Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey

The emerging role of a Stroke Clinical Nurse Specialist (CNS) in Early Supported Discharged: Developing a pathway for stroke nursing for secondary prevention in the community. A scoping review protocol

Background

Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention.

Objective

The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting.

Methods

We will conduct a scoping review in accordance with the Arksey and O'Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted.

Conclusions

This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

A Qualitative Analysis of the Functions of Primary Care Nurses in COVID-19 Vaccination

AIM

To describe vaccination roles of primary care nurses during the COVID-19 pandemic in Canada.

DESIGN

This analysis was part of a larger mixed-methods case study.

METHODS

We conducted semi-structured qualitative interviews from May 2022 to January 2023 with primary care nurses across four provinces: British Columbia, Ontario, Newfoundland and Labrador, and Nova Scotia. We asked participants to describe their roles during various stages of the pandemic, facilitators and challenges encountered and possible roles that nurses could have played. We used thematic analysis and analysed codes relevant to vaccination.

RESULTS

We interviewed a total of 76 nurses and identified four key functions of primary care nurses' roles in COVID-19 vaccination: (1) education, (2) vaccine administration, (3) outreach and (4) advocacy. Themes outlined nurses' roles with respect to patient education, addressing vaccine hesitancy, partaking in vaccination roles outside of regular primary care practice and supporting accessibility in COVID-19 vaccination. Specific tasks varied by nursing professions.

CONCLUSION

Primary care nurses fostered trust through existing patient-provider relationships to enhance roles and activities related to education, outreach and advocacy in COVID-19 vaccination. Some COVID-19 vaccine-related roles were more easily integrated into primary care, whereas others competed with routine primary care roles.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Findings highlight the vital contributions of primary care nurses towards COVID-19 vaccination efforts in Canada. Leveraging nursing expertise can enhance future pandemic response efforts and improve patient care by addressing barriers to vaccination and promoting equitable access to vaccination services.

IMPACT

This study addresses a knowledge gap by describing the vaccination-related roles of primary care nurses during the pandemic. Findings illustrate that nurses demonstrated adaptability through their engagement in vaccine education, administration, outreach and advocacy. This research informs resource allocation, policy development and workforce planning for future vaccination efforts during a pandemic response.

REPORTING METHOD

The authors have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines included in the Empirical Research Qualitative reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides insight into the pivotal roles of primary care nurses during the COVID-19 vaccination efforts in Canada, highlighting their diverse contributions towards education, vaccine administration, outreach and advocacy. Offers implications for future pandemic planning by informing resource allocation, policy development and workforce planning for vaccination efforts.

People with Multiple Long-Term Health Problems: Personalized Care Planning

Background

The personalized care planning is a collaborative process used in managing long-term health conditions when the person and health professionals identify and discuss problems caused by or related to the health condition and develop a plan to address them.

Objective

The aim of the study was to map the evidence on the impact of personalized care planning management on health outcomes in persons with multiple long-term health problems in the community.

Methods

Scoping review was based on the Joanna Briggs Institute protocol; the search strategy was carried out in platforms and databases online; the participants are adults, with chronic disease or long-term health conditions, in the period from 2016 to 2021, in English, Spanish, and Portuguese; the exclusion criteria included studies of adults with dementia and intellectual disability; 22 studies were obtained. We applied critical appraisal, and two independent reviewers performed data extraction; data synthesis was performed in narrative form.

Results

Nursing interventions, the strategies used by nurses, and the production of health gains (maintaining the level of health and well-being) promoted by nurses through the proper management of personalized care planning were identified.

Conclusions

Nurses develop a wide range of interventions, using various strategies that promote health gains through the proper management of personalized care planning.

Contributions to the Practice

Personalized care planning focuses on people with multimorbidity, and the health gains reduce, also, the nurses' workload.

Redeployment Among Primary Care Nurses During the COVID-19 Pandemic: A Qualitative Study

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area.

Chronic Disease Management in a Nurse Practitioner-Led Clinic: An Interpretive Description Study

Introduction

Nurse practitioner-led clinics (NPLC) represent a model of care that has the potential to enhance primary healthcare delivery to community-dwelling adults who are living with chronic disease by providing greater access and continuity of care and reducing the burden on acute care settings. However, there is limited understanding of nurse practitioners' experiences and perspectives on supporting adults in chronic disease management within an NPLC model of care. Increased understanding would contribute to our ability to evaluate the effectiveness of the NPLC model of care for chronic disease management.

Objective

This study explored current chronic disease management practices implemented by nurse practitioners within NPLC throughout the Province of Ontario.

Methods

A qualitative study was implemented using interpretive description. In-depth interviews were conducted between January 2021 and May 2021 with nurse practitioners who were practicing within NPLCs across Ontario. Data was analyzed using thematic analysis.

Results

Eleven interviews were completed with nurse practitioners who provided care to community-dwelling adults who were managing chronic disease in a range of geographic settings. Resultant themes included: the nurse practitioner role in bridging access to patients who fall between the cracks, benefits of interprofessional care, meeting a patient where they are at, and addressing healthcare system burden.

Conclusion

Results suggest that NPLCs are well-positioned to support community-based patients living with chronic disease through provision of on-site interprofessional care, continuity in service provision and increased access to primary healthcare services. This article provides insights into the nurse practitioner led primary healthcare model and how it can facilitate access to services, foster patient self-management and provide a successful alternative model of care.

Experiences in the training of specialist family and community nurses: a qualitative study

Introduction

The specialist Family and Community Nurse Practitioner (FCNP) is a professional who, after a period of training, is qualified to be part of multidisciplinary teams in primary care. The aim of this study was to describe and understand the experiences of nurses during their training process in the specialty of Family and Community Nursing in Spain.

Methods

A descriptive qualitative study was carried out. Participants were recruited by means of convenience sampling from January to April 2022. Sixteen specialist nurses in Family and Community Nursing from different autonomous communities in Spain participated in the study. Twelve individual interviews and one focus group were conducted. Data were analyzed following a thematic analysis method in ATLAS.ti 9.

Results

The results showed two themes and six subthemes: (1) Residency period, more than a training: (a) Training during the residency period; (b) Specializing through a constant struggle; (c) Moderate optimism about the future of the specialty; and (2) A journey from illusion to disappointment: (a) Beginning of the residency: feeling special; (b) During the residency: between satisfaction and misunderstanding; (c) At the end of the residency: power and frustration.

Conclusions

The residency period is important in the training and acquisition of competencies for the Family and Community Nurse Practitioner. Improvements are needed to ensure quality training during residency and to help give visibility to the specialty.

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

BACKGROUND

Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care.

METHODS

A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken.

RESULTS

Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support).

CONCLUSIONS

The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs.

PROTOCOL REGISTRATION ID

PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767 .

Associations of primary care workforce composition with population, professional and system outcomes: retrospective cross-sectional analysis

Background: Diversification of types of staff delivering primary care may affect professional, population and system outcomes. Aim: To estimate associations between workforce composition and outcomes. Design and Setting: Cross-sectional analysis of 6210 GP practices in England in 2019. Method: Multivariable regression analysis relating numbers of staff in four groups (GPs; Nurses; Health Professionals; and Health Associate Professionals) to patient access and satisfaction, quality of clinical care and prescribing, use of hospital services, GP working conditions, and costs to National Health Service. Results: More GPs were associated with higher satisfaction for patients and GPs, More workers of other types had opposite associations with these outcomes. More Nurses and Health Associate Professionals were associated with lower cost per prescription but more prescribing activity. More GPs were associated with higher costs per prescription and lower use of narrow-spectrum antibiotics. Except for Health Associate Professionals, more staff were associated with more hospital activity. Higher NHS costs were associated most with more Nurses and least with more Health Professionals. The effects of different staff types on outcomes were largely independent. Conclusion: Professional, population and system outcomes show a variety of associations with primary care workforce composition. More Nurses are associated with lower quality in some aspects and higher costs and activity. More Health Professionals and Health Associate Professionals associates less than additional GPs with higher costs, but is associated with lower patient and GP satisfaction.

Family Practice Nursing in Newfoundland and Labrador: Are Reported Roles Reflective of Professional Competencies for Registered Nurses in Primary Care?

Background

Family practice nurses are Registered Nurses who work collaboratively in primary care and deliver a range of services. Professional competency statements have been developed to describe the skills and knowledge of family practice nurses as a distinct field.

Purpose

We conducted a secondary analysis of qualitative interview data to examine how family practice nurse roles/activities relate to recently developed professional competencies.

Methods

Family physicians and family practice nurses in Newfoundland and Labrador (NL) participated in semi-structured interviews, during which they discussed roles/activities and scope of practice surrounding family practice nursing. For this secondary analysis, we used competency statements to inform thematic coding of the transcribed interviews.

Results

For the initial study, a total of 8 participants (5 family practice nurses; 3 family physicians) were interviewed from diverse practices. All transcripts from the original study (n = 8) were included in the secondary analysis and analysed across 47 competencies encompassing 6 domains (Professionalism; Clinical Practice; Communication; Collaboration and Partnership; Quality Assurance, Evaluation and Research; Leadership). Roles/activities reported by participants were reflective of the competencies, but with substantial variation in expression.

Conclusions

Family practice nursing competency statements reflect the actual activities of family practice nurses in NL. The professional competencies can serve as a framework to examine contributions of family practice nurses and identify areas warranting further training. The use of competencies to explore family practice nurses' roles and activities can assist with optimizing scope of practice.

National Competencies for Registered Nurses in Primary Care: A Delphi Study

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% (n = 86/137) of participants and 84% (n = 72/86) of these participants completed the second survey. Most statements (n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

A qualitative study exploring the influence of clinic funding on the integration of family practice nurses in Newfoundland and Labrador

AIM

This study explores the contributions of family practice nurses in primary care across Newfoundland and Labrador funded by fee-for-service and alternate payment plans to examine the influence of funding arrangements on nursing roles/activities.

DESIGN

A qualitative descriptive design was employed.

METHODS

Semi-structured telephone interviews were conducted between March-July 2018 with physicians and Registered Nurses working in primary care settings in Newfoundland and Labrador. Interviews were transcribed verbatim, and a content analysis approach was used to identify recurring themes.

RESULTS

Clinic funding was instrumental in the integration of family practice nurses into primary care settings and influenced roles/activities. In fee-for-service practices, nurses work with physicians and focus on one-on-one patient care in office-based settings, whereas nurses in alternate payment plans practices work more independently, in a wider range of settings and with emphasis on both individual and group-based encounters. Compared with alternate payment plans practices, fee-for-service practices tend to be more restrictive due to physician billing requirements.