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Braun-Inglis C, Williams EL, Macchiaroli A, Denicoff A, Gerber DE. Better Late Than Never: Fully Incorporating Oncology Advanced Practice Providers Into Cancer Clinical Trials. JCO Oncol Pract 2022; 18:729-732. [PMID: 35960907 PMCID: PMC9653202 DOI: 10.1200/op.22.00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Christa Braun-Inglis
- University of Hawaii School of Nursing and Dental Hygiene and University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alyssa Macchiaroli
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Denicoff
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Morris L, Moule P, Pearson J, Foster D, Walsh N. Patient view of the advanced practitioner (AP) role in primary care: A realist-informed synthesis. Musculoskeletal Care 2021; 19:462-472. [PMID: 33779062 DOI: 10.1002/msc.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Approximately 30% of general practitioner consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat a range of MSKDs, and could provide the first point of contact for primary care patients. There is limited evidence on whether this role is acceptable to patients; however, previous research has explored advanced practitioner (AP) roles in primary care, which could inform this new initiative. AIMS This study used realist synthesis to explore factors that influence patient acceptability of AP roles in primary care. MATERIALS & METHODS: A realist synthesis was undertaken to identify initial programme theories regarding acceptability. Databases were searched to identify relevant literature. Identified studies were subject to inclusion and exclusion criteria, resulting in 38 studies included for synthesis. Theory-specific data extraction sheets were created and utilised. Data were analysed through identifying contexts, mechanisms and outcomes to formulate hypotheses. Hypotheses were validated through consultation with expert stakeholders. RESULTS Eight theory areas were identified that potentially impacted on patient acceptability of the role: patient's prior experience of condition management; patient's expectations of condition management; communication; continuity of the individual practitioner; practitioner's scope of practice; accessibility; professional hierarchy and promoting the role. Nineteen hypotheses on the AP role were developed around these theory areas. DISCUSSION Role acceptabiliy was influenced significantly by context and may change as the role develops, for instance, as waiting times change. CONCLUSION Hypotheses will inform a subsequent realist evaluation exploring the physiotherapy AP role in primary care. Future research is needed to understand the acceptability of first contact physiotherapists delivering certain skills.
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Affiliation(s)
- Leah Morris
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Pam Moule
- Department of Nursing, University of the West of England, Bristol, UK
| | - Jennifer Pearson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Dave Foster
- Patient Research Partner, University of the West of England, Bristol, UK
| | - Nicola Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
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3
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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4
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Schönenberger N, Sottas B, Merlo C, Essig S, Gysin S. Patients' experiences with the advanced practice nurse role in Swiss family practices: a qualitative study. BMC Nurs 2020; 19:90. [PMID: 32982581 PMCID: PMC7510323 DOI: 10.1186/s12912-020-00482-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background Considering shortages of general practitioners (GP) and strategies for improving the quality of health care provision, many countries have implemented interprofessional care models with advanced practice nurses (APN). International evidence suggests that APN care results in high patient satisfaction. In Switzerland, the role is still new, and the patient perspective has not yet been researched. Our aim was therefore to explore patients’ experiences with the APN role in Swiss family practices. Methods We conducted 22 semi-structured interviews in four different family practices with patients aged 18 to 97 suffering from minor acute to multiple chronic diseases, and who had at least one consultation with an APN. All interviews were audiotaped, transcribed verbatim, and analysed using qualitative content analysis. Results The analysis resulted in five themes: Despite the unfamiliarity, all patients were willing to be consulted by an APN because it was recommended by their GP (1); after several encounters, most participants perceived differences between the APN and the GP consultation in terms of the length and style of the consultations as well as the complexity of their tasks (2); the interviewees emphasised coaching, guidance, care coordination, and GP-assisting tasks as APN core competencies and attributed the characteristics empathetic, trustworthy, and competent to the APN role (3); most patients especially valued home visits and the holistic approach of the APNs, but they also noticed that in certain cases GP supervision was required (4); and due to the close collaboration between the APN and the GP, patients felt safe, well cared for and experienced improvements in physical and psychological well-being as well as in daily activities (5). Conclusion Our results suggested that patients value the APNs’ competencies, despite their initial lack of role knowledge. Trust in the GP seemed to be the most important factor for patients’ receptiveness toward the APN role. Overall, patients perceived an added value due to the enlargement of the scope of practice offered by APNs. The patient perspective might provide valuable insights for further APN role implementation in Swiss family practices.
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Affiliation(s)
- Nicole Schönenberger
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Christoph Merlo
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland
| | - Stefan Gysin
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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5
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Fuller A, Jenkins W, Doherty M, Abhishek A. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology (Oxford) 2020; 59:575-579. [PMID: 31410473 DOI: 10.1093/rheumatology/kez333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore patient satisfaction, gout knowledge, medication adherence and flares among participants receiving nurse-led or general practitioner (GP)-led care of gout in the Nottingham Gout Treatment Trial phase-II (NGTT-II). METHODS A total of 438 participants of NGTT-II were sent a questionnaire enquiring about gout knowledge, satisfaction with health-care practitioner, urate-lowering treatment being undertaken, and gout flares ⩾1 year after their final visit. Nurse-led care participants were asked about their preference for receiving gout treatment from either a GP or a nurse. RESULTS Completed questionnaires were returned by 82% of participants. Participants previously receiving nurse-led care reported greater satisfaction with health-care practitioner (P < 0.001), had better gout knowledge (P = 0.02), were more likely to be taking urate-lowering treatment [adjusted relative risk (95% CI) 1.19 (1.09, 1.30)], and self-reported fewer flares in the previous 12 months [median (inter-quartile range) 0 (0-0) vs 1 (0-3), P < 0.001] than those receiving GP-led care. Of participants receiving nurse-led care, 41-63% indicated preference for receiving gout treatment from a nurse, while only 5-20% indicated preference for receiving treatment from GPs. CONCLUSION The results of this study favour nurse-led care, involving individualized patient education and engagement and a treat-to-target strategy, in terms of patient acceptability, long-term adherence, and flares. Further research is required to evaluate the feasibility of implementing such a model of care in clinical practice.
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Affiliation(s)
- Amy Fuller
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
| | | | - Michael Doherty
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
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6
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Barratt J, Thomas N. Nurse practitioner consultations in primary health care: patient, carer, and nurse practitioner qualitative interpretations of communication processes. Prim Health Care Res Dev 2018; 20:e42. [PMID: 30376908 PMCID: PMC6536759 DOI: 10.1017/s1463423618000798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/08/2018] [Accepted: 09/01/2018] [Indexed: 11/18/2022] Open
Abstract
AIM To advance understanding of the discrete nature of the communication processes and social interactions occurring in nurse practitioner consultations. BACKGROUND Preceding qualitative investigations of nurse practitioner consultations have, when conducting interviews with participants, often exclusively sampled either nurse practitioners or patients. Furthermore, previous qualitative studies of the nature of nurse practitioner consultations have not typically also sampled carers attending with patients for nurse practitioner consultations. Accordingly this study was developed, in part, to address this exclusivity of sampling in qualitative research of nurse practitioner consultations by developing an inclusive sample of patient, carer and nurse practitioner participants of nurse practitioner consultations, so as to conjointly develop an understanding of the multiple perceptions of those participants of communication processes occurring in nurse practitioner consultations. METHODS Qualitative component of a larger mixed methods case study of communication processes and social interactions in nurse practitioner consultations, utilising individual semi-structured interviews with the patient (n = 9), carer (n = 2) and nurse practitioner (n = 3) participants of video-recorded consultations derived from a nurse practitioner-led general practice clinic. Interview transcripts were initially analysed via an emergent thematic analysis, followed up by computer-assisted qualitative data analysis with NVivo 9. FINDINGS The participants' perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes: Consulting style of nurse practitioners; Nurse practitioner - GP comparisons; Lifeworld content or lifeworld style; Nurse practitioner role ambiguity; Creating the impression of time and Expectations for safety netting. The findings identify a need for policy makers to address a perceived ambiguity of the nature of the nurse practitioner role amongst patients and carers. The benefits of nurse practitioners using personable, everyday lifeworld styles of communication for optimising interactions, sharing clinical reasoning and conveying a sense of having time for patients and carers in consultations are also identified.
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Affiliation(s)
- Julian Barratt
- Head of Community Nursing, Institute of Health, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Nicola Thomas
- Associate Professor in Kidney Care, School of Health and Social Care, London South Bank University, London, UK
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7
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Nurse practitioner consultations in primary health care: a case study-based survey of patients' pre-consultation expectations, and post-consultation satisfaction and enablement. Prim Health Care Res Dev 2018; 20:e36. [PMID: 30012232 PMCID: PMC6536762 DOI: 10.1017/s1463423618000415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Research has not yet fully investigated links to consultation duration, patient expectations, satisfaction, and enablement in nurse practitioner consultations. This study was developed to address some of these research gaps in nurse practitioner consultations, particularly with a focus on expectations, satisfaction, and enablement. Aim To explore the influence of pre-consultation expectations, and consultation time length durations on patient satisfaction and enablement in nurse practitioner consultations in primary health care. Design Survey component of a larger convergent parallel mixed methods case study designed to conjointly investigate the communication processes, social interactions, and measured outcomes of nurse practitioner consultations. The survey element of the case study focusses on investigating patients’ pre-consultation expectations and post-consultation patient satisfaction and enablement. Methods A questionnaire measuring pre-consultation expectations, and post-consultation satisfaction and enablement, completed by a convenience sample of 71 adults consulting with nurse practitioners at a general practice clinic. Initial fieldwork took place in September 2011 to November 2012, with subsequent follow-up fieldwork in October 2016. Results Respondents were highly satisfied with their consultations and expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (P=0.003). A significant, small to moderate, positive correlation of 0.427 (P=0.005) between general satisfaction and enablement was noted. No significant correlation was seen between consultation time lengths and satisfaction or enablement. Conclusion Higher levels of patient enablement and satisfaction are not necessarily determined by the time lengths of consultations, and how consultations are conducted may be more important than their time lengths for optimising patient satisfaction and enablement.
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8
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Ljungbeck B, Sjögren Forss K. Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses. BMC Nurs 2017; 16:63. [PMID: 29176932 PMCID: PMC5689167 DOI: 10.1186/s12912-017-0258-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/03/2017] [Indexed: 01/24/2023] Open
Abstract
Background The number of frail elderly people with complex nursing and medical care needs is increasing, and consequently, the healthcare burden. The implementation of Advanced Nurse Practitioners globally has been shown to make healthcare more effective and increase patient safety, continuity of care and access to care. In Sweden, research about Advanced Nurse Practitioners is limited. Thus, this study aimed to investigate the opinions of managers, doctors and nurses in primary care and municipal healthcare about the role of ANPs in municipal healthcare as a way to meet the increasing healthcare needs of the frail elderly. Methods Managers, doctors and specialist nurses in primary care and municipal healthcare adopted a qualitative, descriptive design through 12 semi-structured interviews. The data were analysed using content analysis. Results The participants expressed both opportunities as well as challenges with Advanced Nurse Practitioners in municipal healthcare. This role considered to satisfy frail elderly people’s healthcare needs and making the healthcare more effective as the doctors would have more time for other patients. The challenges mainly consist of doubts from the managers whether the nurses would be motivated to pursue further education to become an Advanced Nurse Practitioner if the role becomes a reality. The doctors were unsure if the nurses would consider taking the responsibility the role would imply. Conclusions Advanced Nurse Practitioner is considered to be a valuable resource not only for the frail elderly but also for the nurses in the municipal healthcare and for the doctors in primary care as they probably would make healthcare more effective. They might be a way to meet the increasing healthcare needs of frail elderly, however there are also challenges to overcome before they can become a reality in a Swedish healthcare context. Consequently, this role deserves further investigation. Electronic supplementary material The online version of this article (10.1186/s12912-017-0258-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Birgitta Ljungbeck
- Municipal Healthcare in Hässleholm, Management of Care and Welfare, Hässleholm, Sweden
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, -205 06 Malmö, SE Sweden
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9
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Eriksson I, Lindblad M, Möller U, Gillsjö C. Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse. Int J Nurs Pract 2017; 24. [PMID: 29071766 PMCID: PMC5813192 DOI: 10.1111/ijn.12603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. AIM To describe patients' experiences of health care provided by an APN in primary health care. METHODS An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. RESULTS The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. CONCLUSION The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context.
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Affiliation(s)
- Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Monica Lindblad
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
| | | | - Catharina Gillsjö
- School of Health and Education, University of Skövde, Skövde, Sweden.,College of Nursing, University of Rhode Island, Kingston, RI, USA
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10
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Abstract
BACKGROUND There has been an evolution of various consultation models in the literature. Men affected by prostate cancer can experience a range of unmet supportive care needs. Thus, effective consultations are paramount in the delivery of supportive care to optimize tailored self-management plans at the individual level of need. OBJECTIVE The aim of this study is to critically appraise existing models of consultation and make recommendations for a model of consultation within the scope of clinical practice for prostate cancer care. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines. Electronic databases were searched using a wide range of keywords and free text items to increase the sensitivity and inclusiveness of the searches. Findings were integrated in a narrative synthesis. RESULTS A total of 1829 articles were retrieved and 17 papers were included. Beneficial features ranged across a number of models that included a person-centered consultation, shared management plans, and safety netting. None of the reviewed models of consultation are suitable for use in prostate cancer care because of a range of limitations and the clinical context in which models were developed. A Cancer Care Consultation Model was informed from critical appraisal of the evidence and expert clinical and service user comment. CONCLUSION Further research is needed to empirically test consultation models in routine clinical practice, specifically for advanced cancer specialist nurses. IMPLICATIONS FOR PRACTICE The Prostate Cancer Model of Consultation can be used to structure clinical consultations to target self-management care plans at the individual level of need over the cancer care continuum.
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11
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Thompson S, Moorley C, Barratt J. A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment. J Adv Nurs 2016; 73:1097-1110. [PMID: 27859497 DOI: 10.1111/jan.13206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
AIM To investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors. BACKGROUND A literature review was conducted, searching for articles published from 1990 - 2012. The review found that nurse practitioners are key to the modernization of the National Health Service. Studies have shown that compared with doctors, nurse practitioners can be efficient and cost-effective in consultations. DESIGN Qualitative research design. METHODS The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. This study was conducted from May 2012 - January 2013. RESULTS The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took 3 minutes longer to complete the scenarios. CONCLUSION This study suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes.
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Affiliation(s)
- Stephen Thompson
- School of Health & Social Care, London South Bank University, UK
| | - Calvin Moorley
- School of Health & Social Care, London South Bank University, UK
| | - Julian Barratt
- Faculty of Education, Health and Wellbeing, University of Wolverhamptom, UK
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12
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Coyne I, Comiskey CM, Lalor JG, Higgins A, Elliott N, Begley C. An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland. BMC Health Serv Res 2016; 16:151. [PMID: 27117714 PMCID: PMC4847185 DOI: 10.1186/s12913-016-1412-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 04/19/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical specialist (CS) and advanced practitioner (AP) roles have increased in nursing and midwifery internationally. This study explored clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners in Ireland. METHODS Using a case study design, interview, observational and documentary data from postholding sites (CSs or APs employed) were compared with data from non-postholding sites (no CSs or APs employed). Interviews and observations were conducted with postholders (n = 23), and compared with data from healthcare professionals (nurses or midwives, doctors) (n = 23) in matched services. Interviews were held with Directors of Nursing and Midwifery (n = 23), healthcare professionals (n = 41), service users (n = 41) with experience of receiving care or working with postholders, and non-postholders in matched services. The data were analysed using Nvivo (Version 8). RESULTS The findings suggest that postholders' practice appeared to differ from non-postholders' in relation to case management and service provision. Postholders were seen as having an impact on readmission rates, waiting lists/times, collaborative decision-making, continuity of care and workload management. Postholders' autonomy to manage caseloads was perceived to lead to smoother transition of patients/clients through the healthcare system. Service-users' self-reports appeared to appreciate the individualised holistic care provided by postholders. Postholders' role in facilitating person-centred care and promoting interprofessional team working, are essential elements in quality care provision and in global healthcare workforce planning. CONCLUSIONS To meet changing healthcare demands, promote person-centred care, and improve service delivery, more specialist and advanced practice posts in nursing and midwifery should be developed and supported within healthcare.
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Affiliation(s)
- Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Catherine M Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Joan G Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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13
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Bentley M, Stirling C, Robinson A, Minstrell M. The nurse practitioner-client therapeutic encounter: an integrative review of interaction in aged and primary care settings. J Adv Nurs 2016; 72:1991-2002. [DOI: 10.1111/jan.12929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Bentley
- School of Health Sciences; University of Tasmania; Hobart Tasmania Australia
| | - Christine Stirling
- School of Health Sciences; University of Tasmania; Hobart Tasmania Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tasmania Australia
| | - Melinda Minstrell
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tasmania Australia
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Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles. Int Psychogeriatr 2015; 27:967-79. [PMID: 25483359 DOI: 10.1017/s1041610214002361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.
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Maul TM, Zaidi A, Kowalski V, Hickey J, Schnug R, Hindes M, Cook S. Patient Preference and Perception of Care Provided by Advance Nurse Practitioners and Physicians in Outpatient Adult Congenital Clinics. CONGENIT HEART DIS 2015; 10:E225-9. [PMID: 26010340 DOI: 10.1111/chd.12273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Nurse practitioners (NPs) have an established role for delivering competent care to patients in the primary care setting. The aim of this study was to compare satisfaction of patients managed by NPs vs. physicians in the outpatient adult congenital heart disease (CHD) clinic. DESIGN A prospective study conducted in two outpatient adult CHD clinics to assess patient satisfaction through standardized surveys. Demographic data included CHD diagnosis, age, and New York Heart Association functional class. All patients completed a Short-Form-12 to assess health status. RESULTS Of the 371 patients recruited (52% men; median age 29 years, severe CHD complexity 31.5%) and seen by NP (n = 187) or physician (n = 184), physician-managed practices had higher perceived: overall experience, courtesy of provider (P < 0.05) and confidence (trust) in provider (P < 0.1). Overall, patients reported satisfaction with an NP providing care (98%), the NP was able to effectively deal with illness/CHD (95%), and an increased chance (94%) or willingness to see an NP at a future visit. Only 73% reported an understanding of NP training and how an NP differed from a registered nurse. There was a stronger perception of how an NP differed from a physician (83%). CONCLUSION Patient satisfaction was high regardless of whether care was provided by physicians or NPs. However, patients appear to make distinctions in what they believe the type of care each practitioner is best at providing. Patient education regarding competence of the different health care providers may continue to improve patient satisfaction.
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Affiliation(s)
- Timothy M Maul
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ali Zaidi
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Vanessa Kowalski
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenne Hickey
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Renee Schnug
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Morgan Hindes
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Cook
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Affiliation(s)
- Abby Barnwell
- Lead Colorectal/Stoma Nurse Specialist, University Hospitals, Coventry, England
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17
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Parker R, Forrest L, McCracken J, McRae I, Cox D. What primary health-care services are Australian consumers willing to accept from nurse practitioners? A National Survey. Health Expect 2014; 17:733-40. [PMID: 22784392 PMCID: PMC5060916 DOI: 10.1111/j.1369-7625.2012.00800.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nurses are becoming increasingly important as providers of primary health care in Australia. In November 2010, Medicare provider rights and Pharmaceutical Benefits Scheme rights for nurse practitioners, working in private practice and in collaboration with a medical practitioner, were introduced in Australia. Although international evidence suggests that nurse practitioners would be appropriate and acceptable providers of care at the first point of contact, such as primary health care, there is little Australian evidence about what care consumers are willing to accept from nurse practitioners. OBJECTIVES To ascertain what care Australian health-care consumers would accept from nurse practitioners in this setting. PARTICIPANTS Australian adults over 18 years of age. METHODS National Survey delivered online. Information about the survey was disseminated through a media campaign, stakeholder engagement and through the health-care consumer networks nationally. RESULTS The total number of respondents that started the survey was n = 1883. Ninety-five percentage (n = 1784) of respondents completed the survey. The majority of respondents were women, aged 25-54 years, had completed tertiary education and had an annual household income of more than A$80,000. The majority of the respondents (n = 1562, 87%) said they would be prepared to see a nurse practitioner for some of their primary health-care needs. CONCLUSIONS The findings of this study suggest consumers are accepting of a range of activities undertaken by nurse practitioners in primary health care and this has relevance for primary health-care workforce mix and organization, particularly for areas that are underserved by medical practitioners.
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Affiliation(s)
- Rhian Parker
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Laura Forrest
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - James McCracken
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Ian McRae
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Darlene Cox
- Health Care Consumers' Association of the Australian Capital TerritoryCanberraACTAustralia
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Jakimowicz S, Stirling C, Duddle M. An investigation of factors that impact patients’ subjective experience of nurse-led clinics: a qualitative systematic review. J Clin Nurs 2014; 24:19-33. [DOI: 10.1111/jocn.12676] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Christine Stirling
- School of Health Sciences; University of Tasmania; Hobart Tas. Australia
| | - Maree Duddle
- School of Nursing & Midwifery; University of Tasmania; Sydney Australia
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McDevitt J, Melby V. An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study. J Clin Nurs 2014; 24:523-35. [DOI: 10.1111/jocn.12639] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Joe McDevitt
- Urgent Care and Treatment Centre; Tyrone County Hospital; Omagh UK
| | - Vidar Melby
- School of Nursing; University of Ulster; Magee Campus; Derry UK
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Desborough J, Banfield M, Parker R. A tool to evaluate patients’ experiences of nursing care in Australian general practice: development of the Patient Enablement and Satisfaction Survey. Aust J Prim Health 2014; 20:209-15. [DOI: 10.1071/py12121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/08/2013] [Indexed: 11/23/2022]
Abstract
Australian health policy initiatives have increasingly supported the employment of nurses in general practice. An understanding of the impact of nursing care on patients in this setting is integral to assuring quality, safety and a patient-centred focus. The aim was to develop a survey to evaluate the satisfaction and enablement of patients who receive nursing care in Australian general practices. The survey was to be simple to administer and analyse, ensuring practicality for use by general practice nurses, doctors and managers. Two validated instruments formed the basis of the Patient Enablement and Satisfaction Survey (PESS). This survey was refined and validated for the Australian setting using focus groups and in-depth interviews with patients, and feedback from general practice nurses. Test-retest and alternate form methods were used to establish the survey’s reliability. Feedback resulted in 14 amendments to the original draft survey. Questions that demonstrated a strong positive correlation for the test-retest and alternate form measures were included in the final survey. The PESS is a useful, practical tool for the evaluation of nursing care in Australian general practice, its validity and reliability established through a patient-centred research approach, reflective of the needs of patients accessing nursing services in this setting.
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Bergman K, Perhed U, Eriksson I, Lindblad U, Fagerström L. Patients' satisfaction with the care offered by advanced practice nurses: a new role in Swedish primary care. Int J Nurs Pract 2013; 19:326-33. [PMID: 23730865 DOI: 10.1111/ijn.12072] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study is to describe patients' satisfaction with the new role of advanced practice nurses (APNs) in Swedish primary care. A questionnaire pertaining to patient satisfaction with the care offered by APNs was sent to respondents. Descriptive statistics, a chi-squared test and manifest qualitative content analysis were used during analysis. Although the results show an overall high level of patient satisfaction as regards APN-led care, those patients informed of the APN role prior to a consultation were significantly more satisfied. Respondents' comments indicate that professional treatment and competence are characteristic of the care offered by APNs and also relate the concepts of increased availability of and continuity in health care to the APN role. In order to guarantee the positive development of the APN role in Sweden, continued research is needed from patient, organizational and interprofessional perspectives, including intervention studies of cost effectiveness and the quality of care.
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23
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Parker R, Forrest L, Ward N, McCracken J, Cox D, Derrett J. How acceptable are primary health care nurse practitioners to Australian consumers? Collegian 2013; 20:35-41. [DOI: 10.1016/j.colegn.2012.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Margolius D, Bodenheimer T. Transforming primary care: from past practice to the practice of the future. Health Aff (Millwood) 2013; 29:779-84. [PMID: 20439861 DOI: 10.1377/hlthaff.2010.0045] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The gap between the supply of primary care physicians and the demand for primary care continues to grow. Primary care practices must find a way to increase their patient capacity without sacrificing quality of care or adding more work to already overburdened physicians. A transformed primary care practice addressing these issues must redefine the physician role such that the physician no longer sees all patients assigned to the practice but acts as a leader for a well-trained, highly functioning primary care team. The team's overall goal would be to advance the health of an entire patient panel. New payment models are among changes that will be central to this transformation.
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Affiliation(s)
- David Margolius
- Alpert Medical School, Brown University, Providence, RI, USA.
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25
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Begley C, Elliott N, Lalor J, Coyne I, Higgins A, Comiskey CM. Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). J Adv Nurs 2012; 69:1323-37. [PMID: 22931391 DOI: 10.1111/j.1365-2648.2012.06124.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2012] [Indexed: 11/28/2022]
Abstract
AIM To report a study designed comparing the roles, responsibilities, and perceived outcomes of Clinical Nurse Specialists, Clinical Midwife Specialists, and Advanced Nurse Practitioners in Ireland. BACKGROUND A clinical career pathway that encompasses progression from staff nurse or midwife through clinical specialist to advanced practitioner level was introduced in Ireland in 2000. Such roles are common internationally, but little evaluation has been conducted and few comparisons have been made between roles. DESIGN A mixed-method case-study design was used. METHODS Following Research Ethics Committee Approval, data were collected in 2009-2010, using non-participant observation (92 hours) of 23 Clinical Specialists and Advanced Practitioners, interviews with 21 clinicians and 13 Directors of Nursing or Midwifery. A survey was completed by 154 service-users. RESULTS A clear difference was seen between Clinical Specialist and Advanced Practitioners, with advanced practice roles providing improved service delivery, greater clinical and professional leadership, increased research, and a clear governance and accreditation structure. Clinical Midwife Specialists were rated at a similar level to Advanced Nurse Practitioners for certain aspects and rated more highly for 'continuity of care and carer'. CONCLUSION Advanced Practitioners do give a higher level of care, particularly at a strategic level. Existing Clinical Specialists should therefore be encouraged to develop their skills and education to achieve advanced practice level and more specialist and advanced practice posts should be instituted.
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Affiliation(s)
- Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
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Vuković M, Gvozdenović BS, Gajić T, Stamatović Gajić B, Jakovljević M, McCormick BP. Validation of a patient satisfaction questionnaire in primary health care. Public Health 2012; 126:710-8. [PMID: 22831911 DOI: 10.1016/j.puhe.2012.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 02/09/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Improvement in patient satisfaction with healthcare services can be evaluated by satisfaction questionnaires of high construct validity. OBJECTIVES To establish the dimensions and construct validity of a 20-item patient satisfaction questionnaire to assess satisfaction with general practice services. SUBJECTS In total, 1314 adult patients of both genders, who were users of healthcare services at the General Medicine Department of Health Centre Valjevo in Serbia for two consecutive years, were included in the study. METHODS Multidimensional scaling (MDS) was employed to identify similarities and dissimilarities among items comprising the satisfaction questionnaire. Patient satisfaction dimensions were estimated by principal component analysis for categorical data (CATAPCA). RESULTS The MDS model configuration derived two dimensions: (1) patient satisfaction with the timeliness of healthcare service provision; and (2) patient centredness related to doctors' and nurses' commitment towards their health. In the CATAPCA model, two dimensions of patient satisfaction were found: the first dimension patient satisfaction with medical staff and the second dimension was indicative of contextual patient dissatisfaction. CONCLUSIONS This study shows that the applied patient satisfaction questionnaire has high validity and reliability. It also has high sensitivity for longitudinal measurements, as well as good discriminatory power in measuring the different levels of patient satisfaction.
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Affiliation(s)
- M Vuković
- Quality Asurance Department, Health Centre Valjevo, Valjevo, Serbia.
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Gao LL, Chan SWC, Cheng BS. The past, present and future of nursing education in the People’s Republic of China: a discussion paper. J Adv Nurs 2011; 68:1429-38. [DOI: 10.1111/j.1365-2648.2011.05828.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Desborough J, Forrest L, Parker R. Nurse-led primary healthcare walk-in centres: an integrative literature review. J Adv Nurs 2011; 68:248-63. [PMID: 21834837 DOI: 10.1111/j.1365-2648.2011.05798.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This paper is a report of an integrative review of the international literature examining established nurse-led primary healthcare walk-in centres and their outcomes to understand whether they are effective in improving access to primary health care. BACKGROUND Reviews of nurse-led primary care walk-in centres have included centres staffed by family physicians and general practitioners. There is a paucity of evidence about walk-in centres staffed solely by nurses. DATA SOURCES Studies were identified through an electronic search using the databases Medline, Cinahl and EBSCO from 1990 until July 2010. Papers were included if they examined walk-in centres providing nurse-led primary care for the general community. Only peer reviewed studies published in English were included. REVIEW METHODS An integrative approach utilizing Bowling's checklist facilitated a systematic appraisal of studies in regard to clarity of aims, objectives, methods and appropriate analysis of data. RESULTS Thirteen publications were categorized into five themes: 'users of walk-in centres', 'quality of care provided at walk-in centres', 'impact on other healthcare providers', 'perceptions of walk-in centres' and 'satisfaction with walk-in centres'. CONCLUSION The possibility that walk-in centres create demand highlights the need for clearer evidence of the drivers of demand for health care in walk-in centres. Innovations in healthcare provision need to be matched with adaptation to nursing education to ensure an adequately prepared nursing workforce. Improvement in access to primary healthcare needs to be measured in terms of equity and the capacity this access has to fill identified gaps in primary healthcare provision in the community.
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Affiliation(s)
- Jane Desborough
- Nursing and Midwifery Office, ACT Health, Canberra, Australian Capital Territory, Australia
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Nieminen AL, Mannevaara B, Fagerström L. Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies. Scand J Caring Sci 2011; 25:661-70. [PMID: 21371072 DOI: 10.1111/j.1471-6712.2011.00876.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice. BACKGROUND Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. THEORETICAL FRAMEWORK The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis. METHODS Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. FINDINGS Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. CONCLUSION Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.
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Affiliation(s)
- Anna-Lena Nieminen
- Health Care and Social Welfare, Novia University of Applied Sciences, Vasa, Finland.
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Jones TL. A holistic framework for nursing time: implications for theory, practice, and research. Nurs Forum 2010; 45:185-96. [PMID: 20690994 DOI: 10.1111/j.1744-6198.2010.00180.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
TOPIC Nursing time has relevance for those who produce it, those who receive it, and those who must pay for it. Although the term nursing time may be commonly used, a common understanding of the concept within the fields of nursing and healthcare administration is lacking. PURPOSE The purposes of this paper are to explore the concept of nursing time and to identify implications for theory development, clinical and administrative practice, and research. DISCUSSION Both physical and psychological forms of time are viewed as fundamental to our experience of time as social beings. Nursing time has significant intrinsic and instrumental value in nursing and health care. A holistic approach incorporating the physical, psychological, and sociological aspects and dimensions of nursing time is advocated. CONCLUSIONS Multiple strategies to enhance the patient experience of nursing time are warranted and should address how much time nurses spend with patients as well as how they spend that time. Patterns of overlapping and competing time structures for nurses should be identified and evaluated for their effect on physical time available for patient care and the psychological experiences of time by nurses and patients.
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Rashid C. Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. J Adv Nurs 2010; 66:1658-70. [PMID: 20649683 DOI: 10.1111/j.1365-2648.2010.05327.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper presents an integrative literature review of studies exploring the benefits and limitations of the recent expansion of the clinical role of nurses working in general practice in the United Kingdom. BACKGROUND Similar clinical outcomes and high levels of satisfaction with consultations undertaken by nurse practitioners compared to general practitioners in primary care have been reported in a Cochrane review [Cochrane Database of Systematic Reviews (2004) vol. 5, p. CD001271]. Since then, nurse consultations have increased considerably as general practitioners have delegated part of their clinical workload to other general practice nurses. However, whether all general practice nurses can fulfil this extended role remains open to question. METHOD An integrative review was performed. Nine electronic databases were searched. UK studies were included if they were published after the previous Cochrane review, i.e. between 2004 and 2009. RESULTS Eight studies were identified, most using qualitative methodology. The evidence suggested that the changes in nurses' role have been predominantly driven by the perceived increase in workload arising from the new general practitioner contract. Delegating work to nurses provided a means of organizing workload within a practice without necessarily allowing patient choice. Patients generally thought that all general practice nurses would be able to deal with simple conditions, but they would prefer to consult with a general practitioner if they thought it necessary. There were concerns about nurses' knowledge base, particularly in diagnostics and therapeutics, and their levels of training and competence in roles formerly undertaken by general practitioners. CONCLUSION There have been few studies in this key area of healthcare policy. There is a need for better training and support for nurses undertaking roles in consultation and for patients' views to be better represented.
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Affiliation(s)
- Claire Rashid
- Research and Development, Leicestershire County and Rutland Community Health Services, Leicester, UK.
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Voogdt-Pruis HR, Gorgels AP, van Ree JW, van Hoef EF, Beusmans GH. Patient perceptions of nurse-delivered cardiovascular prevention: Cross-sectional survey within a randomised trial. Int J Nurs Stud 2010; 47:1237-44. [DOI: 10.1016/j.ijnurstu.2010.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/28/2010] [Accepted: 02/20/2010] [Indexed: 11/29/2022]
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McNamara S, Giguère V, St-Louis L, Boileau J. Development and implementation of the specialized nurse practitioner role: use of the PEPPA framework to achieve success. Nurs Health Sci 2010; 11:318-25. [PMID: 19689642 DOI: 10.1111/j.1442-2018.2009.00467.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2003, amendments to the Nurses' Act in Quebec, Canada, allowed for an expanded nursing role. Specialized nurse practitioners were introduced to the health-care system in 2005. By merging medical knowledge with advanced practice nursing, the specialized nurse practitioner is gaining in popularity and acceptance with staff members and patients. To guide our team through the process, we used the PEPPA (participatory, evidence-based, patient-focused process for guiding the development, implementation, and evaluation of advanced practice nursing) framework. By using a framework specifically designed for the development, implementation, and evaluation of an advanced practice nursing role, we were better prepared for the path that lay ahead. Ultimately, the goal of the implementation of the specialized nurse practitioner role is to improve the quality of care to a specific population of patients, whether it is through individualized clinical follow-up, evidence-based practice, patient teaching, or promoting continuous education for the nurses.
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Cudney S, Weinert C, Kinion E. Forging partnerships between rural women with chronic conditions and their health care providers. J Holist Nurs 2010; 29:53-60. [PMID: 20651303 DOI: 10.1177/0898010110373656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.
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Affiliation(s)
- Shirley Cudney
- Montana State University, College of Nursing, Box 173560, Bozeman, MT 59717, USA.
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Redfern S, Coster S, Evans A, Dewe P. An exploration of personal initiative theory in the role of consultant nurses. J Res Nurs 2010. [DOI: 10.1177/1744987110364916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim in this paper is to investigate the contribution personal initiative theory makes in understanding the consultant nurse role. The role was introduced in the UK in 2000 to improve patient outcomes, clinical leadership and retention of experienced clinicians. A larger study used a multi-method approach to collect quantitative and qualitative data from focus groups, interviews and a questionnaire administered nationally at two time points. Findings from longitudinal telephone interviews with 30 consultant nurses are the focus of this paper. Three consultant nurses were selected as case studies to examine the potential of personal initiative theory when applied to new nursing roles. The activities of two of the three demonstrated a high level of personal initiative in the job. They persisted in overcoming problems faced in improving practice. The third scored lower: she emerged as a reactive conformist and less likely than the other two to pursue initiatives of her own. Personal initiative theory has potential as a framework for evaluating the consultant nurse role, although further research is needed to test it. The longitudinal analysis revealed a determination to stay in the job and overcome difficult challenges when consultants show initiative and are making progress in achieving change.
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Affiliation(s)
- Sally Redfern
- Professor Emeritus, King’s College London, UK, Visiting Professor, Kingston University and St George’s University of London, Faculty of Health & Social Care Sciences, London, UK,
| | - Samantha Coster
- Research Fellow, King’s College London, School of Nursing and Midwifery, London, UK
| | - Amanda Evans
- Postgraduate Research Student, King’s College London, Division of Applied Biomedical Research, London, UK
| | - Philip Dewe
- Vice-Master of Birkbeck College and Professor of Organizational Behaviour, Birkbeck College, Department of Organizational Psychology, University of London, UK
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Young K, Duggan L, Franklin P. Effective consulting and history-taking skills for prescribing practice. ACTA ACUST UNITED AC 2009; 18:1056-61. [PMID: 19798005 DOI: 10.12968/bjon.2009.18.17.44160] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is increasing emphasis on the need for nurses to develop history-taking and consultation skills for prescribing and advanced clinical practice roles. This article discusses both theoretical and practical aspects that could facilitate the development of these skills using safe and structured approaches. It explores some of the origins of consultation theory, and the challenge that nurses face in integrating new consultation skills with existing nursing assessment practice. This article outlines practical generic approaches to history taking in the clinical consultation and considers the main areas that need to be covered to support safe prescribing decisions.
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Affiliation(s)
- Kim Young
- School of Nursing and Midwifery, University of Plymouth, Knowledge Spa, Royal Cornwall Hospital, Truro
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Abstract
This literature review was conducted to identify the attributes of an expert nurse and the direct and indirect impact they have on patient care, health-care organisations and nursing. Given the loss of expert nursing posts as a result of NHS deficits, there is an urgent need to differentiate between a range of expert nursing roles and how these contribute to positive patient and health outcomes and organisational efficiency. The focus of the literature search was on developments in the UK and the results indicated that ambiguity and confusion exist around the terminology and definitions associated with expert nurses. Research shows that expert nurses have a positive impact on patient care and organisational efficiency. However, a lack of clarity leads to a dilution of expert nursing roles and nurse expertise. There is a need for national guidance on the skills required of expert nurses and the necessity of considering the formal protection of nursing titles.
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Dierick-van Daele ATM, Metsemakers JFM, Derckx EWCC, Spreeuwenberg C, Vrijhoef HJM. Nurse practitioners substituting for general practitioners: randomized controlled trial. J Adv Nurs 2009; 65:391-401. [PMID: 19191937 DOI: 10.1111/j.1365-2648.2008.04888.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study conducted to evaluate process and outcomes of care provided to patients with common complaints by general practitioners or specially trained nurse practitioners as first point of contact. BACKGROUND Studies in the United States of America and Great Britain show that substituting nurse practitioners for general practitioners results in higher patient satisfaction and higher quality of care. As the American and British healthcare system and settings differ from that in The Netherlands, a Dutch trial was conducted. METHODS A total of 1501 patients in 15 general practices were randomized to consultation by a general practitioner or a nurse practitioner. Data were collected over a 6-month period in 2006 by means of questionnaires, extracting medical records from practice computer systems and recording the length of consultations. FINDINGS In both groups, the patients highly appreciated the quality of care. No statistically significant differences were found in health status, medical resource consumption and compliance of practical guidelines in primary care in The Netherlands. Patients in the NP intervention group were more often invited to re-attend, had more follow-up consultations and their consultations took statistically significantly longer. CONCLUSION Nurse practitioners and general practitioners provide comparable care. Our findings support an increased involvement of specially trained nurse practitioners in the Dutch primary care and contribute to knowledge of the effectiveness of care provision by nurse practitioners from a national and international perspective.
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Abstract
For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists (n = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.
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Affiliation(s)
- T Rana
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Park House, Cannock, UK
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Bonsall K, Cheater FM. What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review. Int J Nurs Stud 2008; 45:1090-102. [PMID: 17905252 DOI: 10.1016/j.ijnurstu.2007.07.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 07/04/2007] [Accepted: 07/11/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review and draw together the existing research evidence to assess the impact of advanced primary care nursing roles, particularly first contact nursing roles, for patients, nurses themselves and their colleagues in order to highlight salient issues for policy, practice and research. BACKGROUND Internationally, nurses' roles continue to expand in response to doctor shortages and policy drives to provide effective and efficient health services. A body of research exists from which to evaluate the impact of advanced nursing roles on various dimensions of healthcare delivery and organisation. DESIGN AND DATA SOURCES Medline, CINAHL, Applied Social Sciences Index and Abstracts, British Nursing Index, Cochrane Library, EMBASE, National Research Register, and PsycINFO databases were searched, including relevant websites. Studies were included if published in English and relevant to the primary/community care setting. Of a total of 211 papers identified, 88 were of relevance and included in the review. RESULTS Nurses working in many advanced primary care roles such as acute/minor illness, minor injury and long-term conditions provide safe and effective care, and patient satisfaction is generally high. Many factors influence patient satisfaction with, and access to, such services but are little understood. Evidence on cost-effectiveness, efficiency and impact on other health care professionals is inconclusive though research suggests the introduction of extended roles can create uncertainty and intra-/inter-professional tensions. CONCLUSIONS Evidence is of variable quality, often ignoring potentially important effect mediators such as the experience and educational level of advanced nurses, the effect of service 'maturation', organisational characteristics and differing patient preferences. The complex range of factors that influence patient satisfaction, access and outcomes of care need further investigation. Recent UK developments in nurse prescribing and the introduction of a national post-registration competency framework may improve working relations and patient understanding and experience of advanced nursing roles in primary care.
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Thrasher C, Purc-Stephenson R. Patient satisfaction with nurse practitioner care in emergency departments in Canada. ACTA ACUST UNITED AC 2008; 20:231-7. [DOI: 10.1111/j.1745-7599.2008.00312.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fox S, Chesla C. Living with chronic illness: A phenomenological study of the health effects of the patient–provider relationship. ACTA ACUST UNITED AC 2008; 20:109-17. [DOI: 10.1111/j.1745-7599.2007.00295.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIM This paper reports a study to explore how cancer survivors talk about, experience and manage time in everyday life. BACKGROUND There is an increasing interest in specific physical and psychosocial aspects of life after cancer diagnosis and treatment, but hardly any research follows cancer survivors over time to explore how perceptions and experiences change. METHODS An exploratory study was carried out in 2002-2004 with a purposive sample of adults who had experienced various forms of cancer. Data collection included 9 weeks of participant observation at a Cancer Rehabilitation Centre and ethnographic interviews with 23 informants. Ten men and 13 women were interviewed twice: 2 weeks after their stay and 18 months later. FINDINGS Data were analysed from a culture-analytical perspective. Three main themes regarding the survivors' handling and perception of time were found: (1) cancer disrupts time and life; (2) awareness of time increases, time is verbalized and reflected; and (3) the informants appropriate time. A diagnosis of cancer, even for a survivor, means a confrontation with death. It means a disruption of continuous clock and calendar time. Survivors appropriate time, and prioritize how and with whom they want to spend their time. CONCLUSION With an increasing number of people being cured following a cancer diagnosis, nurses and oncology nurse specialists who work with cancer survivors must be aware of the fact that time is a central theme in understanding cancer survivors' lives, and they must know how to guide these survivors in their new lives and take care of their well-being.
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Affiliation(s)
- Dorte M Rasmussen
- Student Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Abstract
AIMS AND OBJECTIVES This paper aims to analyse the concept of advanced nursing practice critically and to demonstrate an appreciation of the development of the role of the advanced nurse practitioner in the Irish context. BACKGROUND The concept of advanced nursing practice has existed in the US since the 1960s and in the UK since the early 1980s. The first signs of the advanced nurse practitioner began to emerge in Ireland in the late 1990s as a result of increasing demands and changes occurring within nursing and health care. Currently, there are 31 advanced nurse practitioners in the country, many of whom practice in the general setting. Strategies are in place to introduce advanced nursing practice into other nursing disciplines in the future. METHODS A literature review was conducted to address the various issues inherent within this concept. RESULTS There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes. In light of this, the advanced nurse practitioner has a valuable role to play in providing a beneficial contribution and filling a gap in healthcare services. CONCLUSION This paper has demonstrated that nursing continues to be a dynamic and ever-changing phenomenon where the onus is firmly on the advanced nurse practitioner as expert, leader and collaborator, to capture the hearts and minds of nurses and healthcare workers, so as to challenge traditional values and transform clinical practice. Failure to do so may allow medicine or other interested parties to shape the future of nursing or even absorb it. RELEVANCE TO CLINICAL PRACTICE Nurses working at an advanced level are striving to develop their expertise, initiate nurse-led services and practice, in collaboration with other professionals in an effort to provide the highest quality care to the patient. Although the idea of the advanced nurse practitioner is relatively new to nursing in Ireland, it is the result of an idea whose time has come and there is nothing more powerful than an idea whose time has come.
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Hankins-Farber R. In response to: Williams A. & Jones M. (2006) Patient's assessments of consulting a nurse practitioner: the time factor. Journal of Advanced Nursing 53(2), 188?195. J Adv Nurs 2007; 58:99-100. [PMID: 17394621 DOI: 10.1111/j.1365-2648.2007.04121.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Redsell S, Stokes T, Jackson C, Hastings A, Baker R. Patients' accounts of the differences in nurses' and general practitioners' roles in primary care. J Adv Nurs 2007; 57:172-80. [PMID: 17214753 DOI: 10.1111/j.1365-2648.2006.04085.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper reports a study of patients' accounts of the differences in nurses' and general medical practitioners' roles in primary care. BACKGROUND Nurses are now diagnosing and treating illnesses including conducting first contact care consultations. However, the findings of international studies reporting patients' views of developments in nursing roles are not consistent. Whilst some studies report higher satisfaction following nurse consultations, others suggest that patients do not want nurses to replace general medical practitioners. Healthcare professionals' views of the boundaries of their roles have been studied, but patients' views have not been reported. METHOD Semi-structured interviews were conducted with 28 adults attending general practices for urgent 'same day' appointments during 2004. Participants were interviewed prior to their consultation with either the nurse or general medical practitioner and 19 participants were interviewed after the consultation. Data collection and analysis were concurrent, and based on the constant comparative method. FINDINGS Participants' views reflected traditional hierarchies in primary care. They preferred to consult with general medical practitioners if they perceived their symptoms to be serious and with nurses for minor symptoms and reassurance. They thought that nurses had more time for them and were more compassionate. Interpersonal/relational continuity of care was important and for most participants this was with a general medical practitioner who knew them. Participants trusted known practitioners; they also placed trust in professional groups and familiar structures such as the practice. CONCLUSION New nursing services should incorporate patients' views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients' views should particularly be evaluated.
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Affiliation(s)
- Sarah Redsell
- School of Nursing, University of Nottingham, Nottingham, UK.
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