The Faculty of Nursing of the Universidad de Huelva has acquired the commitment to offer high qualification training that facilitates the labor insertion of its graduates. This master is in line with the successful achievement of this objective.
The proposed specialization profile will facilitate that the students who take the Master's degree can develop the functions of the advanced Nursing role in the field of chronicity and dependence and be able to promote management and clinical strategies for the promotion of health and health. prevention in people suffering from chronic and / or dependency processes, as well as for the sustainability of the health and social care system.
In Europe, there are numerous masters on Advanced Practice Nursing and on Chronicity and Dependence carried out by the different Universities of the Member States.
It is worth noting the development of these programs at the University of Stirling (Scotland, United Kingdom), which has served as a leading institution in this field, with the advice of expert teachers.
In Spain, despite the importance of the phenomenon of chronicity and dependence associated with chronicity and its implications for the planning of services and interventions, Master's studies that address this problem are scarce. The only one that specifically addresses chronicity and associated dependence is the University Master's Degree in Chronicity and Dependence offered jointly by the Autonomous University of Barcelona and the Pompeu Fabra University (https://www.tecnocampus.cat/es/presentacion -Conicity). There are other Masters who deal with dependence, but generally from the perspective of aging (for example, the Master's Degree in Gerontology, Dependence and Protection of the Elderly of the University of Granada; http://masteres.ugr.es/gerontologia/) and of socio-health care specifically (such as the Master's Degree in Social and Health Care for the Unit of the University of Valencia http://www.masterdependencia.es/).
This situation justifies the need to offer a training program such as the one presented, which aims to train professionals who can respond to the needs of people suffering from chronic processes and associated dependence, and their families, from the integrative perspective of the social and health services offered by the advanced nursing role.
Academic, Scientific and Professional Interest
Needs and demands of the population: challenges in the attention to chronicity and dependence.
In recent decades, there has been a significant change in the sociodemographic profile of the population at national and international level, among which the increase in life expectancy and that increases the prevalence of chronic diseases and higher levels of dependence.
The World Health Organization (WHO) in its 2008 report highlights that these changes have important consequences for health services, which are often unable to respond to the current demands of citizens (1).
According to the Andalusian Plan for Integrated Care for Patients with Chronic Diseases (PAAIPEC) (2012-16) prepared by the Junta de Andalucía, 45.6% of the population over 16 in Andalusia suffers from a chronic process and 22%, two or more (2). Similarly, in the last fifty years there has been a progressive increase in the average age of the population, tripling the number of people over 64 (3). In the Andalusian community there were 725 395 people with disabilities, of which 424 921 suffer dependence (58.6%). Of these, it is estimated that 415,667 are 65 years of age or older. The Andalusian population in a potential dependency situation is 8.3%, more than half are in a real dependency situation and 90% are over 64 years old. These situations cause a continuous demand for care, which is coupled with a lower availability of caregivers within the family environment (4).
Addressing the chronicity and dependence associated with it exceeds the traditional limits of health care. The objective must be reoriented towards the needs of adaptation to the environment of dependent people, so that they are able to make their own decisions and develop a vital process as full and satisfactory as possible taking into account their health conditions. Thus, chronicity, beyond chronic disease, must be considered a complex phenomenon that also requires more complex interventions.The Nurses of Advanced Practice: contextualization and historical journey
In this context, and as derived from international trends, in order to achieve agile, efficient and quality healthcare, it is essential to reorient the existing organizational structure and establish the appropriate mechanisms to meet the needs of the population through a redefinition of the professional competences, in terms of training and responsibilities, where Nursing professionals offer great potential to maintain continuous and comprehensive care, especially in the monitoring of chronic processes (5).
The International Nursing Council defined in 2002 Advanced Practice Nursing (EPA) as a university graduate nurse who has acquired expert knowledge, complex decision-making skills and clinical competence to expand their practice, whose characteristics are configured by context and the country in which it is accredited to practice (6). As a level of entry into this professional profile, high-level postgraduate training (master's or doctorate) is recommended, with structured, recognized and accredited training programs and a formal system of regulation, accreditation, registration, certification and credentials. This nurse can develop her functions in the clinical field focused on patient care, management and clinical consulting, management and research. In countries where it has been fully implemented, it is recognized for its advanced and autonomous role, its own management of the patient portfolio, being a consultant within and outside its discipline and even becoming a gateway to the health system (7 , 8).
EPA models are backed by the trajectory of countries such as the USA, Canada, United Kingdom, Australia, Belgium and Ireland, among others, with a broad, although uneven, degree of development. The emergence of these new roles has been conditioned by the historical context of each country, depending on their political-economic, social and health situation. Initially, the EPA emerged as an alternative to the lack of doctors, in response to the growing demands of the population and, more recently, as a formula for the search for more cost-effective organizational systems that guarantee users' accessibility to services Agile, coordinated and quality (9-11).
So, in the US The EPA has been recognized and regularized since 2008, and must have completed an accredited postgraduate training program that trains it for one of the four recognized profiles or levels (7). In the case of Canada, the EPA is considered as an advanced level of clinical nursing practice that obtains the maximum performance from its preparation through degree training; He has a deep knowledge of Nursing and the analysis and synthesis of scientific evidence; integrates the understanding, interpretation and application of the theory and research in Nursing (8); participates in the development and advancement of nursing knowledge and the profession as a whole (12).
In Europe, perhaps the most developed model is the British, whose health system has many similarities with ours. The training of these nurses must be at least master's level and the Royal College of Nursing has proposed standards for educational institutions that offer these degrees (13-15).
In our country, the model of case management nurses is a benchmark for advanced practice nursing, with characteristics common to the models of other countries, although the regulation of their training and performance is currently being considered in some communities like Andalusia (16, 17).
Competence framework and professional performance
The different figures of Advanced Practice Nurses are based on 4 fundamental axes of professional performance: advanced clinical, clinical management, teaching and research (18).
The EPA can act as the user's first contact with the system through telephone assistance, emergency consultations or scheduled consultations for patients with chronic health problems of low complexity or situations that require greater expertise. A large proportion of the clinical-assistance activity of the EPA focuses on health promotion, health education and disease prevention, both opportunistically and in the process of diagnosis and monitoring of chronic diseases.
Within the organizational context, the EPA bases its care model on case management, through which a new care circuit is created that allows referral to other healthcare professionals and vice versa. Likewise, it plays an important role of inter-level coordination and communication, serving as a link between primary care, hospital care and the socio-health field.
The EPA contemplates important teaching work that includes active participation in continuing education together with other team members.
Applied research is an essential element of the EPA. It acts as a facilitator for the introduction of scientific evidence by participating in the interpretation of evidence-based recommendations, the development of clinical practice protocols and guides and the design of quality indicators and standards. In addition, it contributes to the performance of audits and benchmarking , and to the identification of areas of improvement in practice related to patient safety and quality systems.
Contributions of the EPA in the management of the chronic patient and in a situation of dependency
The main contributions of the EPA in the management of patients with chronic health problems and in situations of dependency could be classified into 3 main sections:
The introduction of the EPA has an impact on the follow-up of patients with chronic health problems. There is consensus on improving the control of diabetes and hypertension, and the associated risk factors (19, 20). In respiratory processes, such as chronic obstructive pulmonary disease and asthma, there is a greater control of symptoms and a decrease in exacerbations, although the results are not always conclusive (21-23). Other authors highlight its usefulness and added value in fragile patients or with a high level of dependence (24-25). It should be noted that the EPA in Primary Care shows the ability to respond satisfactorily to the demand, obtaining high levels of satisfaction, together with a more personalized attention, the provision of information and a greater dedication in the time of consultation (26,27 ).
Coordination and teamwork
The EPA extends the traditional limits of professional performance to include advanced clinical aspects, management, leadership, educators, facilitators, trainers, and acts as a patient advocate and interlocutor, dynamic agent and evaluator of quality standards and related aspects with patient safety, providing greater cohesion within the healthcare team.
This new organizational model allows users to improve access to health services through the different entrance doors, and, consequently, potentially reduce the costs derived from the lack of efficiency (11, 28).
Patient satisfaction and quality of services
The systematic review conducted by Horrocks et al. highlights the qualitative and quantitative contributions of the services provided by the EPA in Primary Care (29) in terms of patient satisfaction level, health status, cost and care process.
Relevance of the training proposal
International evidence demonstrates the imperative need to incorporate new EPA models to improve patient care, especially in chronic processes. All countries agree to establish the key points of advanced practice combining advanced clinical knowledge, management and leadership with a scientific basis and adequate training at the master level, as recommended by international organizations.
Therefore, it is necessary to establish training lines that converge with existing regulatory regulations, so that these types of models can be developed that provide better case management in chronicity and dependence, since their contribution to improvement has been demonstrated of health and quality of life of the patients, the improvement of the quality of the services and cost-efficiency of the interventions, a greater cohesion of the care teams and, of course, that all this contributes to the sustainability of the health system and the user satisfaction (30-32).
This master's degree is intended to offer specific training for Advanced Practice Nursing in chronicity and dependence as complex and multidimensional phenomena, which must integrate social and health perspectives in the comprehensive care of the chronic patient and his family. Despite the high prevalence of chronicity mentioned above (2, 3), and that the need for advanced care in chronicity and dependence is reflected in several documents and strategic plans of the Junta de Andalucía (2, 33-35) no There is no Master's Degree in our community that offers comprehensive and specific training in this area. Only the University of Cádiz teaches a master's degree in Advanced Nursing Practice, very oriented to management and research and without specific content in chronicity and dependence.
It is intended, therefore, with this training offer, to respond to the needs of the population, the health system and the health professionals themselves who require advanced skills to provide quality care to people with chronic processes and in situations of dependence (36).
In the development of this proposal, the recommendations on training needs made by International Institutions such as the World Health Organization, the International Nurses Council and the training proposals of international University Institutions (Universities of Southampton and Manchester in the United Kingdom) have been considered and from Sydney in Australia) and Spanish (Universities of Navarra, Madrid, León and Barcelona). The guidelines emanating from the Care Strategy (PICUIDA) of the Ministry of Health of the Junta de Andalucía (2015) (34) and the I Andalusian Plan for the Promotion of Personal Autonomy and Prevention of the Unit of Dependency have also been taken into account the Ministry of Equality and Social Policies (35).
The population to which this master's degree is destined would be mainly composed of graduates of the Bachelor's Degree in Nursing (approximately 120 each year at the Universidad de Huelva ). The semipresencial character of the master's degree would favor the participation of students from other Andalusian universities, from the rest of the state or even international. Currently, the Faculty of Nursing does not have an official master's degree within the postgraduate training offer. The implementation of the proposed master's degree would complement and diversify the offer of official master's degrees at the Universidad de Huelva , particularly in the branch of Health Sciences that only has two degrees at present (General Health Psychology and Occupational Risk Prevention ).
Adaptation of the objectives, orientation of the degree and integration in the studies of Degree and Doctorate.
This Master's proposal supposes, on the one hand, the formative base of an advanced role that is already integrated into the Public Health System of Andalusia (SSPA) and, on the other hand, the necessary research training as a way of access to the Doctorate and the development of greater research training in clinical practice.
Its development would mean giving continuity to the training programs of the Nursing Degree, thus completing the itinerary for the Degree, Master's and Doctorate in Health Sciences of the Universidad de Huelva .
Final Master's Project
The Master's Final Project (TFM) involves the realization, by the students, of a project, report, professional opinion or original study, in which the knowledge, skills and abilities acquired during the teaching period of the master's degree are integrated and developed. , according to its specialized or multidisciplinary nature, and its academic, professional or research orientation.
The TFM is defined as the performance of an original and unpublished work that each student will perform under the guidance of a tutor. It will aim to show that the student has acquired the ability to integrate and develop the knowledge and skills and abilities acquired in the different subjects of the master. The term "original" refers to the fact that it cannot be a plagiarized work, neither partially, nor in its entirety and that it has not been presented before.
The content of the TFM should address issues related to Advanced Practice Nursing or any other aspect of advanced practice in attention to chronicity and dependence or to any of the topics addressed in the Master's subjects, including External Practices.
The modalities or typologies that can be chosen to carry out the TFM are limited to a research protocol or project, an original research or a secondary research or bibliographic review.
It's Master's Thesis consists of a total of 12 ECTS credits and will be developed in the second semester.
It is regulated by the regulations of the Universidad de Huelva and by the regulations of the Faculty that can be consulted here.
It intends the following learning outcomes:
Being able to integrate the skills acquired in the different subjects of the master in the design and planning of a project or scientific work.
Define a search and information management strategy that serves as the basis and foundation of the work.
Apply a scientific methodology in obtaining research results.
Develop capacity for critical analysis and research.
Present and communicate the results and conclusions of the project or scientific work in written and oral form.