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Medical ACNP : AG - Acute Care Nurse Practitioner Exam

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ACNP test Format | ACNP Course Contents | ACNP Course Outline | ACNP test Syllabus | ACNP test Objectives


The Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Post-Professional Certificate is designed for graduate prepared Nurse Practitioners (NP) or Clinical Nurse certified (CNS) who are seeking to expand their roles via nurse practitioner certification in Adult-Gerontology Acute Care. The curriculum prepares nurse practitioners to function as generalist, principal providers of care for adults and older adults with acute, critical and complex chronic health problems across the continuum of acute care services.

AG-ACNP students may choose a clinical emphasis in cardiopulmonary, critical care, oncology, trauma emergency preparedness or directed study. The directed study allows students to design clinical experiences around a particular area of interest (i.e. internal medicine, general surgery). The curriculum consists of NP and AG-ACNP specialty courses and clinical practice hours.

Graduates of the AG-ACNP Post-Professional Certificate are eligible to sit for the national certification examination in Adult-Gerontology Acute Care offered by the American Nurses Credentialing Center or American Association of Critical Care Nurses. Successful passing of the national certification examination entitles the graduate to apply for certification as a Certified Registered Nurse Practitioner (CRNP) in Adult-Gerontology Acute Care by the State Board of Nurse Examiners of the Commonwealth of Pennsylvania.

Course work may be completed in 3 terms
540 clinical hours
Online or onsite
Students are required to attend 2 onsite laboratory intensives - 2 days in the Summer term and 1 day in the Fall term. Each student will be responsible for the room and board cost during the lab intensives.
Online students will need to arrange for clinical placements and appropriate physician or nurse practitioner preceptors. An Affiliation Agreement between the University and the clinical site is required before clinical hours can begin.

Graduates of the AG-ACNP Post-Professional Certificate are prepared to accomplish the following:

Assume responsibility for promoting, maintaining and restoring health to acutely/critically or complex chronically ill adults and older adults
Identify health risks, promote wellness, and diagnosis and manage acute and chronic illness
Participate in multi-disciplinary research and provide leadership in mobilizing health services



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Medical Acute PDF Download

using factor-of-care simulation to greater manage acute deterioration | ACNP boot camp and Free test PDF

this text describes a point-of-care simulation training mission to increase acute disease management in a community clinic surroundings

abstract

With the shift to more localised healthcare, new models of education and training are mandatory to enrich high-quality and protection, whereas being attractive and empowering for staff. factor-of-care simulation is gaining recognition in healthcare as a training components, and has several merits over usual simulation. this text describes the design, implementation and comparison of a point-of-care simulation practicing assignment to enhance acute sickness focus and management in a neighborhood medical institution setting. The mission assessed competencies, delivered tailored academic content and re-evaluated learning. It enabled the implementation of organisational safety alterations, in addition to improving personnel knowledge and self belief in recognising and managing a deteriorating patient.

citation: Clotworthy ok et al (2021) using element-of-care simulation to stronger control acute deterioration. Nursing times [online]; 117: 12, 39-43.

writer: Kim Clotworthy is lead medical facilitator; Jay Over is senior resuscitation officer; each at Cornwall Partnership NHS groundwork have faith. Adam Pollard is individuals information lead, Royal Cornwall Hospitals NHS have faith.

  • this article has been double-blind peer reviewed
  • Scroll down to read the article or down load a print-friendly PDF here (if the PDF fails to wholly down load please try once again using a special browser)
  • Introduction

    NHS England’s (2019) The NHS long run Plan aims to shift healthcare closer to home, which requires new provider models. This comprises strengthening and setting up neighborhood features to alleviate expanding burdens on acute hospitals.

    Cornwall Partnership NHS foundation have faith provides community features throughout an isolated peninsula in 10 adult physical health community hospitals and in individuals’s buildings. The area is rural, with a generally dispersed population this is served by way of only one acute hospital. setting up the neighborhood hospitals within the vicinity is primary to meet the goals of The NHS long run Plan, Excellerate the fine of patient care, be certain long-time period sustainability of services throughout the county and cut back unnecessary acute sanatorium admissions.

    An stronger knowledgeable and cohesive group body of workers is essential to this. It requires satisfactory equipped and skilled staff, geared up to satisfy healthcare calls for and bring constant, secure and beneficial care. patients should get hold of care it really is proportionate to their needs and within the correct care environment, with the correct care professional, at the appropriate time. This poses a number of challenges, together with round training; aspect-of-care simulation is one skills solution to this.

    Simulation education has been proven to enhance abilities, self belief and conversation in groups when mainly concentrated on emergency management (Crowe et al, 2018). constructive use of simulation has been identified as a key precedence in helping building of the healthcare team of workers. Former chief scientific officer Sir Liam Donaldson described it as a “a must have half in constructing a safer healthcare gadget” (Donaldson, 2009).

    Simulation practicing has additionally been validated as a discovering formulation by the Royal school of Nursing (2017), department of health (2011) and common medical Council (2011); health education England (2018) has published a framework on its use. It gives a true-to-lifestyles discovering atmosphere, mirroring actual-lifestyles eventualities and enabling personnel to put abilities and advantage into follow.

    factor-of-care simulation practicing

    ordinary clinical simulation practising is prescriptive, completed in a managed, enormously technical environment, usually with staff from the identical expert cohorts. it's delivered in a non-clinical setting, which is simulated to appear to be the scientific ambiance. In contrast, the more latest greater resourceful point-of-care, or in-situ, simulation allows multidisciplinary groups to instruct collectively in their regular patient care ambiance.

    studying in regularly occurring teams and environments gives some benefits over common simulation practising. Sleeman et al (2018) showed practising multidisciplinary groups in an acute clinic environment can enhance workforce morale and increase training on the coalface. They found the key turned into making certain staff used their personal talents, resources and machine while working the simulation in precise time. This become also found to be advantageous in addressing human elements and team working dynamics to enrich patient care.

    there is increasing help in the clinical career for simulation-based mostly getting to know as a superior educating and practising components (So et al, 2019). experiences indicate simulation can increase consciousness and intervention in a deteriorating affected person (Lee et al, 2019), together with nursing knowledge and self belief when dealing with advanced emergency instances (Crowe et al, 2018). This contributes to safer patient care.

    less has been written about element-of-care simulation training, however it could be expected to provide equivalent merits. incredibly interactive and immersive studying is generic to be way more beneficial than common studying it truly is completely content-pushed (Pagano, 2013). health schooling England’s simulation framework (2018) states that blended discovering, the usage of simulation alongside other concepts, should still develop into commonplace in working towards pathways and continuing expert construction.

    Healthcare group of workers are still mostly trained in professional ‘silos’ via lecture room strategies. Arguably, common tutorial approaches aren't conducive to interprofessional learning or improving multidisciplinary collaboration and conversation (Vyas et al, 2012). Future getting to know must be inclusive, obtainable and time sensitive; these are all critical points for workforce development in nowadays’s pressurised healthcare working environments.

    Shrestha et al (2020) confirmed an increase in advantage and advantage of junior doctors after in-situ simulation and suggested its incorporation into latest medical training. Smith and Jankowski (2014) found attractive nurses in typical simulation practising boosted advantage, potential, and confidence stages. They also proposed it has skills for charge rate reductions by means of enhancing affected person clinical results. element-of-care simulation with the multidisciplinary team may also tease out latent protection strategies or medical concerns that don't seem to be at all times obvious in simulation rooms, to Excellerate patient safeguard (Shah et al, 2019).

    Bridging the conception–follow gap

    Simulation practicing gives opportunities to bridge gaps between conception and the transition of abilities into apply (Brown, 2019). Their trust requires registered inpatient nurses to:

    These have been mandated for safeguard as a result of the geographical unfold of their health facility teams, faraway community places and reduced on-web site medical professional ability. This may still deliver body of workers with simple competencies and capabilities, together with use of the ABCDE (airway, respiratory, circulation, incapacity, publicity) approach to recognise, investigate, manipulate and deal with, and resuscitate adult sufferers who're acutely unwell. although, local systematic incident stories and group of workers responses recognized a scarcity of self belief around making use of the got potential and potential when transitioning into practice.

    There are a large number of theories on the alternative ways through which freshmen learn; these deserve to be considered to make instructing practices suitable for companies of distinct rookies, while assisting with the transfer of abilities and competencies into scientific follow.

    Kolb’s (1984) experiential discovering cycle theorises a four-stage continuous researching method and quantifies why expertise and knowledge learnt in the classroom may also not absolutely transition into the clinical ambiance. Many barriers were documented as impacting on gaining knowledge of.

    in the first ‘concrete getting to know’ stage in the school room, limitations could encompass the atmosphere and unmet wants in terms of differing researching styles. within the 2d ‘reflective’ stage, lack of time for reflection on advantage learnt, due to work demands, generally is a barrier. The third stage of ‘conceptualisation’, involving birth of educating in a classroom, lacks the context of a medical atmosphere. ultimately, within the closing stage of ‘lively experiential researching’, body of workers have to be in a position to:

  • study directly from experience and every other;
  • follow that researching to clinical apply;
  • Embed their newly bought talents –this may well be missing in apply due to the constraints posed by a busy inpatient ward.
  • Some, if not all, of the boundaries identified could keep away from the transition of competencies and competencies to practice. element-of-care simulation is a method to advertise Kolb’s getting to know processes, and allow staff to discover and reflect on precise-life instances in their group of their usual working atmosphere. This helps to enhance confidence and embed expertise, as well as enhancing the crew’s response and performance in emergency instances.

    With the shift to more localised healthcare, new fashions of education and practicing are essential to enhance first-rate and safeguard, whereas being engaging, inspiring and empowering for team of workers. As such, element-of-care simulation turned into chosen by way of their believe because the academic technique to raise the awareness and management of acute disease in a neighborhood health facility environment.

    The ordinary imaginative and prescient turned into to Excellerate some extent-of-care simulation programme that changed into replicable and transferable and, if a success, can be rolled out across all wards and departments within the have confidence. certain goals and ambitions are outlined in container 1.

    box 1. goals and pursuits of the aspect-of-care simulation project

    aims

  • To evaluation and enhance medical apply around:
  • focus of decay
  • Provision of medication for scientific emergencies, including sepsis and hypoglycaemia
  • administration of a affected person in cardiac arrest
  • leading pursuits

  • determine medical follow around:
  • consciousness of affected person deterioration
  • medicine of sepsis or hypoglycaemia
  • administration of a patient in cardiac arrest
  • Embed using ABCDE (airway, respiration, circulation, incapacity, publicity) assessment using the countrywide Early Warning score (NEWS2)
  • make sure acceptable escalation and care planning the usage of medical protocols and the SBARD (situation, heritage, assessment, advice, determination) conversation tool
  • improve a educated multidisciplinary crew within the community health center atmosphere that can determine, deal with and control the deteriorating patient with ease
  • document and make strategies to increase patient care when it comes to picking and managing deterioration and acute illness, together with latent safeguard and human-factor concerns
  • Implementation

    We used a plan, do, analyze, act (PDSA) cycle for the assignment (Aguayo, 1990). This became chosen for its pragmatic methodology and durability of effectiveness in imposing change and assisting groups to Excellerate first-class of care.

    The undertaking become deliberate in three phases. every thinking a number planned activities and become discipline to its personal PDSA cycle, permitting evolution and development to the next section. Three simulation situations have been identified and devised:

  • Sepsis;
  • severe hypoglycaemia;
  • Cardiac arrest.
  • The undertaking turned into delivered in ward-based groups throughout two hospitals at separate instances over one year. A 20-mattress ward at one sanatorium turned into used to test the mannequin. Amendments were made after evaluation, after which simulation become delivered on two wards on the second health center. An superior simulator manikin with excessive-fidelity features changed into used and patient simulation situations have been developed.

    Three evaluation tools had been devised to measure knowledge improvements:

  • Pre- and put up-mission group of workers abilities and self assurance surveys;
  • point-of-care simulation evaluation of staff performance – knowledge, talents, crew working/human factors;
  • submit-simulation remarks.
  • The pre- and put up-task body of workers self belief surveys were used to analyse team of workers notion of their expertise and confidence about points of managing a deteriorating patient and their participation in managing a cardiac arrest. The questionnaires used a 5-scale Likert ranking for responders to specify their level of contract to an announcement; the pre-assignment survey had extra questions about old journey and involvement in simulation practising.

    team of workers had been requested to supply formal comments after each simulation session. comments became based round six questions about the price of the factor-of-care simulation working experience, improving self assurance and skill, and enhancing practices.

    section one

    Three simulation eventualities had been delivered with no boost warning or further working towards; all the way through each one, staff performance turned into assessed the use of one agreed efficiency criteria device for hypoglycaemia and sepsis, and a further for cardiac arrest. staff have been graded on whether or not they met the assessment standards completely, partly or not at all for each and every of the domains outlined in container 2.

    box 2. assessment of personnel performance: phase one

    Hypoglycaemia and sepsis simulation scenarios

    The seven domains assessed comprised:

  • Early awareness of degradation
  • The ABCDE (airway, respiratory, circulation, incapacity, publicity) approach to evaluation and medicine
  • beginning of acceptable medication
  • Use of believe treatment protocols
  • Drug administration following affected person neighborhood directives (if acceptable)
  • Use of the SPARD – situation, historical past, evaluation, suggestion, decision conversation device to quit affected person counsel
  • effective team working
  • Cardiac arrest simulation scenario

  • Domains assessed focused on:
  • DRSABC (danger, response, ship for aid, airway, respiratory, cardiopulmonary resuscitation)
  • fundamental existence help and defibrillation knowledge
  • phase two

    section two involved evaluating the results from phase one, and implementing security movements and bespoke working towards the place necessary.

    phase three

    The subsequent step changed into to deliver identical simulations using the identical assessment tool to evaluate efficiency. although, on the primary medical institution web site, this became most effective feasible for hypoglycaemia and sepsis, as medical and organisational challenges prevented us working simulations for cardiac arrest. because of Covid-19, they have been also unable to run phase three on the 2nd health center web page.

    effects

    overall, 107 members were concerned in 31 simulations, comprising nurses (32%), healthcare assistants (38%), doctors (5%), nursing college students (18%) and others (7%). beginning of training on the factor of care enabled the diverse professions to train and gain knowledge of collectively.

    capabilities and confidence

    The initial survey confirmed that greater than half (fifty eight.2%) of body of workers had prior to now participated in some variety of simulation practicing, however most effective a third (32.7%) in element-of-care simulations. A assessment of pre- and submit-venture survey responses showed that group of workers felt more a professional and assured after the challenge’s completion (Fig 1). The best development turned into viewed in team of workers self belief in the management of sepsis and hypoglycamia. The enviornment of least improvement became self belief in the use of the SBARD (condition, heritage, assessment, suggestion, determination) communique device, however there became no lower in self belief.

    Simulation evaluation

    measurement of performance improvement for all seven domains for sepsis and hypoglycaemia showed more standards had been fully met in phase three than in phase one, and all efficiency criteria were met at the least in part in part three. The largest percent growth turned into in team of workers the use of all facets of the SBARD communique tool (60%), adopted via delivery of appropriate patient remedy (forty nine%). body of workers efficiency greater least within the use of protocol tools (2%), with little improvement observed in the use of a structured ABCDE in assessing deteriorating sufferers (7%).

    put up-simulation comments

    evaluation of comments on the conclusion of the venture recommended factor-of-care simulation turned into well obtained as a researching resource by using staff; the ordinary ranking concerning its cost become 4.6 out of 5 for all six questions.

    dialogue

    we have proven that element-of-care simulation training has a number of benefits, including providing experiential studying opportunities that facilitate interprofessional experiences. This suits with the vision of the NHS’s (2014) 5 year forward View for features to be integrated across the affected person journey and involve multidisciplinary crew working.

    aspect-of-care simulation can have two key advantages:

  • improving construction of community health center inpatient workforce capabilities, potential and self assurance;
  • increasing multidisciplinary working and collaboration.
  • here's a concept already neatly developed with nursing college students, as an instance, during the Collaborative researching in follow system, which creates interactions with others the usage of collective potential, capabilities and attitudes (Hill et al, 2020).

    We expert total teams together in true time, throughout various staff disciplines, working of their regular environments the use of universal gadget. This turned into tremendously effective for body of workers discovering and the documented results. Their outcomes showed improvements in all three assessment measures used.

    apparently, on the task end, youngsters body of workers expressed least self belief in using SBARD, this become seen to be essentially the most improved area of group of workers performance. Least development become in the use of protocols/guidelines to aid control patient deterioration, however the appropriate treatment alternate options for sepsis and hypoglycaemia had been well delivered by way of part three.

    As their clinical body of workers obtain usual working towards within the ABCDE approach to recognising deterioration, they were anticipated to be assured and display it smartly in each phases. youngsters, within the pre-assignment survey, best 22% of body of workers felt very confident in assessing and recognising a deteriorating patient (which would consist of the ABCDE strategy); submit seasoned­ject, this rose to 50%. standard, the proportion of performance standards being completely met extended from 30% pre-project to 65% after beginning of the entire simulations, an increase of 35%.

    we now have already outlined the obstacles in the transition of capabilities from school room to follow, and had hoped factor-of-care simulation would help bridge that disparity between idea and practice. The probability for a debrief is an essential component of simulation, as well as being critical to support meet position expectations for graduate nursing training (Ali et al, 2020). in advance of the assignment, most staff have been no longer privy to any debrief models and highlighted that debrief hardly ever happened after emergency movements. They used Denning and Davis’ (2018) gaining knowledge of dialog to explore performances right through the post-simulation debrief.

    comments is additionally pivotal to the researching procedure when specializing in abilities, leadership, human components and non-technical competencies. Productive conversations initiated and led by using the novices – and mediated the use of energetic listening and advocacy with enquiry, as needed – proved extremely beneficial. staff learnt with, and from, each and every different, which further supported their boom and construction.

    The merits of embedding element-of-care simulation are clear, no longer handiest in addressing building and change, as recognized in the plan for the NHS, but in driving ahead measures for the protected and useful birth of notable care. factor-of-care simulation also resulted in the identification of a few medical and patient defense issues, as well as organisational risks (corresponding to flawed gadget and protocols in emergency containers); this allowed them to be rectified before hurt may ensue.

    in the 2d half of the venture, the united kingdom became hit by using the Covid-19 pandemic. To take power off the extreme health center, their have confidence developed community evaluation medication contraptions (CATUs) that permitted direct GP or ambulance referrals.

    the primary CATU was developed on the 2d project web page, the place the simulation practising grew to become out to be valuable, boosting personnel talents and scientific construction. devoid of it, the launch may had been delayed and functions within the region might also not have coped as well.

    boundaries

    As already touched on, they skilled some challenges in offering and evaluating the factor-of-care simulation training:

  • on the first hospital web site used to examine the mannequin, only the hypoglycaemia and sepsis eventualities can be re-assessed as they have been unable to run the cardiac arrest simulations in section three;
  • Rota planning on the first health center additionally intended distinct group of workers attended in phases one and three. This supposed some staff neglected a primary attempt on the scenarios and, without this baseline data, they couldn't reveal improvement of their subject potential;
  • on the 2nd health facility, they were most effective capable of bring phases one and two due to Covid-19, so statistics on personnel development in talents, self assurance and general efficiency turned into missing;
  • once more, the same workforce did not all the time attend phases one and three, so in-situ evaluation records, and comparison of advantage and self belief become collated the use of generalised responses in place of tracking particular person growth;
  • The deliberate blended learning method (part two) become challenging to obtain. restricted uptake of taught classes supposed they changed to deliberate working with workforce on the ward to embed the skills clinically. however, this was then cancelled due to Covid-19, and each areas advanced into self-directed examine with electronically disseminated resources.
  • Conclusion

    Simulation training is a tried-and-validated tutorial system. increasingly, it's used to carry practising across a number of professions and businesses international. factor-of-care simulation has many benefits over general simulation and is gaining recognition in healthcare. It addresses venue, transport and staff time constraints, whereas being immersive on the point of care start, helping staff capabilities, retention and bear in mind. It additionally improves confidence in dealing with emergency situations and multidisciplinary team working.

    practising multidisciplinary groups of their usual place of work makes sense and is supported through the literature. If delivered regularly, it might probably support create a extra resilient group of workers.

    The exposure of patent protection considerations, along with manner, ergonomic or environmental blunders, is additionally exciting to the element-of-care practicing manner. It makes it possible for remedial action to be taken before a real-existence incident occurs, thereby improving patient protection.

    Our mission showed that aspect-of-care simulation could be used to replace body of workers skills, and Excellerate their potential and confidence in acute sickness management. It gave body of workers more desirable self-assurance in dealing with emergency routine, whereas encouraging multidisciplinary team integration, interprofessional studying and advantageous care beginning. element-of-care simulation is an ingenious training tool that is awfully smartly obtained via group of workers as a mode of learning, as proven by using their qualitative and quantitative project evaluation remarks facts.

    We intend to construct on the mission’s success with the aid of growing and embedding a sustainable aspect-of-care simulation programme trustwide. This may be replicated by other organizations constructing practising in acute disease consciousness and administration.

    Key points
  • patients who're acutely ill are increasingly being cared for in group settings
  • tutorial programmes are crucial to increase emergency administration knowledge for group medical institution body of workers
  • point-of-care simulation raises team of workers self belief and helps embed talents into follow for safer, more-constructive patient care
  • factor-of-care simulation helps and enhances multidisciplinary crew working
  • This training approach can enrich the focus and management of acute affliction in community hospitals
  • References

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    Brown JE (2019) Graduate nurses’ notion of the effect of simulation on reducing the idea- follow gap. Sage Open Nursing; 5: 2377960819896963.

    Crowe S et al (2018) The have an effect on of simulation primarily based schooling on nursing confidence, capabilities and patient outcomes on frequent drugs devices. Nurse training in apply; 29: 70-seventy five.

    Denning okay, Davis M (2018) Listening through the getting to know conversation: a notion frightening intervention. MedEdPublish; 7: three, 19.

    department of health (2011) A Framework for know-how stronger getting to know. DH.

    Donaldson LJ (2009) one hundred fifty Years of the Annual report of the manager medical Officer. DH.

    widely wide-spread scientific Council (2011) The Trainee doctor. GMC.

    fitness training England (2018) countrywide Framework for Simulation based training (SBE). HEE.

    Hill R et al (2020) Collaborative getting to know in follow (CLIP): assessment of a new approach to scientific researching. Nurse training nowadays; 85, 104295.

    Kolb DA (1984) Experiential studying: experience because the source of gaining knowledge of and building. Prentice corridor.

    Lee C et al (2019) The affect of health facility-based mostly in situ simulation on nurses’ recognition and intervention of affected person deterioration. Journal for Nurses in professional building; 35: 1, 18-24.

    NHS England (2019) The NHS long term Plan. NHSE.

    NHS England (2014) five year ahead View. NHSE.

    Pagano KO (2013) Immersive gaining knowledge of. American Society for working towards and development.

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    Sleeman k et al (2018) element-of-care simulation working towards to address severe untoward incidence of hypoglycaemia. Journal of Diabetes Nursing; 22: JDN004.

    Smith M, Jankowski S (2014) Simulation-based practicing improves ITU personnel expertise in the administration of head injuries. BMJ Open satisfactory; three: u201041.w972.

    Shah A et al (2019) Simulation-based mostly training and team training. Otolaryngologic Clinics of North america; 52: 6, 995-1003.

    Shrestha R et al (2020) In-situ simulation-primarily based module to coach interns in resuscitation talents all over cardiac arrest. Advances in medical education and follow; eleven: 271-285.

    So HY et al (2019) Simulation in clinical education. Journal of the Royal faculty of Physicians Edinburgh; forty nine: 1, 52-fifty seven.

    Vyas D et al (2012) An interprofessional route the usage of human affected person simulation to train affected person protection and teamwork talents. American Journal of Pharmaceutical training; 76: 4, 71.


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