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Anderson H, Scantlebury A, Galdas P, Adamson J. Remote and technology-mediated working during the COVID-19 pandemic: A qualitative exploration of the experiences of nurses working in general practice (the GenCo Study). J Adv Nurs 2024; 80:1592-1606. [PMID: 37909600 DOI: 10.1111/jan.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
AIM To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. DESIGN Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. METHODS Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. RESULTS Participants continued to deliver a significant proportion of patient care in-person. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. CONCLUSION The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. IMPACT The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. REPORTING METHOD Standards for Reporting Qualitative Research (O'Brien et al., 2014). PATIENT OR PUBLIC CONTRIBUTION This was a workforce study so there was no patient or public contribution. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward.
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Affiliation(s)
- Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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McCabe C, McCann M, Connolly D, McGrath J, Begley J, Ball JC, Harris E. Impact of unscheduled nurse-led virtual care for people with diabetes on nursing practices and patient satisfaction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:236-241. [PMID: 38446518 DOI: 10.12968/bjon.2024.33.5.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic and its social restrictions accelerated the expansion of virtual clinical care, and this has been reported to be safe, low cost and flexible. AIM This study aimed to examine nursing practices and patient satisfaction with unscheduled nurse-led virtual care for people with diabetes. METHODS A cross-sectional descriptive survey of clinical nurse specialists and patients was carried out, using an activities log for nursing practices and a satisfaction and enablement survey for callers. FINDINGS Patients reported high satisfaction levels and greater self-confidence in keeping themselves healthy after receiving virtual care. Most calls (74.8%) from patients were for advice and education. Each call led to an average of 2.5 actions for the clinical nurse specialist. CONCLUSION The service is highly valued and is effective, but adds to the nurse workload burden.
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Affiliation(s)
- Catherine McCabe
- Associate Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret McCann
- Associate Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - David Connolly
- Research Assistant, Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin, Ireland
| | - Jackie McGrath
- Clinical Nurse Specialist Diabetes, Naas General Hospital, Naas, County Kildare, Ireland
| | - Joanne Begley
- Clinical Nurse Specialist Diabetes, Naas General Hospital, Naas, County Kildare, Ireland
| | - Jane C Ball
- Clinical Informatics Nurse, Naas General Hospital, Naas, County Kildare, Ireland
| | - Elaine Harris
- Nurse Practice Development Co-ordinator, Naas General Hospital, Naas, County Kildare, Ireland
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Javanparast S, Roeger L, Reed RL. General practice staff and patient experiences of a multicomponent intervention for people at high risk of poor health outcomes: a qualitative study. BMC PRIMARY CARE 2024; 25:18. [PMID: 38191349 PMCID: PMC10775450 DOI: 10.1186/s12875-023-02256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND This study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant's (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed. METHODS A qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode. RESULTS Interviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding. CONCLUSIONS The multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.
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Affiliation(s)
- Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leigh Roeger
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Govindasamy S, Beek K, Yates K, Jayasuriya R, Reynolds R, de Wit JBF, Harris M. Experiences of overweight and obese patients with diabetes and practice nurses during implementation of a brief weight management intervention in general practice settings serving Culturally and Linguistically Diverse disadvantaged populations. Aust J Prim Health 2023; 29:358-364. [PMID: 36502858 DOI: 10.1071/py22013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/14/2022] [Indexed: 08/15/2023]
Abstract
BACKGROUND To explore the perspectives of overweight and obese patients with diabetes from culturally and linguistically diverse, and disadvantaged backgrounds, as well as practice nurses (PNs) during implementation of a brief PN-supported self-regulation nutrition strategy for weight management in general practice settings serving disadvantaged populations. METHODS During intervention implementation, semi-structured interviews were conducted with 12 patients and four nurses in two general practices located in metropolitan suburbs in Sydney, Australia. RESULTS Patients and PNs found challenges related to cultural expectations and the requirement of patients to set and adhere to dietary change goals and behaviours. Although patients expressed high levels of satisfaction with PNs, the suitability of the intervention to this group was questioned by PNs. Obstacles were also encountered in delivering the intervention in a busy general practice setting. CONCLUSIONS This pilot study provided initial evidence of the acceptability of a self-regulation nutrition intervention for weight management for overweight and obese patients with type 2 diabetes that was delivered by PNs. Cultural expectations of provider-patient roles, the type of intervention and flexibility in the workplace are important future considerations.
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Affiliation(s)
- Sumathi Govindasamy
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Kristen Beek
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Ken Yates
- Western Sydney University, School of Social Sciences, 100 Macquarie Street, Liverpool, NSW 2170, Australia
| | - Rohan Jayasuriya
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Rebecca Reynolds
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - John B F de Wit
- UNSW Sydney, Centre for Social Research in Health, Level 2, Goodsell Building, Kensington, NSW 2052, Australia; and Utrecht University, Department of Interdisciplinary Social Science, PO Box 80140, 3508 TC Utrecht, the Netherlands
| | - Mark Harris
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia; and University of New South Wales, Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, Sydney, NSW 2052, Australia
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Mazza D, Shankar M, Botfield JR, Moulton JE, Chakraborty SP, Black K, Tomnay J, Bateson D, Church J, Laba TL, Kasza J, Norman WV. Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice. BMJ Open 2023; 13:e065137. [PMID: 36948556 PMCID: PMC10040016 DOI: 10.1136/bmjopen-2022-065137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
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Affiliation(s)
- Danielle Mazza
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Mridula Shankar
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica R Botfield
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica E Moulton
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Samantha Paubrey Chakraborty
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
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Gonçalves I, Mendes DA, Caldeira S, Jesus É, Nunes E. The Primary Nursing Care Model and Inpatients' Nursing-Sensitive Outcomes: A Systematic Review and Narrative Synthesis of Quantitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2391. [PMID: 36767759 PMCID: PMC9915435 DOI: 10.3390/ijerph20032391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The delivery of quality, safe, and patient-centered care is foundational for professional practice. The primary nursing model allows nurses to have excellent knowledge about patients and families and to plan and coordinate care from admission to discharge, with better management of health situations. Nurses play a crucial role in improving patients' outcomes, namely those sensitive to nursing care. The knowledge of the relationship between the primary nursing model and the nursing-sensitive outcomes provides new scientific evidence that strengthens the relevance of this nursing care organization model in the inpatients' health outcomes. This systematic review describes the relationship between nurse-sensitive inpatients' outcomes and the primary nursing care model. METHODS A systematic review was conducted with a narrative synthesis, and the following databases were searched: MEDLINE, CINAHL, Web of Science, Nursing & Allied Health Collection, SciELO Collections, and Cochrane. RESULTS A total of 22 full texts were assessed, of which five were included in the study according to the selection criteria. The analysis results indicated that the primary nursing care model was related to nursing-sensitive patient safety outcomes. Patients' experience was also considered a nursing-sensitive outcome, namely in the satisfaction with nursing care. CONCLUSION The negative outcomes are clearly related to the primary nursing care model. There is scarce research that relates primary nursing to positive outcomes, such as patients' functional status and self-care abilities, and more studies are needed.
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Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
- Hospital da Luz Lisboa, Avenida Lusíada, 100, 1500-650 Lisbon, Portugal
| | - Diana Arvelos Mendes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, NURSE’IN-UIESI, Estefanilha, 2910-761 Setúbal, Portugal
| | - Sílvia Caldeira
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
| | - Élvio Jesus
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
| | - Elisabete Nunes
- Escola Superior de Enfermagem de Lisboa, Nursing Research, Innovation and Development Centre of Lisbon, 1600-190 Lisbon, Portugal
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Davidson AR, Reidlinger DP. A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce. Nutr Diet 2022; 79:497-548. [PMID: 35989542 PMCID: PMC9545586 DOI: 10.1111/1747-0080.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
Aim The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care. Methods A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce. Results A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs. Conclusions The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Lukewich J, Martin-Misener R, Norful AA, Poitras ME, Bryant-Lukosius D, Asghari S, Marshall EG, Mathews M, Swab M, Ryan D, Tranmer J. Effectiveness of registered nurses on patient outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:740. [PMID: 35659215 PMCID: PMC9166606 DOI: 10.1186/s12913-022-07866-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
Background Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies. Results Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care. Conclusions This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs’ unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care. Protocol registration ID PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07866-x.
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Yeung S, Perriman D, Chhabra M, Phillips C, Parkinson A, Glasgow N, Douglas KA, Cox D, Smith P, Desborough J. ACT Transition from Hospital to Home Orthopaedic Survey: a cross-sectional survey of unplanned 30-day readmissions for patients having total hip arthroplasty. BMJ Open 2022; 12:e055576. [PMID: 35636791 PMCID: PMC9152933 DOI: 10.1136/bmjopen-2021-055576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify patient, hospital and transitional factors associated with unplanned 30-day readmissions in patients who had a total hip arthroplasty (THA). DESIGN A cross-sectional survey was performed. All patients attending a 6-week follow-up after a THA in the Australian Capital Territory (ACT) at four public and private clinics in the ACT from 1 February 2018 to 31 January 2019, were invited to complete an ACT Transition from Hospital to Home Orthopaedic Survey. PARTICIPANTS Within the ACT, 431 patients over the age of 16 attending their 6-week post-surgery consultation following a THA entered and completed the survey (response rate 77%). PRIMARY OUTCOME MEASURE The primary outcome measure was self-reported readmissions for any reason within 30 days of discharge after a THA. Multiple logistic regression was used to estimate ORs of factors associated with unplanned 30-day readmissions. RESULTS Of the 431 participants (representing 40% of all THAs conducted in the ACT during the study period), 27 (6%) were readmitted within 30 days of discharge. After controlling for age and sex, patients who did not feel rested on discharge were more likely to be readmitted within 30 days than those who felt rested on discharge (OR=5.75, 95% CI: (2.13 to 15.55), p=0.001). There was no association between post-hospital syndrome (ie, in-hospital experiences of pain, sleep and diet) overall and readmission. Patients who suffered peripheral vascular disease (PVD) were significantly more likely to have an unplanned 30-day readmission (OR=16.9, 95% CI: (3.06 to 93.53), p=0.001). There was no significant difference between private and public patient readmissions CONCLUSIONS: Hospitals should develop strategies that maximise rest and sleep during patients' hospital stay. Diagnosis and optimum treatment of pre-existing PVD prior to THA should also be a priority to minimise the odds of subsequent unplanned readmissions.
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Affiliation(s)
- Sybil Yeung
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Research School of Population Health, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumer Association, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- The Trauma and Orthopaedic Resarch Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Loftus Moran O, Casey M, O'Connor L, Cullen W. Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol. HRB Open Res 2022; 5:10. [PMID: 35505692 PMCID: PMC9024129 DOI: 10.12688/hrbopenres.13483.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.
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Affiliation(s)
- Orla Loftus Moran
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- General Practice, Castlebar Family Practice, Castlebar, Ireland
| | - Mary Casey
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Laserina O'Connor
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences, University College Dublin, Dublin, Ireland
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Chhabra M, Perriman D, Phillips C, Parkinson A, Glasgow N, Douglas K, Cox D, Smith P, Desborough J. Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey. BMJ Open 2022; 12:e053831. [PMID: 35410923 PMCID: PMC9003601 DOI: 10.1136/bmjopen-2021-053831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home. DESIGN, SETTING AND PARTICIPANTS A cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders. RESULTS Of the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study. CONCLUSION Reasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems.
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Affiliation(s)
- Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Kirsty Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumers Association, ACT, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Loftus Moran O, Casey M, O'Connor L, Cullen W. Quality care metrics for nurses working in general practice, mapping the evidence: a scoping review protocol. HRB Open Res 2022; 5:10. [DOI: 10.12688/hrbopenres.13483.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands over the past three decades. However, as nursing care in general practice advances at pace, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to carefully assess the role and facilitate development of services are required. Nursing quality care metrics (QCM) are an established mechanism which measure nursing care process, evaluate quality, and impact of care, and inform service development. The use of nursing QCM has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development of QCM within Irish GPN settings. Aim: To explore and map the literature regarding the use, application, and impact of nursing quality care metrics within a general practice, primary care setting. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCM which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about QCM, their use in general practice or primary care settings, and enrich understanding of their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary care in Ireland.
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Chen X, Zhang Y, Qin W, Yu Z, Yu J, Lin Y, Li X, Zheng Z, Wang Y. How does overall hospital satisfaction relate to patient experience with nursing care? a cross-sectional study in China. BMJ Open 2022; 12:e053899. [PMID: 35039296 PMCID: PMC8765024 DOI: 10.1136/bmjopen-2021-053899] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine how patient experience with nursing care influence patient satisfaction with overall hospital services. DESIGN This was a cross-sectional study. SETTING Inpatients were consecutively recruited at the national hospital (with 2000 beds) in Shanghai, China. PARTICIPANTS The inclusion criteria were as follows: (1) hospitalised for 2 days or more; (2) able to read and understand Chinese; and (3) aged 18 years old or above. Patients with mental health problems were excluded. 756 patient surveys distributed among 36 wards were analysed. The mean age of participants in the study was 57.7 (SD=14.5) and ranged from 18 to 80 years. Most participants were men (61.5%) and ever married (94.6%). PRIMARY AND SECONDARY OUTCOME MEASURES Patient experience with nursing care, meaning the sum of all interactions between patients and nurses, was measured using the self-designed questionnaire, which was developed by patient interviews, literature analysis and expert consultation. The overall patient satisfaction question was measured with a 10-point response option ranging from 1 to 10. RESULTS A linear relationship between the patient experience with nursing care and overall patient satisfaction was observed. The patient experience with nursing care was significantly associated with overall satisfaction in the crude model and in the adjusted models. Even after adjusting for six sociodemographic and three disease-related factors, the patient experience with nursing care explained 34.9% of the variation in overall patient satisfaction. CONCLUSIONS This study showed that patient experience with nursing care was an important predictor for overall patient satisfaction.
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Affiliation(s)
- Xiao Chen
- Department of Nursing, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wei Qin
- Department of Nursing, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhenghong Yu
- Department of Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - JingXian Yu
- Department of Liver Disease, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ying Lin
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - XiaoRong Li
- Department of Internal Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zheng Zheng
- Department of Respiratory, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ying Wang
- Department of Internal Medicine, Zhongshan Hospital Fudan University, Shanghai, China
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14
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Morris L, Moule P, Pearson J, Foster D, Walsh N. Patient view of the advanced practitioner (AP) role in primary care: A realist-informed synthesis. Musculoskeletal Care 2021; 19:462-472. [PMID: 33779062 DOI: 10.1002/msc.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Approximately 30% of general practitioner consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat a range of MSKDs, and could provide the first point of contact for primary care patients. There is limited evidence on whether this role is acceptable to patients; however, previous research has explored advanced practitioner (AP) roles in primary care, which could inform this new initiative. AIMS This study used realist synthesis to explore factors that influence patient acceptability of AP roles in primary care. MATERIALS & METHODS: A realist synthesis was undertaken to identify initial programme theories regarding acceptability. Databases were searched to identify relevant literature. Identified studies were subject to inclusion and exclusion criteria, resulting in 38 studies included for synthesis. Theory-specific data extraction sheets were created and utilised. Data were analysed through identifying contexts, mechanisms and outcomes to formulate hypotheses. Hypotheses were validated through consultation with expert stakeholders. RESULTS Eight theory areas were identified that potentially impacted on patient acceptability of the role: patient's prior experience of condition management; patient's expectations of condition management; communication; continuity of the individual practitioner; practitioner's scope of practice; accessibility; professional hierarchy and promoting the role. Nineteen hypotheses on the AP role were developed around these theory areas. DISCUSSION Role acceptabiliy was influenced significantly by context and may change as the role develops, for instance, as waiting times change. CONCLUSION Hypotheses will inform a subsequent realist evaluation exploring the physiotherapy AP role in primary care. Future research is needed to understand the acceptability of first contact physiotherapists delivering certain skills.
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Affiliation(s)
- Leah Morris
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Pam Moule
- Department of Nursing, University of the West of England, Bristol, UK
| | - Jennifer Pearson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Dave Foster
- Patient Research Partner, University of the West of England, Bristol, UK
| | - Nicola Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
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15
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O'Reilly D, Brady AM, Bryant-Lukosius D, Varley J, Daly L, Cotter P, Elliot N, Lehane E, Fleming S, Savage E, Hegarty J, Drennan J. Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey. J Adv Nurs 2021; 77:4279-4289. [PMID: 34449917 DOI: 10.1111/jan.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
AIM The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice. DESIGN Cross-sectional survey; validity and reliability analysis. METHODS The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations. RESULTS A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement. CONCLUSION The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP. IMPACT Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.
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Affiliation(s)
- David O'Reilly
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Jarlath Varley
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Daly
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Cotter
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Naomi Elliot
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Sandra Fleming
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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16
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McKenzie KJ, Fletcher SL, Pierce D, Gunn JM. Moving from "let's fix them" to "actually listen": the development of a primary care intervention for mental-physical multimorbidity. BMC Health Serv Res 2021; 21:301. [PMID: 33794883 PMCID: PMC8017734 DOI: 10.1186/s12913-021-06307-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/22/2021] [Indexed: 01/27/2023] Open
Abstract
Background Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses. Methods A multimethod approach to intervention development involving review and integration of the theoretical principles of Theory of Planned Behavior and the patient-centred clinical skills of motivational interviewing, review of the expert consensus clinical guidelines for multimorbidity, and incorporation of a thematic analysis of group interviews with Australian nurses about their perspectives of what is needed in intervention to support people living with mental-physical multimorbidity. Results Three mechanisms emerged from the review of theory, guidelines and practitioner perspective; the intervention needs to actively ‘engage’ patients through the development of a collaborative and empathic relationship, ‘focus’ on the patient’s priorities, and ‘empower’ people to make behaviour change. Conclusion The outcome of the present study is a fully described primary care intervention for people living with mental-physical multimorbidity, with a particular focus on people living with depression and a physical health condition. It builds on theory, expert consensus guidelines and clinician perspective, and is to be tested in a clinical trial. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06307-5.
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Affiliation(s)
- Kylie J McKenzie
- Department of General Practice, University of Melbourne, Melbourne, Australia.
| | - Susan L Fletcher
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - David Pierce
- Department of Rural Health, University of Melbourne, Ballarat, Australia
| | - Jane M Gunn
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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James S, Halcomb E, Desborough J, McInnes S. Barriers and facilitators to lifestyle risk communication by Australian general practice nurses. Aust J Prim Health 2021; 27:30-35. [PMID: 33222756 DOI: 10.1071/py20139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
Lifestyle risk factors are antecedents to many chronic conditions and are largely modifiable. Health professional support is often sought to reduce lifestyle risk. The ongoing relationship general practice nurses typically have with patients situates them ideally to provide this support. This paper explores the barriers and facilitators to lifestyle risk communication by registered nurses (RNs) in Australian general practice. Fifteen general practice RNs from south-eastern Australia participated in semistructured interviews. Verbatim transcriptions of the audio-recorded interviews were analysed using thematic analysis. Six themes emerged in terms of perceived barriers and facilitators: educational preparation and confidence; organisational and funding arrangements; lifestyle risk prioritisation; organisational support; autonomous roles; and supporting patients' needs. Although communication about lifestyle risk factors is within the general practice nurses' scope of practice, concerted efforts fostering interdisciplinary collaboration, the prioritisation of time, funding and educational opportunities would better support this role, at the same time optimising chronic disease management and patient outcomes.
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Affiliation(s)
- Sharon James
- School of Nursing, University of Wollongong, Auckland Street, Bega, NSW 2550, Australia; and Corresponding author.
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Medicine, Biology and the Environment, Australian National University, 63 Eggleston Road, Acton, ACT 2601, Australia
| | - Susan McInnes
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
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18
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James S, Mcinnes S, Halcomb E, Desborough J. General practice nurses’ communication strategies for lifestyle risk reduction: A content analysis. J Adv Nurs 2020; 76:3082-3091. [DOI: 10.1111/jan.14518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Sharon James
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong Bega Australia
| | - Susan Mcinnes
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Elizabeth Halcomb
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population HealthCollege of Medicine, Biology and the EnvironmentAustralian National University Acton Australia
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19
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Skarbalienė A, Jurgutis A, Strandberg EL, Pawlikowska T. Patient involvement in assessing consultation quality: validation of patient enablement instrument (PEI) in Lithuanian general practice. BMC FAMILY PRACTICE 2019; 20:167. [PMID: 31795934 PMCID: PMC6892019 DOI: 10.1186/s12875-019-1061-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/27/2019] [Indexed: 11/10/2022]
Abstract
Background The Patient Enablement Instrument (PEI) was designed to encapsulate consultation outcome from the perspective that increasing their understanding and coping ability would underpin a positive consultation outcome for patients. The objective of the study was the validation of the PEI in Lithuanian general practice and comparison of Lithuanian patients’ enablement with previous studies in Europe to see if factors associated with patient enablement in Lithuania were reflective of those in the previous studies. Methods The Patient Enablement Instrument was translated into Lithuanian and included in the questionnaire along with the questions about a person’s health, reasons for visiting the doctor and feeling about the consultation. Practices from 4 different municipalities that are situated in different geographical regions which have both town and rural areas were sampled randomly. Patients scheduled consecutively aged 18 years or more were the subjects of the study. The data analyses focused on internal reliability and concept validity. Results The overall mean patient enablement score was 6.43. Enablement scores declined with increasing patient age, and female patients were more enabled. Patients with biomedical problems had the highest enablement results, while patients with complex problems had the lower results. Enablement was positively related to receiving a prescription and knowing a doctor, and negatively related to wish having consultation with another doctor. Conclusions This study substantiates the rationality of using PEI in assessing primary care consultations in Lithuania. The correlations of enablement largely reflect the situation in Western and Central Europe: longer consultation and access to the same physician increases patient enablement.
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Affiliation(s)
- Aelita Skarbalienė
- Faculty of Health Sciences, Klaipeda University, H.Manto, 84, Klaipeda, Lithuania.
| | - Arnoldas Jurgutis
- Faculty of Health Sciences, Klaipeda University, H.Manto, 84, Klaipeda, Lithuania
| | - Eva Lena Strandberg
- Faculty of Medicine, Lund University, Jan Waldenströms gata, 35, Malmö, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI, 123 St. Stephen's Green, Dublin 2, Ireland
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20
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Freilich J, Wiking E, Nilsson GH, Olsson C. Patients' ideas, concerns, expectations and satisfaction in primary health care - a questionnaire study of patients and health care professionals' perspectives. Scand J Prim Health Care 2019; 37:468-475. [PMID: 31724460 PMCID: PMC6883420 DOI: 10.1080/02813432.2019.1684430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Explore the perceptions of patients and health care professionals about patients' ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).Design: Cross-sectional questionnaire study of participants in planned consultations.Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.Subjects: Pairs of patients and GPs (n = 156), patients and DNs (n = 73), and patients and PTs (n = 69).Main outcome measures: Multiple-choice questions about patients' ICE and satisfaction.Results: Approximately 75% of patients and GPs reported that patients' thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.Key pointsPatient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.Health care professionals thought patients' experiences were more negative than they were.This discrepancy was observed in responses to questions about patients' concerns, expectations and satisfaction.
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Affiliation(s)
- Joel Freilich
- Roslags Näsby Health Care Center, Stockholm County Council, Stockholm, Sweden;
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden;
- CONTACT Joel Freilich MMC/System Safety in Health Care, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm 17177, Sweden
| | - Eivor Wiking
- Mörby Academic Primary Health Care Center, Stockholm County Council, Stockholm, Sweden;
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Christina Olsson
- Mörby Academic Primary Health Care Center, Stockholm County Council, Stockholm, Sweden;
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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21
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James S, McInnes S, Halcomb E, Desborough J. Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements. J Adv Nurs 2019; 76:234-242. [DOI: 10.1111/jan.14221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong Bega NSW Australia
| | - Susan McInnes
- School of Nursing University of Wollongong Wollongong NSW Australia
| | | | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University Canberra ACT Australia
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22
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Desborough J, Parkinson A, Korda R, Han J, McManus M, Aung E. The practical use of the Patient Enablement and Satisfaction Model in nurse-led outpatient cardiac clinics. Collegian 2019. [DOI: 10.1016/j.colegn.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Patients' satisfaction with the quality of nursing care in thalassemia units. Appl Nurs Res 2019; 47:46-51. [DOI: 10.1016/j.apnr.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/29/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
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Dawson J, Rigby-Brown A, Adams L, Baker R, Fernando J, Forrest A, Kirkwood A, Murray R, West M, Wike P, Wilde M. Developing and evaluating a tool to measure general practice productivity: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Systems for measuring the performance of general practices are extremely limited.
Objectives
The aim was to develop, pilot test and evaluate a measure of productivity that can be applied across all typical general practices in England, and that may result in improvements in practice, thereby leading to better patient outcomes.
Methods
Stage 1 – the approach used was based on the Productivity Measurement and Enhancement System (ProMES). Through 16 workshops with 80 general practice staff and 72 patient representatives, the objectives of general practices were identified, as were indicators that could measure these objectives and systems to convert the indicators into an effectiveness score and a productivity index. This was followed by a consensus exercise involving a face-to-face meeting with 16 stakeholders and an online survey with 27 respondents. An online version of the tool [termed the General Practice Effectiveness Tool (GPET)] and detailed guidance were created. Stage 2 – 51 practices were trained to use the GPET for up to 6 months, entering data on each indicator monthly and getting automated feedback on changes in effectiveness over time. The feasibility and acceptability of the GPET were examined via 38 telephone interviews with practice representatives, an online survey of practice managers and two focus groups with patient representatives.
Results
The workshops resulted in 11 objectives across four performance areas: (1) clinical care, (2) practice management, (3) patient focus and (4) external focus. These were measured by 52 indicators, gathered from clinical information systems, practice records, checklists, a short patient questionnaire and a short staff questionnaire. The consensus exercise suggested that this model was appropriate, but that the tool would be of more benefit in tracking productivity within practices than in performance management. Thirty-eight out of 51 practices provided monthly data, but only 28 practices did so for the full period. Limited time and personnel changes made participation difficult for some. Over the pilot period, practice effectiveness increased significantly. Perceptions of the GPET were varied. Usefulness was given an average rating of 4.5 out of 10.0. Ease of use was more positive, scoring 5.6 out of 10.0. Five indicators were highlighted as problematic to gather, and 27% of practices had difficulties entering data. Feedback from interviews suggested difficulties using the online system and finding time to make use of feedback. Most practices could not provide sufficient monthly financial data to calculate a conventional productivity index.
Limitations
It was not possible to create a measure that provides comparability between all practices, and most practices could not provide sufficient financial data to create a productivity index, leaving an effectiveness measure instead. Having a relatively small number of practices, with no control group, limited this study, and there was a limited timescale for the testing and evaluation.
Implications
The GPET has demonstrated some viability as a tool to aid practice improvement. The model devised could serve as a basis for measuring effectiveness in general practice more widely.
Future work
Some additional research is needed to refine the GPET. Enhanced testing with a control sample would evaluate whether or not it is the use of the GPET that leads to improved performance.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jeremy Dawson
- Sheffield University Management School, The University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Rigby-Brown
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Lee Adams
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Amanda Forrest
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Kirkwood
- The Medical School, The University of Sheffield, Sheffield, UK
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James S, Halcomb E, Desborough J, McInnes S. Lifestyle risk communication by general practice nurses: An integrative literature review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Sillero Sillero A, Zabalegui A. Satisfaction of surgical patients with perioperative nursing care in a Spanish tertiary care hospital. SAGE Open Med 2018; 6:2050312118818304. [PMID: 30574305 PMCID: PMC6295759 DOI: 10.1177/2050312118818304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care. METHOD A descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica-Oberst Patient Satisfaction Scale (LOPSS-12). RESULTS 150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica-Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe's Content Validity Index was 0.76) and moderate reliability (Cronbach's alpha = 0.70). Two variables-patient sex and the presence of comorbidities-were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses "impatient," but also considered the nurses' advice to be "useful." Patients with hospital-acquired complications were more likely to perceive nurses to be "more interested in completing tasks than in listening," although they also felt that nurses worked "conscientiously." CONCLUSION Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica-Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.
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Affiliation(s)
| | - Adelaida Zabalegui
- Department of Nursing Research and Education, Hospital Clinic of Barcelona, Barcelona, Spain
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27
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Bahr SJ, Weiss ME. Clarifying model for continuity of care: A concept analysis. Int J Nurs Pract 2018; 25:e12704. [DOI: 10.1111/ijn.12704] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah J. Bahr
- College of NursingMarquette University Milwaukee Wisconsin USA
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28
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Frost J, Currie MJ, Cruickshank M, Northam H. Using the lens of enablement to explore patients’ experiences of Nurse Practitioner care in the Primary Health Care setting. Collegian 2018. [DOI: 10.1016/j.colegn.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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Stephen CM, Hermiz OS, Halcomb EJ, McInnes S, Zwar N. Feasibility and acceptability of a nurse-led hypertension management intervention in general practice. Collegian 2018. [DOI: 10.1016/j.colegn.2017.03.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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30
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Desborough J, Phillips C, Mills J, Korda R, Bagheri N, Banfield M. Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement. J Adv Nurs 2017; 74:564-578. [DOI: 10.1111/jan.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Christine Phillips
- Australian National University Medical School; Australian National University; Canberra ACT Australia
| | - Jane Mills
- College of Health; Massey University; Palmerston North New Zealand
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health; Research School of Population Health; Australian National University; Canberra ACT Australia
| | - Nasser Bagheri
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Research School of Population Health; Australian National University; Canberra ACT Australia
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Mohammadipour F, Atashzadeh-Shoorideh F, Parvizy S, Hosseini M. An explanatory study on the concept of nursing presence from the perspective of patients admitted to hospitals. J Clin Nurs 2017; 26:4313-4324. [PMID: 28178371 DOI: 10.1111/jocn.13758] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To clarify the concept of nursing presence through patients' perception. BACKGROUND The holistic caring process at the bedside must incorporate the concept of nursing presence. Most of the research about nursing presence is based on nurses' experiences, and research into patients' experiences is minimal. According to goals of patient centredness, the association between the patient satisfaction and nursing presence, and patients' ability to understand this concept, it is important to explore this concept from the patients' perspective. DESIGN A qualitative approach. METHODS Based on purposive sampling technique, 12 patients were recruited. After participant observation, 15 interviews were carried out with participants. Data were transcribed verbatim and analysed using conventional qualitative content analysis. RESULTS Five main categories were drawn from the data including informed concentration, task-centred/patient-centred relationship, clarification of meanings, comprehensive participation and accountable encounter. Data analysis alongside the authors' reflections resulted in the emergence of one overarching theme, 'coconstructed interaction', which shows the notion that effective nurse-patient interaction enhances cooperation, coordination and collaboration in caring and improves nursing outcomes. CONCLUSIONS Accordingly, the nursing presence would be ideal for patient-centred caring. RELEVANCE TO CLINICAL PRACTICE Knowing the perspectives of patients is important as the evaluation of nursing care quality should rely on outcome indicators that are sensitive to patients. For instance, client satisfaction and health status acceptance, especially as it relates to coping, comfort level, hope, and participation in decision-making, are included in the nursing outcomes' classification system. Thus, the findings of this study may facilitate improvement in the quality of care by continuous improvement in knowledge, attitudes and abilities of nurses. It is therefore recommended that managers and clinical nurses, by relying on these findings, design the caring activities so that nurses' presence can act as a facilitating factor for improving quality assurance.
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Affiliation(s)
- Fatemeh Mohammadipour
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Tehran and Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Nursing Management, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroor Parvizy
- Pediatric Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Department of Community Health Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Desborough J, Banfield M, Phillips C, Mills J. The process of patient enablement in general practice nurse consultations: a grounded theory study. J Adv Nurs 2016; 73:1085-1096. [DOI: 10.1111/jan.13199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Australian National University; Canberra Australia
| | - Christine Phillips
- Social Foundations of Medicine; Australian National University Medical School; Australian National University; Canberra Australia
| | - Jane Mills
- School of Health & Biomedical Sciences; RMIT University; Melbourne Victoria Australia
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