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Currie J, Carter MA, Lutze M, Edwards L. Preparing Australian Nurse Practitioners to Meet Health Care Demand. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ervin K, Reid C, Moran A, Opie C, Haines H. Implementation of an older person's nurse practitioner in rural aged care in Victoria, Australia: a qualitative study. HUMAN RESOURCES FOR HEALTH 2019; 17:80. [PMID: 31675960 PMCID: PMC6824051 DOI: 10.1186/s12960-019-0415-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/10/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND There are staff shortages nation-wide in residential aged care, which is only predicted to grow as the population ages in Australia. The aged care staff shortage is compounded in rural and remote areas where the health service workforce overall experiences difficulties in recruitment and retention. There is evidence that nurse practitioners fill important service gaps in aged care and rural health care but also evidence that barriers exist in introducing this extended practice role. METHODS In 2018, 58 medical and direct care staff participated in interviews and focus groups about the implementation of an older person's nurse practitioner (OPNP) in aged care. All 58 interviewees had previously or currently worked in an aged care setting where the OPNP delivered services. The interviews were analysed using May's implementation theory framework to better understand staff perceptions of barriers and enablers when an OPNP was introduced to the workplace. RESULTS The major perceived barrier to capacity of implementing the OPNP was a lack of material resources, namely funding of the role given the OPNP's limited ability to self-fund through access to the Medicare Benefits Schedule (MBS). Staff perceived that benefits included timely access to care for residents, hospital avoidance and improved resident health outcomes. CONCLUSION Despite staff perceptions of more timely access to care for residents and improved outcomes, widespread implementation of the OPNP role may be hampered by a poor understanding of the role of an OPNP and the legislative requirement for a collaborative arrangement with a medical practitioner as well as limited access to the MBS. This study was not a registered trial.
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Affiliation(s)
- Kaye Ervin
- University of Melbourne, Melbourne, Australia
| | - Carol Reid
- University of Melbourne, Melbourne, Australia
| | - Anna Moran
- University of Melbourne, Melbourne, Australia
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Nieuwboer MS, van der Sande R, van der Marck MA, Olde Rikkert MGM, Perry M. Clinical leadership and integrated primary care: A systematic literature review. Eur J Gen Pract 2019; 25:7-18. [PMID: 30474447 PMCID: PMC6394325 DOI: 10.1080/13814788.2018.1515907] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/18/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear. OBJECTIVES To review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice. METHODS We systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills. RESULTS Of the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders' relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders. CONCLUSION Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.
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Affiliation(s)
- Minke S. Nieuwboer
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Rob van der Sande
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Faculty of Health, Behaviour and Society, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marjolein A. van der Marck
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Forbes V, Harvey C, Meyer A. Nurse practitioners in aged care settings: a study of general practitioners’ and registered nurses’ views. Contemp Nurse 2018; 54:220-231. [DOI: 10.1080/10376178.2018.1484258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Vicki Forbes
- Eastern Institute of Technology (Hawke’s Bay), 501 Gloucester St, Taradale, Napier 4112, New Zealand
| | - Clare Harvey
- School of Nursing, Midwifery, and Social Sciences, Central Queensland University, Mackay Campus, Mackay, QLD, AUS 4740, Australia
| | - Alannah Meyer
- Eastern Institute of Technology (Hawke’s Bay), 501 Gloucester St, Taradale, Napier 4112, New Zealand
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Dwyer T, Craswell A, Rossi D, Holzberger D. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. BMC Health Serv Res 2017; 17:33. [PMID: 28086869 PMCID: PMC5237281 DOI: 10.1186/s12913-017-1977-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/04/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. METHODS Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. RESULTS Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. CONCLUSIONS This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.
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Affiliation(s)
- Trudy Dwyer
- Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q 4702 Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556 Australia
| | - Dolene Rossi
- Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q 4702 Australia
| | - Darren Holzberger
- Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Q 4770 Australia
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Helms C, Gardner A, McInnes E. Consensus on an Australian Nurse practitioner specialty framework using Delphi methodology: results from the CLLEVER 2 study. J Adv Nurs 2016; 73:433-447. [PMID: 27539007 DOI: 10.1111/jan.13109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework. BACKGROUND Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties. DESIGN This study employed an online three-round modified Delphi method. METHOD Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience (n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties. RESULTS One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation. CONCLUSION A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.
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Affiliation(s)
- Christopher Helms
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Watson, Australian Capital Territory, Australia
| | - Anne Gardner
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, James Cook University, Townsville, Queensland, Australia
| | - Elizabeth McInnes
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia.,Nursing Research Institute SVHA (Syd) & ACU, St Vincents Hospital, Darlinghurst, New South Wales, Australia
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Ahern T, Gardner A, Gardner G, Middleton S, Della P. Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers. NURSE EDUCATION TODAY 2013; 33:470-474. [PMID: 22658374 DOI: 10.1016/j.nedt.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 04/10/2012] [Accepted: 05/01/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The final phase of a three phase study analysing the implementation and impact of the nurse practitioner role in Australia (the Australian Nurse Practitioner Project or AUSPRAC) was undertaken in 2009, requiring nurse telephone interviewers to gather information about health outcomes directly from patients and their treating nurse practitioners. A team of several registered nurses was recruited and trained as telephone interviewers. The aim of this paper is to report on development and evaluation of the training process for telephone interviewers. METHODS The training process involved planning the content and methods to be used in the training session; delivering the session; testing skills and understanding of interviewers post-training; collecting and analysing data to determine the degree to which the training process was successful in meeting objectives and post-training follow-up. All aspects of the training process were informed by established educational principles. RESULTS Interrater reliability between interviewers was high for well-validated sections of the survey instrument resulting in 100% agreement between interviewers. Other sections with unvalidated questions showed lower agreement (between 75% and 90%). Overall the agreement between interviewers was 92%. Each interviewer was also measured against a specifically developed master script or gold standard and for this each interviewer achieved a percentage of correct answers of 94.7% or better. This equated to a Kappa value of 0.92 or better. CONCLUSION The telephone interviewer training process was very effective and achieved high interrater reliability. We argue that the high reliability was due to the use of well validated instruments and the carefully planned programme based on established educational principles. There is limited published literature on how to successfully operationalise educational principles and tailor them for specific research studies; this report addresses this knowledge gap.
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Clark S, Parker R, Prosser B, Davey R. Aged care nurse practitioners in Australia: evidence for the development of their role. AUST HEALTH REV 2013; 37:594-601. [DOI: 10.1071/ah13052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/02/2013] [Indexed: 11/23/2022]
Abstract
Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings. Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required. What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner. There is international evidence that nurse practitioners provide high-quality healthcare. Despite being established in the United States for nearly 50 years, nurse practitioners are a relatively recent addition to the Australian health workforce. What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations. What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.
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