Nursing case studies
Hilary
Hilary, a public representative from our Advanced Practice Public Advisory group (APPAG) shares her experience of receiving care from an Advanced nurse practitioner. Hilary also has experience of working with universities in the education of nurses as part of a public involvement programme.
Following is a snippet of a discussion between Hilary and the chair of our APPAG:
Hilary: This was treatment by an advanced nurse practitioner in my last GP Practice. I saw the same nurse in three different settings - in the drop in centre, which was like A&E. Then she came to my home and I saw her in the GP surgery. I was aware of her role and thought it was marvellous because she was taking some of the strain off the GPs. Her knowledge was amazing. She took more time with me than a GP would as she explained her role. She was extremely competent and picked something up that actually was challenged later on, but in fact it was found to be correct. She was a person that I felt very safe with and respected. It was absolutely amazing that she was so well used within that practice and was able to work in all those different settings and able to prescribe. So I thought it was a fantastic role.
Chair: Did the confidence you have in this nurse from the time you met her first and then after you’d finished the treatment?
Hilary: No, I felt very secure with her. My own family has nurses within it and with my involvement with nurse training at Swansea, I am well aware of the training and competencies required of nurses and here was this really qualified practitioner sitting above other nurses, somewhat like sitting between a nurse and a doctor; and she was a respectful, a very active listener and I just felt very safe in her hands. I don't know whether that was a particular personality trait of hers, or whether that was to do with her advanced training.
Chair: And my final question, did you ever worry about the regulated level of nurse that this person that you're working with or did it did it ever cross your mind?
Hilary: I felt very privileged! Privileged to meet this person and be treated by her, because I knew that her level of training was high, I knew that her competencies were high. So, I felt very secure with her.
Mrs J
This scenario shows an example of the sort of work that Advanced Nurse Practitioners do:
Mrs J, a 65-year-old lady, attends her GP surgery having developed a persistent cough following a walking holiday in Pembrokeshire. Mrs J is seen by Anna, who introduces herself as an Advanced Nurse Practitioner.
Anna explains that she’s had additional training and experience and is working at a higher level, meaning she has the skills to manage Mrs J’s presenting complaint, prescribe treatment, refer and follow up as required.
Anna undertakes assessment, orders further lung function tests, reviews the results and explains to Mrs J that she has a condition called chronic obstructive pulmonary disease.
Anna reassures Mrs J that the symptoms can be managed but that she will require ongoing care on a fairly regular basis to ensure that the condition is stable, and that Mrs J knows what to do should her symptoms worsen.
Anna prescribes medication for Mrs J and arranges follow up. Over the coming weeks, Mrs J is seen regularly by Anna and she adjusts her medications according to her needs.
Anna arranges for the respiratory team to undertake an exercise programme with Mrs J and for the home COPD team to visit to ensure that Mrs J’s home environment is conducive to managing her condition.
It becomes clear to Anna that Mrs J’s condition is not responding as she would expect, so she liaises directly with the respiratory clinician at the local hospital who advises on next steps in management that should be tried.
Mrs J’s condition responds to this treatment, and she continues to see Anna every six months as part of routine care. Mrs J finds she rarely needs to book an appointment with the GP about her condition and feels well cared for and listened to and values the relationship she has developed with Anna
Midwifery case studies
These scenarios show examples of the sort of care that Advanced Midwifery Practitioners provide:
Ms O
Ms O had sadly experienced multiple pregnancy losses before she thankfully went on to have her baby daughter. During this pregnancy, because of her previous pregnancy history and complications, her maternity care was picked up early on by midwifery specialists who assessed her initially at a maternity assessment unit.
Ms O considered the midwifery role titles and names of those who treated her as being 'very important' to help her understand the parameters of the care and support they could provide to her.
This included a knowledge and fundamental understanding of what medications they could safely prescribe to her during her pregnancy.
Ms O felt reassured and supported with the quality of care provided by her Advanced Midwifery Practitioner (AMP), whom she felt properly understood her healthcare needs.
She specifically highlighted how her AMP was able to advocate for her on some different things during her pregnancy. In concluding her story, she powerfully stated "she believes this is one of the reasons her baby is here today".
Ms M
Ms M recalls being cared for by an Advanced Midwifery Practitioner (AMP) during her pregnancy. She suffered with severe ‘Hyperemesis Gravidarum (HG)’ during her latest pregnancy.
She welcomed her AMP's sound knowledge of medication and competence in prescribing to support her care.
She felt particularly reassured by her Consultant Midwife, who is an AMP, when she discussed concerns with her, and “felt they understood the drawbacks, benefits of and alternatives to different medication”, to be able to effectively ensure she had the best treatment for her HG, to help support her through her pregnancy as smoothly as possible.
Ms B
Ms B described what a vitally important role her Advanced Midwifery Practitioner (AMP) played during her recent pregnancy, with her third baby.
She had an ‘incompetent cervix’ identified at 12 weeks in her previous pregnancy, resulting in an immediate cervical cerclage.
In this pregnancy she was informed by her midwife that her cervix would again be assessed at 12 weeks. This gave her cause for concern as she was aware that her cervix was likely to have been further compromised from another pregnancy and delivery and that she would therefore potentially require the procedure earlier in this pregnancy.
She therefore contacted her Consultant Midwife, who is an AMP, she was seen for assessment promptly within two days, and the AMP subsequently arranged for surgery to happen soon after at 10 weeks.
Ms B appreciated that their AMP had the "autonomy in use their professional judgment to do things differently”, to provide her with the best care possible.
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