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Anderson H, Brady L, Adamson J. Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice: A qualitative study protocol. J Adv Nurs 2024. [PMID: 38969343 DOI: 10.1111/jan.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
AIM(S) The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice. BACKGROUND One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re-evaluating their professional futures, adjusting work-life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly. DESIGN Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024. METHODS Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30-40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis. DISCUSSION/CONCLUSION This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis. IMPACT What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice. REPORTING METHOD Standards for Reporting Qualitative Research (O'Brien et al., 2014). PATIENT OR PUBLIC CONTRIBUTION As this is a workforce study protocol, there is no patient or public contribution.
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Affiliation(s)
- Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Louise Brady
- National Primary Care Nursing Lead (England), Nursing Directorate, NHS England, Leeds, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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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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Anderson H, Scantlebury A, Galdas P, Adamson J. The well-being of nurses working in general practice during the COVID-19 pandemic: A qualitative study (The GenCo Study). J Adv Nurs 2024; 80:1574-1591. [PMID: 37902132 DOI: 10.1111/jan.15919] [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: 10/31/2023]
Abstract
AIM Exploration of experiences of nurses working in general practice during the COVID-19 pandemic to evaluate the impact on nurses' professional well-being. DESIGN An exploratory qualitative study comprised of case studies of three general practice sites in England and a nationwide interview study of nurses working in general practice and nurse leaders. The study was funded by The General Nursing Council for England and Wales Trust. University of York ethics approval (HSRGC/2021/458/I) and Health Research Authority approval was obtained (IRAS: 30353, Protocol number: R23982, Ref 21/HRA/5132, CPMS: 51834). METHODS Forty participants took part. Case site data consisted of interviews/focus groups and national data consisted of semi-structured interviews. Data collection took place between April and August 2022. Analysis was underpinned by West et al.'s The courage of compassion. Supporting nurses and midwives to deliver high-quality care, The King's fund, 2020 ABC framework of nurses' core work well-being needs. FINDINGS The majority of participants experienced challenges to their professional well-being contributed to by lack of recognition, feeling undervalued and lack of involvement in higher-level decision-making. Some participants displayed burnout and stress. Structural and cultural issues contributed to this and many experiences pre-dated, but were exacerbated by, the COVID-19 pandemic. CONCLUSIONS By mapping findings to the ABC framework, we highlight the impact of the COVID-19 pandemic on the well-being of nurses working in general practice and contributing workplace factors. The issues identified have implications for retention and for the future of nursing in general practice. The study highlights how this professional group can be supported in the future. IMPACT The study contributes to our understanding of the experiences of nurses working in general practice during the COVID-19 pandemic and beyond. Findings have implications for this skilled and experienced workforce, for retention of nurses in general practice, the sustainability of the profession more broadly and care quality and patient safety. REPORTING METHOD Standards for Reporting Qualitative Research (O'Brien et al. in Journal of the Association of American Medical Colleges, 89(9), 1245-1251, 2014). PATIENT OR PUBLIC CONTRIBUTION As this was a workforce study there was no patient or public contribution.
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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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Hong B, Allam A, Heese O, Gerlach R, Gheewala H, Rosahl SK, Stoffel M, Ryang YM, Burger R, Carl B, Kristof RA, Westermaier T, Terzis J, Youssef F, Kuhlen R, Hohenstein S, Bollmann A, Dengler J. Trends in frailty in brain tumor care during the COVID-19 pandemic in a nationwide hospital network in Germany. Eur Geriatr Med 2023; 14:1383-1391. [PMID: 37955830 PMCID: PMC10754727 DOI: 10.1007/s41999-023-00880-0] [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: 06/04/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Among brain tumor patients, frailty is associated with poor outcomes. The COVID-19 pandemic has led to increased frailty in the general population. To date, evidence on changes in frailty among brain tumor patients during the pandemic is lacking. We aimed to compare frailty among brain tumor patients in Germany during the COVID-19 pandemic to the pre-pandemic era and to assess potential effects on brain tumor care. METHODS In this retrospective observational study, we compared frailty among brain tumor patients hospitalized during the COVID-19 pandemic in years 2020 through 2022 to pre-pandemic years 2016 through 2019 based on administrative data from a nationwide network of 78 hospitals in Germany. Using the Hospital Frailty Risk Score (HFRS), frailty was categorized as low, intermediate, or high. We examined changes in frailty, patient demographics, the burden of comorbidity, rates of surgery, and mortality rates for different frailty groups during the pandemic and compared them to pre-pandemic levels. RESULTS Of the 20,005 included hospitalizations for brain tumors, 7979 were during the pandemic (mean age 60.0 years (± 18.4); females: 49.8%), and 12,026 in the pre-pandemic period (mean age: 59.0 years [± 18.4]; females: 49.2%). Average daily admissions decreased from 8.2 (± 5.1) during pre-pandemic years to 7.3 (± 4.5) during the pandemic (p < 0.01). The overall median HFRS decreased from 3.1 (IQR: 0.9-7.3) during the pre-pandemic years to 2.6 (IQR: 0.3-6.8) during the pandemic (p < 0.01). At the same time, the Elixhauser Comorbidity Index (ECI) decreased from 17.0 (± 12.4) to 16.1 (± 12.0; p < 0.01), but to a larger degree among high compared to low frailty cases (by 1.8 vs. 0.3 points; p = 0.04). In the entire cohort, the mean length of stay was significantly shorter in the pandemic period (9.5 days [± 10.7]) compared with pre-pandemic levels (10.2 days [± 11.8]; p < 0.01) with similar differences in the three frailty groups. Rates of brain tumor resection increased from 29.9% in pre-pandemic years to 36.6% during the pandemic (p < 0.001) without differences between frailty levels. Rates of in-hospital mortality did not change during the pandemic (6.1% vs. 6.7%, p = 0.07), and there was no interaction with frailty. CONCLUSION Even though our findings are limited in that the HFRS is validated only for patients ≥ 75 years of age, our study among patients of all ages hospitalized for brain tumors in Germany suggests a marked decrease in levels of frailty and in the burden of comorbidities during the COVID-19 pandemic.
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Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany
| | - Ali Allam
- Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany
| | - Oliver Heese
- Department of Neurosurgery, HELIOS Hospital Schwerin, Schwerin, Germany
| | - Rüdiger Gerlach
- Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Hussain Gheewala
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany
| | - Steffen K Rosahl
- Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Michael Stoffel
- Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery and Center for Spine Therapy, HELIOS Hospital Berlin Buch, Berlin, Germany
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Ralf Burger
- Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
- Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Rudolf A Kristof
- Department of Neurosurgery, HELIOS Hospital Meiningen, Meiningen, Germany
| | | | - Jorge Terzis
- Department of Neurosurgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany
| | - Farid Youssef
- Department of Neurosurgery, HELIOS Hospital Plauen, Plauen, Germany
| | | | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Andreas Bollmann
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Julius Dengler
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany.
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李 毅, 王 聪, 胡 沁, 许 珂, 朱 伟, 蒋 艳. [Problems and Suggested Solutions of Advanced Practice Nursing in Disaster Events]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:741-745. [PMID: 37545067 PMCID: PMC10442633 DOI: 10.12182/20230760104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 08/08/2023]
Abstract
Nurses constitute the largest component of the healthcare workforce and are often the mainstay of disaster management. The leadership, decision-making, and coordination skills that advanced practice nurses possess are of critical value for disaster precision nursing. However, previous studies mostly focused on disaster specialist nurses and emergency or critical care nurses and little attention was directed at advanced practice nurses. In this paper, we reviewed published research and summarized the current status of advanced practice nursing in disaster events. We identified through our analysis the problems in advanced practice nursing, including poor disaster education, a lack of clearly-defined rescue roles, and difficulty in the implementation of practice reform. We suggested solutions, including developing a whole-process and multi-form disaster curriculum, refining rescue tasks from a team perspective, and establishing a system of quality and safety supervision for advanced practice nursing, aiming to provide new ideas for the development of disaster nursing in China.
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Affiliation(s)
- 毅静 李
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 聪 王
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 沁 胡
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 珂 许
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 伟 朱
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 艳 蒋
- 四川大学华西医院护理部/四川大学华西护理学院 (成都 610041)Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
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Zhang H, Wu Y, Wang N, Sun X, Wang Y, Zhang Y. Caregivers' experiences and perspectives on caring for the elderly during the COVID-19 pandemic: A qualitative systematic review. J Nurs Manag 2022; 30:3972-3995. [PMID: 36208194 PMCID: PMC9874760 DOI: 10.1111/jonm.13859] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/19/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
AIMS The goal of this study was to explore caregivers' experiences, perspectives, emotions, knowledge and needs in caring for older people during the COVID-19 pandemic. These included, but were not limited to, experiences in hospital care, home care and nursing home care. BACKGROUND Because of the high mortality rate associated with the COVID-19 pandemic, senior care is critical. During the COVID-19 pandemic, caregivers caring for older people have had unique experiences potentially affecting the quality of care provided. This topic has received substantial attention since the start of the pandemic and has been studied by numerous researchers. However, experiences may differ among countries and time periods. In addition, no qualitative systematic reviews on this topic appear to have been published. EVALUATION In this systematic review of qualitative studies, data were collected from the following electronic databases: PubMed, Web of Science, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Science Direct and PsycINFO. Titles and abstracts were screened according to the inclusion and exclusion criteria, full texts were screened and the methodological quality of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research by two independent reviewers. KEY ISSUE(S) A total of 141 findings were extracted and aggregated into 20 categories; 6 synthesized findings were identified. CONCLUSION This review indicates caregivers' experiences and perceptions regarding caring for older people during the COVID-19 pandemic. The results of a qualitative systematic review show that caregivers' emotions, cognitions and knowledge have affected the quality of caregivers' senior care services during the pandemic. Caregivers caring for older adults should practise self-awareness, understanding their knowledge and attitudes to improve the quality of senior care. Moreover, health care administrators and policymakers should make concerted efforts to cultivate a better working environment. IMPLICATIONS FOR NURSING MANAGEMENT Managers should formulate timely and effective management strategies. During the COVID-19 pandemic, the workload of caregivers has increased, thus requiring better scheduling by managers. Furthermore, managers should consider the negative emotions of caregivers and prevent negative emotions from affecting their work. Besides, virtual technology should be applied to senior care and psychological support be provided for caregivers in this special care setting.
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Affiliation(s)
- Huichao Zhang
- School of NursingNanjing University of Chinese MedicineNanjingJiangsuChina
| | - Yuan Wu
- School of NursingNanjing University of Chinese MedicineNanjingJiangsuChina
| | - Nannan Wang
- School of NursingNanjing University of Chinese MedicineNanjingJiangsuChina
| | - Xuhan Sun
- School of NursingNanjing University of Chinese MedicineNanjingJiangsuChina
| | - Yuqing Wang
- School of NursingNanjing University of Chinese MedicineNanjingJiangsuChina
| | - Yuxi Zhang
- Geriatric Hematology/Radiotherapy Wardthe First Affiliated Hospital of Nanjing Medical University300 Guangzhou RoadNanjingJiangsuChina
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Advanced Practice Nurses Globally: Responding to Health Challenges, Improving Outcomes. Int J Nurs Stud 2022; 132:104262. [PMID: 35633596 PMCID: PMC9040455 DOI: 10.1016/j.ijnurstu.2022.104262] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
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