1. Nursing in Contexts of Marginalised Health Conference DCU 2015 ‘Development of practice and career pathways in marginalised health nursing’

2. Definition? Who/What is a Marginalised group? those with no recourse to public funds asylum seekers and refugees care leavers people who experience homelessness (particularly rough sleepers) people living in remote rural areas people with mental health problems people with learning disabilities people with physical disabilities substance mis users

3. Irish travellers, Roma travellers ethnic or religious minorities sex workers non-English speaking linguistic minorities those in severe and persistent poverty migrant workers those in severely deprived neighbourhoods old people men/women suffering domestic violence Prisoners and ex-offenders

4. Health management Outreach and case finding & management Develop trusting non judgemental relationships that conveys compassion, respect, dignity and value Physical & Psychosocial assessment Illicit drug use, risky sexual behaviours Mental health issues Counselling Identify their talents and strengths to enable recovery

5. Nurse led health services Clinical care: working in outreach and case management (direct & indirect) Acting as a liaison between homeless and all others (consultant) Provides screening, prevention, early intervention clinical interventions, medications & health promotion Advocacy : be their voice Care planning, Discharge planning, care pathways

6. Professional Accountability & Scope of Practice The scope of nursing practice is the range of roles, functions, responsibilities and activities which a registered nurse is educated, competent and has authority to perform (ABA 2000).

7. Core Concepts of the CNS/CMS Role 1.Clinical Focus (Direct/Indirect Care) 2.Patient/Client Advocate 3.Education & Training 4.Audit & Research 5.Consultant

8. Criteria for posts The post must arise from an identified health service need The post must have a major clinical focus, incorporating assessment, planning, delivery and evaluation of care given to patients and their families in hospital, community and outpatient settings The post will allow for its holder, in consultation where necessary with the interdisciplinary team, to make clinical decisions based on agreed protocols The post will involve working closely with medical, paramedical and other colleagues

9. Criteria for Posts The post requires that practice should be research and evidenced based and dissemination of research be paramount The post involves participation in nursing/midwifery research and audit The post involves being an advocate for the patient The post involves being a consultant to interdisciplinary colleagues The reporting relationship on professional nursing & midwifery manager

10. Criteria for individual CNS/CMS The person must be a registered nurse or midwife The person must be registered in the division in which the application is being made The person must have extensive experience and clinical expertise i.e. a minimum of 5 years post registration experience including a minimum of 2 years experience in the specialist area The person must provide evidence that they engage in CPD The person must have undertaken formal recognised post- registration education relevant to his/her area of specialist practice at level 8 or above on NQAI framework

11. Identification of Need for CNSp/CMSp Development of job description Submission of application to regional NMPD NMPD reviews application Application sent to ONMSD Patient/client need Service need Inclusion in service Plan to secure funding Role description Level of decision Making Outline case load Scope of Practice Core Competencies Send application form, Job description and person specification Send financial approval form Review by NMPD Does this fit with regional plans? If criteria met Director of NMPD approves, signs and forwards to ONMSD designated Area Director NMPD Review of application by ONMSD Designated Area Directors NMPD details entered in record if criteria met. If details missing or incorrect further information sought via NMPD Director of Nursing/ Midwifery Director of NMPD Service manager Director of Nursing/ Midwifery Service manager Director of Nursing/ Midwifery Service manager Director of NMPDONMSD Process for Approval of a CNSp/CMSp Post Process for Approval of the Person into a Post Advertise approved post according to local policy Director of Nursing/Midwifery ensures individual fulfils all the criteria outlined by the NCNM Director of Nursing/Midwifery Service Manager Submission of application to regional NMPD Send post holder details to NMPD Director of Nursing/Midwifery NMPD reviews application Review of applications by ONMSD Review by NMPD If criteria met Director of NMPD signs and forwards to ONMSD Designated Area Directors NMPD Review application by ONMSD Designated Area Director NMPD Details entered in record if criteria met If details missing or incorrect further information sought via NMPD Director of NMPDONMSD