Participants and their practice environment

The study took place at an Eye Hospital in Jerusalem. The Hospital is a charitable non-governmental organization that provides eye care to Palestinians living in the West Bank, Gaza and East Jerusalem. In 2014, there were more than 120,000 patients’ visits to the Hospital and more than 5,000 patients underwent sight saving eye operations (St. John Eye Hospital, 2014). The Hospital caters mainly for those who are unable to pay for private eye care.

The Hospital provides inpatients (surgical and medical eye care) and outpatient care in addition to community mobile services. The Hospital has three Satellite Clinics in the north and south of the West Bank and the Gaza Strip. In addition, to its community outreach services, the Hospital also provides eye screening services for diabetic patients in the West Bank.

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Since the year 2000, twelve nurse practitioners have undergone and successfully completed the ONP course at the Hospital and eleven of them remain practicing at the Hospital Group. All were invited to participate in the research and in total the experiences of eight practicing ONPs were explored. Four ONPs participated in the personal

interviews and six participated in the focus group session with two participating in both. All participants are Palestinians who trained as nurses at local universities, expect one participant who trained in Jordan but undertook the eye course before he worked at the hospital and then trained as an ONP. All participants were practicing at the Hospital in the various clinical setting: two had management responsibilities in addition to their clinical practice commitments.

ONPs practice in the primary care clinic, retinal clinic, minor procedures room and the mobile outreach services. At the primary care clinic, ONPs examine patients who self- refer and conduct comprehensive assessment and make diagnosis. Treatment is prescribed by the medical staff due to restrictions imposed by law on nurse prescribing. Patients who attend the primary care clinic are triaged and those who meet the inclusion criteria for management by ONPs are referred to be managed by ONPs and the remaining patients are directed to ophthalmologists working in the department. In the retinal unit, all patients who attend the clinic have prior appointments. When patients call at the clinic, ONPs workup patients and carry out primary examinations and procedures before patients are briefly seen by ophthalmologists who make final decisions and plans of care. No treatment or prescribing takes place in the retinal unit by the ONPs. On the mobile outreach

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comprehensive assessment, diagnosis and plan of treatment for patients. Prescriptions for patients are the responsibility of the ophthalmologists. In the minor procedure room, patients are referred to the ONP by ophthalmologists. Patients who need to undergo minor surgery are invited by the medical staff to give consent and are operated on by ONPs. The ONPs undertake procedures such as minor lid surgeries, removal of corneal foreign bodies and removal of corneal sutures. No prescribing is carried out by the ONPs in this department either. Figure 5.1 summarizes the roles of ONPs in the various

departments.

Figure 5.1: roles of the ONPs in the various setting of their practice.

All ONPs underwent the ophthalmic nursing course to become specialist

ophthalmic staff nurses at the hospital. Senior ophthalmic staff nurses are then eligible to

Primary care clinic

Patients’ assessment, ordering of diagnostic tests, patient management and or referral to ophthalmologists and health education/promotion.

No prescribing or discharging patients.

Outreach services

Patients’ assessments, ordering of diagnostic tests, patient management, referral to ophthalmologists, health education/promotion.

Minor procedures room

Lid surgery, removal of foreign bodies, removal of sutures, minor ophthalmic procedures

No prescribing or discharging patients.

Retinal unit

Patients’ assessment, ordering of diagnostic tests, referral to ophthalmologists and health education/promotion.

No prescribing or discharging patients.

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undertake the ONP course. Figure 5.2 explains the various ophthalmic training conducted at the Hospital.

Figure 5. 2: training nurses undergo prior to becoming Ophthalmic Nurse Practitioners.

All the practitioners are registered nurses, some with post graduate degrees. Most of the ONPs worked at the Hospital for more than 15 years prior to their enrolment on the

Senior ophthalmic staff Nurse

Staff Nurse with ophthalmic specialty (ophthalmic Staff nurses).

Qualified general staff nurse and student ophthalmic nurse who undertake the eye specialty course to become ophthalmic staff nurses

Ophthalmic Nurse Practitioner course

Unregistered nurses with extensive ophthalmic experience

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ONP course. Only one ONP worked at the hospital for 8 years prior to his training as an ONP. Table 5.1 provides a summary of profiles for participants’ experience.

Table 5.1: Summary of profiles for practicing ONPs

Participant Qualifications Years of nursing experience

Area of practice

1 BSN, MA 18 Primary care clinic

2 BSN 20 Retinal unit

3 BSN 27 Outreach

4 BSN 13 Outreach

5 BSN 16 Primary Care and

management

6 BSN 19 Retinal unit and

management

7 BSN , MA 8 Minor Surgical Room

8 BSN 14 Primary care

The variation in the participants experience and profile provides an opportunity to explore the various views and experiences with regards to the evolution ONPs role in Palestine. In addition, participants work in the four areas of practice for ONPs at the Hospital which provides a wide range of experiences and views with regard to the role development and management. The remaining three ONPs who did not participate in this study fall into similar profile description especially with regards to qualifications and also their experience.

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