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Moulton JE, Arefadib N, Botfield JR, Freilich K, Tomnay J, Bateson D, Black KI, Norman WV, Mazza D. A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers. J Adv Nurs 2024. [PMID: 38953531 DOI: 10.1111/jan.16299] [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: 01/09/2024] [Revised: 05/17/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
AIM To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. DESIGN Co-design methodology informed by the Experience-Based Co-Design Framework. METHODS Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. RESULTS Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. CONCLUSION Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. IMPACT Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. REPORTING METHOD Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. PATIENT OR PUBLIC CONTRIBUTION Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Noushin Arefadib
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Karen Freilich
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy V Norman
- Department of Family Practice, 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
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nieuwboer M, Van der Sande R, Olde Rikkert M, Van der Marck M, Perry M. Clinical leadership training in integrated primary care networks: a qualitative evaluation. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo explore how a clinical leadership training programme contributes to successful implementation of integrated dementia care in local primary care networks.Methods and analysisA qualitative design was used in local primary care networks in the Netherlands. Twenty-six primary care professionals, nurses (n=22), general practitioners (n=2) and occupational therapists (n=2) followed a 2-year practice-based educational programme including individual coaching and interactive group training. Embedded leadership training created opportunities for direct application of acquired leadership skills. Reports of coaching sessions and transcripts of semi-structured interviews with 20 leadership trainees, 8 network members and a focus group interview with 9 leadership trainees were thematically analysed.ResultsThey identified 50 learning goals, mostly associated with personal leadership competences. These professionals perceived some improvement in their leadership behaviour and preferred a duo-network leadership arrangement. Individual coaching sessions and group training sessions were perceived as fruitful support. Coaching sessions were found to facilitate learning processes regarding personal competencies, collaboration issues and role clarification. Group meetings were appreciated for exercises on transformational leadership behaviour and exchange of experiences. Network leaders and members observed improved quality of care and mentioned continuity of leadership, perseverance of leaders and a sufficient time period to bring about change as important facilitating factors.ConclusionClinical leadership training to stimulate integrated primary care is promising as it was positively valued and contributed to improved perceived leadership competencies. Network leaders and members experienced improved quality of care when at least continuity in leadership was warranted.
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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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Perez D, Murphy G, Wilkes L, Peters K. One size does not fit all - overcoming barriers to participant recruitment in qualitative research. Nurse Res 2022; 30:24-30. [PMID: 34989213 DOI: 10.7748/nr.2022.e1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND It can be challenging to recruit participants for qualitative research. Recruitment can be affected by factors such as systemic barriers, as well as potential participants being reluctant to enrol in research they view as time-consuming and burdensome - particularly research exploring sensitive topics. AIM To analyse and describe the implementation of multiple recruitment strategies used to overcome the recruitment barriers in a qualitative study exploring the use of physical restraints during mechanical ventilation in intensive care. DISCUSSION Recruitment strategies that are helpful for one study may not be successful in another. Qualitative researchers may face many recruitment challenges specific to the contexts of their studies. Overcoming these challenges can be costly, time-consuming and often frustrating, so it is important that researchers develop qualities and skills that enable them to navigate these barriers. CONCLUSION Nurse researchers must consider the contexts of their target populations and tailor their recruitment strategies to the populations' needs. They must also be flexible, innovative and persistent in their approach, despite the challenges they face. IMPLICATIONS FOR PRACTICE This paper provides insights into the recruitment barriers faced during a qualitative study and possible solutions. These insights can guide nurse researchers facing similar challenges in qualitative research.
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Affiliation(s)
- Dawn Perez
- Western Sydney University, Campbelltown, NSW, Australia
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW, Australia
| | - Lesley Wilkes
- School of Nursing, Western Sydney University, Campbelltown, NSW, Australia
| | - Kath Peters
- Western Sydney University, Campbelltown, NSW, Australia
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Vrijmoeth T, Wassenaar A, Koopmans RTCM, Nieuwboer MS, Perry M. Generalist-Specialist Collaboration in Primary Care for Frail Older Persons: A Promising Model for the Future. J Am Med Dir Assoc 2021; 23:288-296.e3. [PMID: 34973166 DOI: 10.1016/j.jamda.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The complex care needs of frail older persons living at home is a major challenge for health care systems worldwide. One possible solution is to employ a primary care physician (PCP) with additional geriatric expertise. In the Netherlands, elderly care physicians (ECPs), who traditionally work in nursing homes, are increasingly encouraged to utilize their expertise within primary care. However, little is known about how PCPs and ECPs collaborate. Therefore, we aimed to unravel the nature of the current PCP-ECP collaboration in primary care for frail older persons, and to identify key concepts for success. DESIGN A qualitative multiple case study with semistructured interviews. SETTING AND PARTICIPANTS A selection of 22 participants from 7 "established collaboration practices" within the primary care setting in the Netherlands, including at least 1 ECP, 1 PCP, and 1 other health care professional for every included established collaboration practice. METHODS Transcripts of individual interviews were analyzed using largely double and independent open and axial coding, and formulation of themes and subthemes. RESULTS Data analysis revealed 4 key concepts for success: (1) clarification of roles and expectations (ie, patient-centered care and embedding in existing care networks), (2) trust, respect, and familiarity as drivers for collaboration (ie, mutual trust through knowing each other and having shared goals); (3) framework for regular communication (ie, structural meetings and a shared vision); and (4) government, payer, and organization support (ie, financial support and emphasis on the collaboration's urgency by organizations and national policy makers). CONCLUSIONS AND IMPLICATIONS For a successful generalist-specialist collaboration, health care professionals need to invest in building relationships and mutual trust, and incorporating their efforts in the existing care networks to guarantee patient-centeredness. When provided with reimbursement and appreciation, this collaboration is a promising change in general practice to improve the care and outcomes of frail older persons.
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Affiliation(s)
- Talitha Vrijmoeth
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Annelies Wassenaar
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands; Radboudumc Alzheimer Centre, Radboud university medical center, Nijmegen, the Netherlands; Joachim en Anna Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Minke S Nieuwboer
- Radboudumc Alzheimer Centre, Radboud university medical center, Nijmegen, the Netherlands; Academy of Health and Vitality, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands; Radboudumc Alzheimer Centre, Radboud university medical center, Nijmegen, the Netherlands; Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
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Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis. Healthcare (Basel) 2021; 9:healthcare9121674. [PMID: 34946398 PMCID: PMC8701295 DOI: 10.3390/healthcare9121674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan’s first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians’ contexts, interprofessional collaboration, involvement in nurses’ work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.
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Karam M, Macq J, Duchesnes C, Crismer A, Belche JL. Interprofessional collaboration between general practitioners and primary care nurses in Belgium: a participatory action research. J Interprof Care 2021; 36:380-389. [PMID: 34382494 DOI: 10.1080/13561820.2021.1929878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the sociodemographic challenges facing the Belgian primary care system, it is essential to strengthen interprofessional collaboration (IPC) between healthcare providers. Therefore, our aims for this study were to assess IPC between general practitioners (GPs) and nurses; identify target priorities for improving IPC; and facilitate the planning and implementation of the proposed improvement strategies. Based on diversity criteria, six groups of GPs and nurses were chosen for a participatory action research. Participants performed a SWOT analysis of their IPC to identify strengths and weaknesses of their collaboration practice configurations. Main factors limiting IPC were related to the type of financing system which impeded or facilitated multidisciplinary team meetings, a weak functional integration, and a lack of interprofessional education. Overall, communication and task delegation were co-identified as common priorities. Actions prioritized by each group were related to these two priorities and accounted for local, specific needs. Communication could be supported through improved tools and dedicating time for multidisciplinary team meetings. Task delegation was more challenging and raised questions related to nurses' training, legislation, and payment systems. IPC seems to be easier to achieve when healthcare professionals belong to the same organization and consider themselves a team.
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Affiliation(s)
- Marlène Karam
- Université catholique de Louvain, Faculty of Public Health, Institute of Health and society, Brussels, Belgium
| | - Jean Macq
- Université catholique de Louvain, Faculty of Public Health, Institute of Health and society, Brussels, Belgium
| | | | - André Crismer
- Université de Liège, Department of Family Medicine, Liège, Belgium
| | - Jean-Luc Belche
- Université de Liège, Department of Family Medicine, Liège, Belgium
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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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Halcomb E, Bird S, Mcinnes S, Ashley C, Huckel K. Exploring job satisfaction and turnover intentions among general practice nurses in an Australian Primary Health Network. J Nurs Manag 2020; 29:943-952. [PMID: 33306862 DOI: 10.1111/jonm.13230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
AIM To explore the job satisfaction and turnover intentions of general practice nurses and examine factors that influence job satisfaction and turnover intention. BACKGROUND Workforce issues such as satisfaction, retention and turnover intention have been explored in acute care. However, increasingly nurses are being employed outside hospitals. General practice is a significantly different work environment to acute care. Understanding workforce issues in community settings is important for employers, managers and policymakers to sustain and grow this workforce to meet consumer demands. METHOD A descriptive survey was conducted within a single Primary Health Network in Australia. RESULTS Having an identified practice nurse leader/manager, feeling that their training and qualifications are used to the full and not feeling isolated, alone or lacking opportunities for mentoring were all significantly correlated with higher job satisfaction. The lowest average satisfaction scores related to pay. 44.9% of participants were unsure whether they would remain working in general practice. The relationship between total job satisfaction and intention to leave was significant. CONCLUSION These findings guide managers in developing strategies to recruit and retain nurses in general practice employment. IMPLICATIONS FOR NURSING MANAGEMENT Managers must consider factors influencing job satisfaction and turnover intention to maximize recruitment and retention of nurses.
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Affiliation(s)
- Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Sonia Bird
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Susan Mcinnes
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Christine Ashley
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Karen Huckel
- South Western Sydney Primary Health Network, Campbelltown, NSW, Australia
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Swaithes L, Dziedzic K, Finney A, Cottrell E, Jinks C, Mallen C, Currie G, Paskins Z. Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework. Implement Sci 2020; 15:95. [PMID: 33115490 PMCID: PMC7594414 DOI: 10.1186/s13012-020-01055-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023] Open
Abstract
Background Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation. Methods This study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5–8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results. Results In operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. ‘Instinctive facilitation’ may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation. Conclusion This theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01055-2.
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Affiliation(s)
- Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Clare Jinks
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian Mallen
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Graeme Currie
- Entrepreneurship & Innovation, Organising Healthcare Research Network, Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
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Nieuwboer MS, van der Sande R, Maassen ITHM, Olde Rikkert MGM, Perry M, van der Marck MA. Communication between Dutch community nurses and general practitioners lacks structure: An explorative mixed methods study . Eur J Gen Pract 2020; 26:86-94. [PMID: 32648497 PMCID: PMC7470078 DOI: 10.1080/13814788.2020.1782883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Community nurses and general practitioners evaluate their patient-related communication to be poor. However, their actual communication has hardly been investigated and specific strategies for improvement are unclear. Objectives To explore actual community nurse-general practitioner communication in primary care and gain insights into communication style, and conversation structure and their determinants. Methods A mixed-methods design was applied. Telephone conversations between community nurses and general practitioners in the Netherlands were recorded and transcribed verbatim. We measured structure and the duration of their conversations, and community nurses’ self-confidence towards general practitioners and their trust in and familiarity with the conversation partner. A thematic analysis was applied to the transcripts of the conversations. Correlations between these determinants were calculated using Spearman’s correlation coefficient. Results The 18 community nurses recorded 23 conversations with general practitioners. Qualitative analysis revealed that many conversations lacked structure and conciseness, i.e. the nurses started conversations without a clearly articulated question and did not provide adequate background information. The mean duration of their conversations with doctors was 8.8 min. Community nurses with higher self-confidence towards doctors communicated in a more structured way (p = 0.01) and general practitioners were more satisfied about the conversations (p = 0.01). Conclusion This exploratory study of actual community nurse-doctor telephone conversations in primary care identified communication structure and nurse self-confidence towards general practitioners as key targets for the improvement of interprofessional communication, which may increase the effectiveness of community nurse-general practitioner collaboration.
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Affiliation(s)
- Minke S Nieuwboer
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Rob van der Sande
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical centre, Nijmegen, The Netherlands.,Faculty of health, behaviour and society, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Irma T H M Maassen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud university medical centre, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical centre, Nijmegen, The Netherlands
| | - Marjolein A van der Marck
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud university medical centre, Nijmegen, The Netherlands
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Sørensen M, Groven KS, Gjelsvik B, Almendingen K, Garnweidner-Holme L. The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice. Scand J Prim Health Care 2020; 38:12-23. [PMID: 31960746 PMCID: PMC7054922 DOI: 10.1080/02813432.2020.1714145] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.
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Affiliation(s)
- Monica Sørensen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway;
- CONTACT Monica Sørensen Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Karen Synne Groven
- Faculty of Health Sciences, Department of Physiotherapy, OsloMet University, Oslo, Norway;
| | - Bjørn Gjelsvik
- Department of General Practice, Institute for Health and Society, University of Oslo, Oslo, Norway;
| | - Kari Almendingen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
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Taranta E, Marcinowicz L. Collaboration between the family nurse and family doctor from the perspective of patients: a qualitative study. Fam Pract 2020; 37:118-123. [PMID: 31281923 DOI: 10.1093/fampra/cmz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is increasing focus on collaboration in primary health care, but there is insufficient patient perspective on collaboration between the family nurse and family doctor. OBJECTIVE To explore how patients perceive collaboration between the family nurse and family doctor in primary health care in Poland. METHODS A qualitative approach and an inductive, naturalistic inquiry strategy were used. Thirty-seven patients from eight general practice clinics in the north-eastern part of Poland participated in semi-structured, face-to-face interviews. The qualitative data were examined by means of thematic analysis. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS Four subthemes emerged in the context of nurse-doctor collaboration, namely: (i) carrying out the doctor's orders; (ii) visit preparation; (iii) the family nurse as a source of information and (iv) participants' perceptions of the status of the family nurse. Nurses performing instrumental activities connected with a doctor's orders was understood by the participants to be collaboration and prevailed in their responses. CONCLUSION The perception of collaboration (or lack thereof) between the family nurse and family doctor results from patients' varied experiences and observations during their visits to a primary care clinic. The traditional model of nursing care and the hierarchical relationship, in which the doctor has the dominant role, are evident in the patients' remarks. The autonomy of nursing could be strengthened by expanding, and highlighting, the primary care activities that a nurse can perform on her own.
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Affiliation(s)
- Ewa Taranta
- Department of Primary Health Care, Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Primary Health Care, Medical University of Bialystok, Bialystok, Poland
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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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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Szafran O, Kennett SL, Bell NR, Torti JMI. Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team. BMC FAMILY PRACTICE 2019; 20:44. [PMID: 30871513 PMCID: PMC6419394 DOI: 10.1186/s12875-019-0932-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Canada, most patients with type 2 diabetes mellitus (T2DM) are cared for in the primary care setting in the practices of family physicians. This care is delivered through a variety of practice models ranging from a single practitioner to interprofessional team models of care. This study examined the extent to which family physicians collaborate with other health professionals in the care of patients with T2DM, comparing those who are part of an interprofessional health care team called a Primary Care Network (PCN) to those who are not part of a PCN. METHODS Family physicians in Alberta, Canada were surveyed to ascertain: which health professionals they refer to or have collaborative arrangements with when caring for T2DM patients; satisfaction and confidence with other professionals' involvement in diabetes care; and perceived effects of having other professionals involved in diabetes care. Chi-squared and Fishers Exact tests were used to test for differences between PCN and non-PCN physicians. RESULTS 170 (34%) family physicians responded to the survey, of whom 127 were PCN physicians and 41 were non-PCN physicians (2 not recorded). A significantly greater proportion of PCN physicians vs non-PCN physicians referred patients to pharmacists (23.6% vs 2.6%) or had collaborative working arrangements with diabetes educators (55.3% vs 18.4%), dietitians (54.5% vs 21.1%), or pharmacists (43.1% vs 21.1%), respectively. Regardless of PCN status, family physicians expressed greater satisfaction and confidence in specialists than in other family physicians or health professionals in medication management of patients with T2DM. Physicians who were affiliated with a PCN perceived that interprofessional collaboration enabled them to delegate diabetes education and monitoring and/or adjustment of medications to other health professionals and resulted in improved patient care. CONCLUSIONS This study sheds new insight on the influence that being part of a primary care team has on physicians' practice. Specifically, supporting physicians' access to other health professionals in the primary care setting is perceived to facilitate interprofessional collaboration in the care of patients with T2DM and improve patient care.
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Affiliation(s)
- Olga Szafran
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta T6G 2T4 Canada
| | - Sandra L. Kennett
- Edmonton Oliver Primary Care Network, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta Canada
- Primary Care, Health Canada, Suite 730, 9700 Jasper Avenue, Edmonton, Alberta T5J 4C3 Canada
| | - Neil R. Bell
- Department of Family Medicine, University of Alberta, Family Medicine Clinic, Misericordia Community Hospital, 16940 - 87 Avenue, Edmonton, Alberta T5R 4H5 Canada
| | - Jacqueline M. I. Torti
- Department of Family Medicine, University of Alberta, Health Sciences Addition Room 110, London, Ontario N6A 5C1 Canada
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 110, London, Ontario N6A 5C1 Canada
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Forsdike K, Murphy TA, Hegarty K. Supporting primary care nurses to work at an advanced level through changing practices' organisational governance. Aust J Prim Health 2019; 24:171-176. [PMID: 29622061 DOI: 10.1071/py17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022]
Abstract
General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.
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Affiliation(s)
- Kirsty Forsdike
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Tracy Ann Murphy
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
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18
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Halcomb EJ, McInnes S, Patterson C, Moxham L. Nurse-delivered interventions for mental health in primary care: a systematic review of randomized controlled trials. Fam Pract 2019; 36:64-71. [PMID: 30364968 DOI: 10.1093/fampra/cmy101] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental health issues are increasingly prevalent within the community. Many people experiencing mental health issues have established relationships with primary care providers, including general practice nurses (GPNs). With the recent growth of general practice nursing, it is timely to explore the evidence for GPNs to provide mental health interventions for adults with mental illness within their scope of practice. OBJECTIVE To synthesize the evidence about nurse-delivered interventions in primary care for adults with mental illness. METHODS A systematic review of randomized control trials (RCTs) retrieved from the CINAHL, Ovid MEDLINE and EBSCO electronic databases between 1998 and 2017. RESULTS Nine randomized controlled trials were identified, which reported nurse-delivered interventions in primary care for the management of mental health in adults with mental illness. The heterogeneity of interventions and outcomes made comparison of studies difficult. Seven studies demonstrated significant improvement in at least one outcome following the intervention. In some studies, these improvements were sustained well beyond the intervention. Additionally, consumers were satisfied with the interventions and the role of the GPN. CONCLUSION There is currently limited evidence of the impact of nurse-delivered interventions in primary care for adults with mental illness. Given the significant improvements in symptoms and the acceptability of interventions seen in included studies, there is a need for further robust research exploring the role of the GPN both individually and within the multidisciplinary team. Such research will enable stronger conclusions to be drawn about the impact of nurse-delivered interventions in primary care for adults with mental illness.
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Affiliation(s)
| | - Susan McInnes
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, Australia
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19
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Nieuwboer MS, Perry M, van der Sande R, Maassen ITHM, Olde Rikkert MGM, van der Marck MA. Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: a qualitative focus group study. Fam Pract 2018. [PMID: 29529183 DOI: 10.1093/fampra/cmy009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. OBJECTIVE To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication. METHOD A qualitative focus group design was used to identify the facilitating and hindering factors and strategies for improvement. In a Dutch primary care setting, 6 mono-professional focus group interviews (3 meetings of 13 GPs; 3 meetings of 18 CNs) were organized between June 2015 and April 2016, recorded and transcribed verbatim. Two independent researchers performed the coding of these interviews, identifying their categories and themes. RESULTS Results show that, despite the regular contact between GPs and CNs, communication was generally perceived as poor in effectiveness and efficiency by both professions. Mutual trust was considered the most important facilitating factor for effective communication. Profession-specific factors (e.g. differences in responsibility and profession-specific language) and organizational factors (e.g. lack of shared care plans, no in-person communication, lack of time) may be of influence on communication. Participants' suggestions for improvement included organizing well-structured and reimbursed team meetings and facilitating face-to-face contact. CONCLUSION GP-CN patient-related communication benefits most from trusting inter-personal relationships. Inter-professional training programmes should address both professional and organizational factors and should be evaluated for their effect on quality of care.
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Affiliation(s)
- Minke S Nieuwboer
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob van der Sande
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health, Behaviour and Society, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Irma T H M Maassen
- Radboud Institute for Health Science, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolein A van der Marck
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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McKittrick R, McKenzie R. A narrative review and synthesis to inform health workforce preparation for the Health Care Homes model in primary healthcare in Australia. Aust J Prim Health 2018; 24:PY18045. [PMID: 30103852 DOI: 10.1071/py18045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/03/2018] [Indexed: 02/28/2024]
Abstract
The Australian Government Health Care Homes (HCH) model recently implemented in general practice targets people with chronic complex conditions. Identifying how general practitioners (GPs) and practice nurses (PNs) can work within this model is important given existing health workforce challenges. A narrative review and synthesis has been undertaken to develop a preliminary understanding of this, incorporating literature describing health workforce challenges, GP and PN functions, and team-based care; supplemented by interviews with key informants from within the primary healthcare system. Narrative synthesis principles guided literature analysis. Interview data were thematically analysed. A clear rationale for health workforce reform was ascertained and functions for the GP and PN under the HCH model were determined. The model was found to be an opportunity for an enhanced PN role in a team-based approach to care with the GP. Challenges to advancing the PN role and team-based care were identified, including the medical dominance of the health system and the significant culture change required by general practices to fully implement the model. Enablers included strong nursing leadership and improved ongoing education for PNs to unlock their capacity. The HCH model is an opportunity to strengthen primary healthcare, provided concerted action is taken regarding these challenges and enablers.
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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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McInnes S, Peters K, Bonney A, Halcomb E. A qualitative study of collaboration in general practice: understanding the general practice nurse's role. J Clin Nurs 2017; 26:1960-1968. [DOI: 10.1111/jocn.13598] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Susan McInnes
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Kath Peters
- School of Nursing & Midwifery; Western Sydney University; Campbelltown NSW Australia
| | - Andrew Bonney
- School of Medicine; University of Wollongong; Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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