHS) change management model will be used to develop a change in management project. I will use the patient data produced to initiate change and encourage the followers to support change in an organization. The practitioner should initiate and develop strong relationships with others, creating clarity of team roles and encouraging productive working (Maxwell, 2017). In my plan, I want to be a change leader, and I should be a transformational leader who introduces and implements management changes (Ferreira et al.,2020). The field of ACP requires innovativeness, always managing the changes, and using the most appropriate change models.

I plan to develop my leadership and management skills through reflective practices; for example, I will use the current data available in my practice for high HbA1c to build a case for change in Afro-Caribbeans. The data is used in leading change management and innovation; leading change in an organisation demands that practitioners have practical skills that convince the team (Rekha, 2020). In my capacity, I will use transformational leadership skills to initiate and implement the changes, I have strong leadership skills characterized by practical communication skills and the ability to identify issues and provide solutions.

The change management would be implemented using Kurt Lewin’s change management model (Hamdo, 2021). The model is based on three phases of unfreezing, change management and refreezing, and I identify the issue and change status quo, implement the changes and ensuring followers are part of change. I can successfully initiate and implement the change by managing resistance. I will engage every stakeholder and team member in an organization such that they can accept the changes and implement all the requirements in change. Some changes require structural changes and, therefore, the best way to implement change successfully. The change also requires accountability, and as a leader, I will take responsibility for all the changes and innovations in an organization (Van Kraaij et al., 2019). The change management would require the use of leadership skills to ensure that changes are implemented successfully and all the nursing departments adapts the changes.

Conclusion

In this module and work-based learning activity, I have gained vast knowledge and skills applicable to my academic development and essential in professional practice. At the advanced level, the key skills and knowledge include evidence in specific subjects and competencies that allow the practitioner to partner and work with individuals, families, and careers. Skills in the assessment include using historical records, a holistic assessment, identifying risk factors, and mental health. The clinical practitioner should synthesise the information collected from multiple sources and make an appropriate judgment based on evidence. The advanced clinical practitioner should use expertise and decision-making skills to inform clinical reasoning. The first skills I have developed in this module are the clinical skills that include assessment, diagnosis, and implementation. The hard skills that I have developed in this module include the following:

• Diagnosing the illness.
• Providing prescription.
• Encouraging preventive care.
• Managing the acute disease.
• Practicing a clinical standard and adhering to hygiene and safety standards.

I have developed critical thinking skills, decision-making, and problem-solving through assessment and diagnosis learning. At the Advanced Clinical Practice level, it is more critical thinking and the ability to make autonomous decisions. The advanced level means one uses critical thinking to solve problems, and I gained these skills. I can work independently and make decisions that centre on the patient’s interests and ensure customer satisfaction. I used Rolfe’s reflective model to evaluate my clinical advanced practice pillars and I feel I have covered the most important parts of learning.

I have also acquired soft skills that are imperative in this profession and field, which include leadership, time management, attention to detail, and communication. My leadership skills are well-developed, and I can direct patient care and manage the work of other nursing professionals. I have learned to lead and manage change through innovative means and successfully implement the transition. I learned the importance of time management because, in healthcare, there are cases that require an emergency response, and one with time management can effectively respond to the issue. In this module, I have developed attention to detail; the assessment and diagnosis of the patient require the ability to look at the details.

In the future, I would like to learn and develop more in some areas, and the first field is education and development; learning is a continuous process. I plan to enrol in a professional development course that will widen my knowledge and skills. I also wish to learn about problem-solving such that I identify an issue and provide potential solutions. Problem-solving is essential in advanced clinical practice because there are always different problems because of the dynamic world and changes in population needs. I also want to improve on resourcefulness to take advantage of ways to seek financial help and use the little resources available to maximize the outcome. The advanced level involves making critical decisions and using limited resources to serve the broad population, the demand is high, and the supply of services and resources is low.

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