Advanced Practice Nurses and Attending Physicians: A Collaboration to Improve Quality of Care in the Nursing Home

Advanced practice nurses' daily practices delivering primary care to residents in long-term care facilities: a qualitative study

BACKGROUND

Globally, there is a growing shortage of primary care professionals, including those who serve residents in long-term care facilities (LTCFs). In recent decades, numerous new care models have been implemented to improve these residents' care. Many incorporate Advanced Practice Nurses (APNs) into interprofessional healthcare teams. In Switzerland, little is known about how these models function, and few facilities have integrated APNs. This study aims to explore the everyday practice of APNs employed at a medical centre in the Bernese Seeland region delivering care to LTC residents and collaborating with LTCFs staff.

METHODS

This qualitative study uses the "Interpretive Description" methodology, which builds on existing knowledge and examines phenomena interpreted through a social constructivist approach. We conducted six semi-structured individual interviews, one semi-structured focus group interview, and an examination of secondary data. Our thematic analysis followed Braun and Clarke's guidelines for data analysis.

RESULTS

In LTCFs, APNs perform tasks similar to those of primary care physicians, e.g., patient visits and therapy adjustments, within the limits set by their supervising physicians. In addition, they contribute significantly to facility-wide quality improvement. We identified three fundamental elements for successful collaboration between APNs and LTCF staff: 1) clarifying roles and responsibilities; 2) establishing well-defined communication methods and pathways; and 3) building and maintaining trust. Together with LTCF staff, APNs provide multidimensional, person-centred care that focuses on medical, social, and nursing issues with the goal of maintaining the residents' best possible quality of life.

CONCLUSIONS

Our results suggest that integrating APNs into the LTCF care system improves care quality for residents and increases staff members' job satisfaction.

Parent Perspectives of Receiving Early Information About Palliative and End-of-Life Care Options From Their Child's Pediatric Providers

BACKGROUND

Parents of children diagnosed with cancer may experience decision regret about cancer treatment decisions and dissatisfaction with the perceived clarity in information received from their child's providers.

OBJECTIVE

The aim of this study was to describe parental perspectives about receiving an early palliative care and end-of-life (PC/EOL) communication intervention titled "Communication Plan: Early through End of Life Intervention" (COMPLETE) from an interprofessional team of physician and registered nurse providers.

METHODS

Ten parents participated in semistructured interviews after receiving the COMPLETE intervention. The COMPLETE intervention included 3 sessions delivered shortly after diagnosis and at the next 2 cancer treatment evaluations. Sessions of COMPLETE focused on early PC/EOL care discussions at diagnosis and after tumor response evaluations with their child's providers.

RESULTS

Results included 2 theme categories: (1) COMPLETE nurtures realistic hope and meaningful dialogue by parents connecting with healthcare providers as a dyad, and (2) benefits of COMPLETE helped parents to make informed decisions. In addition, there were offered suggestions to improve COMPLETE.

CONCLUSION

The COMPLETE intervention provided a unique mechanism to foster early discussions about PC/EOL options between parents and an interprofessional team during the first 6 months of the child's cancer treatment. Future study is needed using a randomized clinical control-group design to evaluate COMPLETE with a large sample of parents.

IMPLICATIONS FOR PRACTICE

Findings provide promising evidence of parents' preference and receptivity to receive early information about PC/EOL care options for a child with a brain tumor with a poor prognosis. The COMPLETE intervention provided a mechanism to help encourage parental consideration of realistic hoped-for goals for their child's condition and care.

Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care

Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].

Development, validation and testing of a nursing home to emergency room transfer checklist

AIMS AND OBJECTIVES

To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer.

BACKGROUND

Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking.

DESIGN

Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist.

METHODS

Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay.

RESULTS

Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%.

CONCLUSIONS

The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process.

RELEVANCE TO CLINICAL PRACTICE

Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals.

RETRACTED: Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editors-in-Chief. The authors have plagiarized part of a report that had already appeared in Delamaire M-L, Lafortune G. Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries. OECD Health Working Papers No. 54. Paris: Organisation for Economic Co-operation and Development, 2010. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.

Attitudes towards interprofessional collaboration among primary care physicians and nurses in Singapore

Interprofessional collaboration (IPC) has been shown to improve patient outcomes, cost efficiency, and health professional satisfaction, and enhance healthy workplaces. We determined the attitudes of primary care physicians and nurses towards IPC and factors facilitating IPC using a cross-sectional study design in Singapore. A self-administered anonymous questionnaire, based on the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), was distributed to primary healthcare physicians and nurses working in National Healthcare Group Polyclinics (N = 455). We found that the mean JSAPNC score for physicians was poorer than that for nurses (50.39 [SD = 4.67] vs. 51.61 [SD = 4.19], respectively, mean difference, MD = 1.22, CI = 0.35-2.09, p = .006). Nurses with advanced education had better mean JSAPNC score than nurses with basic education (52.28 [SD = 4.22] vs. 51.12 [SD = 4.11], respectively, MD = 1.16, CI = 0.12-2.20, p = .029). Male participants had poorer mean JSAPNC score compared to females (50.27 [SD = 5.02] vs. 51.38 [SD = 4.22], respectively MD = 1.11, CI = 0.07-2.14, p = .036). With regression analysis, only educational qualification among nurses was independently and positively associated with JSAPNC scores (p = .018). In conclusion, primary care nurses in Singapore had more positive attitudes towards IPC than physicians. Among nurses, those with advanced education had more positive attitudes than those with basic education. Greater emphasis on IPC education in training of physicians and nurses could help improve attitudes further.

Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000-2010

OBJECTIVE

To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000-2010.

DATA SOURCES

Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample).

METHODS

NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use.

PRINCIPAL FINDINGS

NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000-2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000-2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000-2010. The impact of state scope-of-practice regulations was mixed.

CONCLUSIONS

NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended.

Nursing home control of physician resources

OBJECTIVE

Physician services are increasingly recognized as important contributors to quality care provision in nursing homes (NH)s, but knowledge of ways in which NHs manage/control physician resources is lacking.

DATA

Primary data from surveys of NH administrators and directors of nursing from a nationally representative sample of 1938 freestanding United States NHs in 2009-2010 matched to Online Survey Certification and Reporting, aggregated NH Minimum Data Set assessments, Medicare claims, and county information from the Area Resource File.

METHODS

The concept of NH Control of Physician Resources (NHCOPR) was measured using NH administrators' reports of management implementation of rules, policies, and procedures aimed at coordinating work activities. The NHCOPR scale was based on measures of formal relationships, physician oversight and credentialing. Scale values ranged from weakest (0) to tightest (3) control. Several hypotheses of expected associations between NHCOPR and other measures of NH and market characteristics were tested.

RESULTS

The full NHCOPR score averaged 1.58 (standard deviation = 0.77) on the 0-3 scale. Nearly 30% of NHs had weak control (NHCOPR ≤1), 47.5% had average control (NHCOPR between 1 and 2), and the remaining 24.8% had tight control (NHCOPR >2). NHCOPR exhibited good face- and predictive-validity as exhibited by positive associations with more beds, more Medicare services, cross coverage, and number of physicians in the market.

CONCLUSIONS

The NHCOPR scale capturing NH's formal structure of control of physician resources can be useful in studying the impact of NH's physician resources on residents' outcomes with potential for targeted interventions by education and promotion of NH administration regarding physician staff.

The Nurse Practitioner and Policy in End-of-Life Care

The focus of this column is the interface between policy and end-of-life care, particularly as provided by advanced nurse practitioners. The complexities of end-of-life along with barriers in practice can diminish quality of life for patients and their families. Changes in policy are needed to enable nurse practitioners their full scope of practice in a way that benefits patients and families at end-of-life. Three areas particularly relevant to policy for nursing practitioners and end-of-life care are addressed: scope of practice, reimbursement, and prescribing practices. Other recommendations for policy and end-of-life care are discussed.

An international survey of nursing homes

This article reports the results of an exploratory survey of nursing home care in 30 countries. Most countries used either a social or nursing home model, with a physician model being less common. Resident Assessment Instruments were used in only 35% of countries. Physician visits to the nursing home occurred in 37%. All but 2 countries used advanced practice nurses. Medication use was high, with 82% of countries reporting residents taking 6 or more medicines a day.

Medical care in the nursing home

With the advent of the graying of the baby boomers, there is an urgent need to enhance care in the nursing home. This article focuses on the areas where high-quality care can improve outcomes.