New steps in the municipal health care staircase: Educating for new roles and innovative models for treatment and care of frail elders

This study has contributed to the development, implementation and evaluation of new and innovative service models to address the needs of frail elders in the community. Furthermore, the results have informed and strengthened the quality and relevance of the Master's program in advanced geriatric nursing at the University of Oslo, the first of its kind in Norway. The overarching program goal is to contribute to meeting the competence needs in the municipal health care services. Through the collaborative efforts of five municipalities and the Master's program in Advanced Geriatric Nursing at the University of Oslo, we have developed and tested context specific service models, addressing the specific needs of each municipality. Participatory action research and multiple case studies were employed to meet the aims. Local stake holders have participated in developing and testing of the models. Students in the master's program have been part of the delveopmental process, both during the education and after graduation in the collaborating municipalities.

De viktigste virkningene og effektene av prosjektet er utviklingen og utprøvingen av fem lokalt tilpassede kommunale modeller for integrering av Avanserte geriatriske sykepleiere AGer) i de kommunale helse- og omsorgstjenestene. Dette er viktig for kommunalpartnerne i prosjektet. Dette resultater har imidlertid stort potensiale utover de fem partnerkommunene. Fordi prosjektet har bidratt til kontekstuell tilpasning og evaluering av modellene, foreligger det nå et systematisert kunnskapsgrunnlag som andre kommuner kan nyttiggjøre seg når de eventuelt vil integrere AGSer i sine tjenester. I løpet av prosjektperioden har har norske helsemyndigheter besluttet at denne type utdanning skal gjøres tilgjengelig for norske kommuner og har innført spesialistgodkjenning for disse sykepleierne fra 2020. KD har sammen med HOD utformet en nasjonal retningslinje for utdanning av denne typen sykepleiere (kalt avanserte allmennsykepleiere), også godkjent i januar 2020.

This Research and Development (R&D) project comprises the establishment and testing of new service models within the municipal health service. Through collaborative efforts, we plan to develop and test a virtual ward, a communal nursing clinic and other innovative service models for the growing population of sick and frail elders with high utilization of primary and specialist health services. The purpose of these programs is to strengthen health, functioning, self-care and quality of life, particularly among chronically ill elders. The innovation project involves collaboration between five municipalities (Nøtterøy, Eidsberg, Tvedestrand, Nord-Odal, and Bærum) and the Institute of Health and Society (Helsam) at University of Oslo (UiO). The common thread of all the sub-projects is the testing of a new and extended role of clinical nurse specialists (Advanced geriatric nurses), focusing on comprehensive clinical evaluation, health promotion, rehabilitation and care of sick and frail elders. Education for this role, newly established at UiO, is the first of its kind in Norway. It is based on well established, international evidence of effectiveness. However, adjustment and evaluation within the Norwegian context is necessary. The new clinicians work closely with local, multi-professional teams. The project explores effective community-based health services addressing the needs of sick and frail elder. Furthermore, the results from the project informs the develpment of the educational program at the University of Oslo. The partners from the municipalities are actively involved in the evaluation.