Translating evidence into practice

Hypertension is the leading risk factor for death and causes heart attacks, strokes, and kidney disease (Canadian Hypertension Education Program [CHEP], 2013; Heart & Stroke Foundation, 2012; Hypertension Canada, 2013). Over 21% of Islanders have been diagnosed with hypertension, and research indicates that less than 25% are meeting recommended targets (Centers for Disease Control and Prevention [CDCP], 2011; Heart & Stroke Foundation of Ontario, 2013; Siegel, 2005). There is limited access to primary care practitioners on Prince Edward Island (P.E.I.), and according to Statistics Canada (2013), over 10% of Islanders report not having a physician and are referred to as unaffiliated patients. This means that over 15,000 unaffiliated patients rely on walk-in clinics and emergency departments for their primary care needs (Statistics Canada, 2013). The proposed Nurse Practitioner (NP)-led Hypertension Program for Unaffiliated Patients can significantly reduce the gap in primary care services by addressing unaffiliated patients’ needs through partnering with them to reduce modifiable risk factors by providing education, appropriate pharmacological and non-pharmacological interventions, and regular follow-up. This NP-led Hypertension Program for Unaffiliated Patients is designed to optimize blood pressure control for unaffiliated patients and therefore reduce the risk of heart attack and stroke, improve quality of life, and improve access to high quality health services

The development of a nurse practitioner-led fracture liaison service on Prince Edward Island

Osteoporosis-related fragility fractures are associated with high levels of morbidity and mortality and are associated with human suffering. Untreated osteoporosis poses a substantial financial burden to the Canadian healthcare system. A significant osteoporosis care gap exists in Canada where many individuals living with brittle bones are undertreated. Prince Edward Island (PEI) has high rates of significant modifiable risk-factors for osteoporosis. In this document, I propose a nurse practitioner-led pilot project to increase accessibility to holistic osteoporosis care. The pilot project will serve individuals over the age of 55 and provide pharmacological and non-pharmacological interventions with regular follow-up to decrease the incidence of fractures. The nurse practitioner-led clinic will engage in primary and secondary prevention, with a special emphasis on the early recognition of an initial fragility fracture. Early intervention, including a comprehensive treatment plan, will minimize the chance of sustaining a future fracture. The success of other fracture liaison service (FLS) programs will be analyzed. Input from, and collaboration with stakeholders, is encouraged to make this worthy program a reality on PEI

Optimizing well-pregnancy care on Prince Edward Island

While pregnancy is a normal, transitional life event many women experience, the need exists for competent, holistic health care during this time in their lives. On Prince Edward Island, 90% of perinatal care is administered by obstetricians following a medical model of care; this is 30% greater than the national average (Public Health Agency of Canada [PHAC], 2009). Pregnancy outcomes on P.E.I., in regards to folic acid supplementation, high pre-pregnancy and pregnancy body mass indexes (BMI), overweight or obese expectant mothers, substance use, and breastfeeding consistently fall outside national averages (P.E.I. Reproductive Care Program [P.E.I. RCP], 2008; PHAC, 2009, 2012). An initiative to implement nurse practitioner-led perinatal care for healthy pregnant women can help to address these outcomes by ensuring appropriate ongoing physical assessment, addressing psychosocial needs, and increasing perinatal education to women and their families during the preconception, prenatal, and postpartum periods. The initiative will include communication to key stakeholders, and a timeline of planned activities and will follow the PHAC’s (2001) Project Evaluation to assess success of the project

Improving access to mental health services

Mental illness is a global crisis affecting one in four individuals worldwide, and occurring in one of every five Canadians. The impact of mental illness affects almost every Canadian and does not discriminate against age, gender, culture, or socioeconomic status. Timely access to mental health services is a provincial priority in Prince Edward Island, however wait times for persons seeking mental health services are more than double the recommended provincial wait times due to an increased prevalence of mental illness and a lack of skilled professionals. Delays in treating mental illness have negative consequences such as: deterioration in mental condition; unemployment; disability; homelessness; inappropriate incarceration; stigma; discrimination; reduced life expectancy; and suicide. In order to address extended wait times, more emphasis in providing mental health services within the community is required. Nurse practitioners, who have demonstrated positive outcomes when caring for those with mental illness, have been identified nationally as cost–effective practitioners who can fill this gap. A health initiative implementing a nurse practitioner-led mental health team into a primary care network as a 1 year pilot project will attempt to reduce the gap in mental health services in Prince Edward Island

Optimizing home-based palliative care

Hospice Palliative Care (HPC) aims to relieve suffering and improve the quality of life for individuals/families encountering a life-limiting illness. The need for HPC is predicted to rise over the next 40 years due to Canada’s aging population and increased prevalence of chronic disease. Prince Edward Island’s (P.E.I.) population is older, and has a higher prevalence of chronic disease and higher rates of mortality than its nation. Ninety percent of Canadians wish to remain in their home surrounded by friends and family in their final days, yet 70% of Canadians facing end of life decisions deaths occur in hospital. Unfortunately, in P.E.I. only a small percentage of deaths in 2013 were home-based palliative care deaths. P.E.I. has shown promising approaches to end-of-life care with the Provincial Palliative Care Team and the Integrated Palliative Care Program. Strained healthcare resources limit the opportunity for P.E.I. residents to experience a family-centred home death. Nurse Practitioners (NP) possess the competencies to deliver all domains of care at the end of life and demonstrate increased/improved patient satisfaction, symptom management, and quality of life. The proposed integration of an NP into the P.E.I. Provincial Palliative Care Team will build capacity within existing services to support more opportunity for desired home deaths of palliative care patients