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Zhao Y, Quadros W, Nagraj S, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med 2024; 22:286. [PMID: 38978070 PMCID: PMC11232288 DOI: 10.1186/s12916-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
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Affiliation(s)
- Yingxi Zhao
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | | | - Shobhana Nagraj
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Attakrit Leckcivilize
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
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Pollard T, Gibson K, Griffith B, Jeffries J, Moffatt S. Implementation and impact of a social prescribing intervention: an ethnographic exploration. Br J Gen Pract 2023; 73:e789-e797. [PMID: 37429735 PMCID: PMC10355812 DOI: 10.3399/bjgp.2022.0638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social prescribing involves referral of patients from primary care to link workers, who work with them to access appropriate local voluntary and community sector services. AIM To explore how a social prescribing intervention was delivered by link workers and the experiences of those referred to the intervention. DESIGN AND SETTING The study used ethnographic methods to conduct a process evaluation of a social prescribing intervention delivered to support those living with long-term conditions in an economically deprived urban area of the North of England. METHOD Participant observation, shadowing, interviews, and focus groups were used to examine the experiences and practices of 20 link workers and 19 clients over a period of 19 months. RESULTS Social prescribing provided significant help for some people living with long-term health conditions. However, link workers experienced challenges in embedding social prescribing in an established primary care and voluntary sector landscape. The organisations providing social prescribing drew on broader social discourses emphasising personal responsibility for health, which encouraged a drift towards an approach that emphasised empowerment for lifestyle change more than intensive support. Pressures to complete assessments, required for funding, also encouraged a drift to this lighter-touch approach. A focus on individual responsibility was helpful for some clients but had limited capacity to improve the circumstances or health of those living in the most disadvantaged circumstances. CONCLUSION Careful consideration of how social prescribing is implemented within primary care is required if it is to provide the support needed by those living in disadvantaged circumstances.
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Affiliation(s)
- Tessa Pollard
- Department of Anthropology, Durham University, Durham
| | - Kate Gibson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Bethan Griffith
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Jayne Jeffries
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Suzanne Moffatt
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
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Lippler N. [Advanced nursing practice in a medical-psychological center]. Soins Psychiatr 2023; 44:39-42. [PMID: 37328230 DOI: 10.1016/j.spsy.2023.04.010] [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: 06/18/2023]
Abstract
The introduction of an advanced practice nurse in psychiatry and mental health (APN) at the University Hospital of Nîmes has made it possible to improve the quality and safety of care while controlling costs and ensuring the satisfaction of patients, partners and care teams. A favorable institutional policy, the involvement of the management, psychiatrists and the IPA PSM facilitated the acceptance of this new profession by the care teams and other professionals, despite the existence of statutory and logistical obstacles.
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Affiliation(s)
- Nadia Lippler
- Centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France.
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Van Hecke A, Vlerick I, Akhayad S, Daem M, Decoene E, Kinnaer LM. Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams. Eur J Oncol Nurs 2023; 62:102257. [PMID: 36634592 DOI: 10.1016/j.ejon.2022.102257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years. METHODS A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes. RESULTS ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN. CONCLUSION ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Isabel Vlerick
- Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Soumaya Akhayad
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Michiel Daem
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Wang L, Zhang X, Zhang P, Zhou Q, Wang Q, Cheng J. Development and psychometric evaluation of the trauma nurse core competency scale. Front Public Health 2022; 10:959176. [PMID: 36523571 PMCID: PMC9745320 DOI: 10.3389/fpubh.2022.959176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trauma, especially severe trauma, has become a significant public health problem worldwide. This postulates higher requirements on the core competence of trauma nurses. However, limited scales exist to assess it validly and reliably. This study aims to develop and evaluate the psychometric properties of the Trauma Nurse Core Competency Scale (TNCCS). Methods This study included three stages. First, scale development was based on a broad literature review and two rounds of Delphi expert consultation. Then, a pre-investigation was conducted with 106 trauma nurses, and a formal scale was formed. Finally, scale evaluation of reliability and validity, based on a cross-sectional study, was tested with 1,107 trauma nurses. Content validity and structure validity were used to evaluate the validity of TNCCS. The Cronbach's α coefficient and the split-half reliability coefficient were used to evaluate the reliability of TNCCS. Results The final scale contained 46 items under three dimensions, which were Knowledge and skills (21 items), Comprehensive literacy (20 items), and Professionalism & physical and mental health (5 items). The Content Validity Index (CVI) of the total scale was 0.980. The goodness-of-fit indices (χ2/df = 3.547, RMSEA = 0.065, GFI = 0.929, CFI = 0.912, NFI = 0.904, IFI = 0.929) signified a good fit for this model. The Construct Reliability (CR) ranged from 0.89 to 0.98, and the Average Variance Extracted (AVE) ranged from 0.62 to 0.69. The Cronbach's α coefficient of the scale was 0.99, ranging from 0.90 to 0.98 for the subscales. The split-half reliability coefficient was 0.84. Conclusions The TNCCS demonstrated good validity and reliability, and it could be used to assess the core competency of trauma nurses. The present study has valuable implications for nursing managers to take corresponding measures to train and improve the core competence of trauma nurses.
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Affiliation(s)
- Lu Wang
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Jing Cheng
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Rioux-Dubois A, Perron A. Enacting primary healthcare interprofessional collaboration: a multisite ethnography of nurse practitioner integration in Ontario, Canada. J Interprof Care 2022; 37:532-540. [PMID: 35997230 DOI: 10.1080/13561820.2022.2102591] [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: 10/15/2022]
Abstract
Interprofessional collaboration (IPC) is known to enhance patient outcomes and satisfaction. In primary healthcare (PHC), IPC aims to transform care provision and team functioning, but its implementation is challenging and has yielded mixed results. We aimed to describe the enactment of IPC in PHC settings, particularly as it relates to nurse practitioner (NP) integration. A multisite ethnography involving 6 Canadian PHC clinics was carried out. We conducted 330 hours of direct observation, 23 semi-structured interviews with PHC NPs, informal interviews with key PHC partners, and document analysis. IPC in PHC was found to rest on human and non-human actors that interact in complex ways. Organizational mandates and remuneration models, physical spaces and schedules played a decisive role in the enactment of IPC. Power structures embedded in certain designations (i.e., most responsible provider) or NPs' commitments to physicians' practices stood in contrast with the principles of IPC. NPs enacted various role to develop, enhance, and maintain IPC. Despite shifts in PHC provision, IPC remains poorly defined and precariously sustained.
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Affiliation(s)
- Annie Rioux-Dubois
- Department des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Amélie Perron
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Lie MLS, McParlin C, McColl E, Graham RH, Robson SC. Emesis in pregnancy - a qualitative study on trial recruitment failure from the EMPOWER internal pilot. Pilot Feasibility Stud 2022; 8:146. [PMID: 35836285 PMCID: PMC9281005 DOI: 10.1186/s40814-022-01093-1] [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: 04/08/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of the internal pilot of the EMPOWER trial investigating the second-line antiemetic therapies in severe emesis in pregnancy ( https://www.isrctn.com/ISRCTN16924692 ), a qualitative study of women's views was carried out, to improve our understanding of why women did, or did not, consent to participation in the trial. Interviews were also conducted with site research staff, to broaden our analysis and explore other factors affecting recruitment. METHODS The sample comprised women who accepted or declined trial participation (n=21) and site research staff (n=22). A structured topic guide was used, in four email interviews and 17 telephone interviews with women, and semi-structured telephone interviews were carried out with staff. Of the women interviewed, seven had declined trial participation, and of the staff interviewed, 16 were research midwives/research nurses and six were principal investigators. All transcripts were checked for accuracy, anonymised and entered into NVIVO12 for indexing and retrieval. Data was analysed using a reflexive thematic analytic approach. In total, 72 codes were generated from the thematic analysis, and 36 from each sample group. RESULTS Three key themes based on all the interviews were (a) the diversity of recruitment pathways and boundaries of care, (b) the impact of trial complexity on recruitment and staff morale and (c) the ethics of caring for a patient with emesis. Ethical issues discussed included the use of double dummy and time to treat, particularly those suffering severely from the effects of nausea and vomiting. To illustrate these themes, staff perspectives are given more prominence. CONCLUSIONS The main reason the trial was stopped related to the high proportion of women ineligible for recruitment due to prior treatment with study drug(s) because of unanticipated changes in clinical practice. The qualitative results also demonstrate the impact of the trial on women and staff and highlight how the diversity of referral pathways, boundaries of care and the complexity of the trial and protocol resulted in additional barriers to successful trial recruitment. Qualitative work in pilot and feasibility studies of a clinical trial is recommended, to evaluate whether recruitment strategies remain viable in unanticipated contexts. TRIAL REGISTRATION Trial registration number ISRCTN16924692 . Date: 08/01/2018.
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Maymi M, Madden M, Bauer C, Reuter-Rice K. Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis. J Pediatr Health Care 2022; 36:e11-e21. [PMID: 34836734 DOI: 10.1016/j.pedhc.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). RESULTS Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%). DISCUSSION This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.
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Weber CE, Kortkamp C, Maurer I, Hummers E. Boundary work in response to professionals’ contextual constraints: Micro-strategies in interprofessional collaboration. ORGANIZATION STUDIES 2022. [DOI: 10.1177/01708406221074135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Boundary-work research has extensively explored how professionals engage in boundary work to protect or expand their professional boundaries in interprofessional collaboration (IPC). Yet professionals’ contextual constraints in everyday work, such as time pressure or legal restrictions, often result in competing interests of the professionals involved in IPC, prompting them to engage in boundary work to limit—instead of protect or expand—their boundaries. Our empirical analysis uses comprehensive qualitative data on IPC in Germany between self-employed general practitioners (GPs) and registered nurses employed in nursing homes in which GPs’ efficiency interests compete with nurses’ safeguarding interests, leading both professionals to engage in boundary-work efforts to limit their boundaries. Our findings provide a comprehensive understanding and framework of professionals’ boundary work, showing that individual GPs and nurses typically hold a portfolio of various defending and accommodating micro-strategies. Based on our first-order findings, we identify how different sources of power enable particular micro-strategies and explore how the choice of micro-strategies depends on different forms of trust in the collaborating partner. Lastly, we outline interactions of micro-strategies, illustrating how the outcomes of professionals’ bilateral boundary work depend on the sequence of these strategies.
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Affiliation(s)
| | | | | | - Eva Hummers
- University Medical Center Göttingen, Germany
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Pervaz Iqbal M, Manias E, Mimmo L, Mears S, Jack B, Hay L, Harrison R. Clinicians' experience of providing care: a rapid review. BMC Health Serv Res 2020; 20:952. [PMID: 33059673 PMCID: PMC7559170 DOI: 10.1186/s12913-020-05812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/09/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. METHODS A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. RESULTS Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools. CONCLUSION Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.
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Affiliation(s)
- Maha Pervaz Iqbal
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Laurel Mimmo
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
- Sydney Children’s Hospitals, Network, Sydney, NSW Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, NSW 2350 Australia
| | - Briony Jack
- Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Liz Hay
- Economics and Analysis, Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
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Kilpatrick K, Paquette L, Jabbour M, Tchouaket E, Fernandez N, Al Hakim G, Landry V, Gauthier N, Beaulieu MD, Dubois CA. Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams. PLoS One 2020; 15:e0234416. [PMID: 32520943 PMCID: PMC7286504 DOI: 10.1371/journal.pone.0234416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
AIM Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. METHODS A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. RESULTS Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. DISCUSSION Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. CONCLUSION Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine, McGill University, Montréal, Québec, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Québec, Canada
| | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Grace Al Hakim
- Clinical and Professional Development Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Véronique Landry
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Gauthier
- Nursing and Physical Health Directorate, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Québec, Canada
| | | | - Carl-Ardy Dubois
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
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Côté N, Freeman A, Jean E, Denis JL. New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning. BMC Health Serv Res 2019; 19:882. [PMID: 31752860 PMCID: PMC6873448 DOI: 10.1186/s12913-019-4731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada). METHODS We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017. RESULTS Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity). CONCLUSION Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.
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Affiliation(s)
- Nancy Côté
- Faculty of Social Sciences, Université Laval, Quebec City, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
| | - Andrew Freeman
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Emmanuelle Jean
- Department of Nursing Sciences, Université du Québec à Rimouski, Rimouski, Canada
| | - Jean-Louis Denis
- Département de gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, Canada
- Chaire de recherche du Canada sur la transformation, le design et l’amélioration des systèmes de santé, Montréal, Canada
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Kilpatrick K, Paquette L, Bird M, Jabbour M, Carter N, Tchouaket É. Team Functioning And Beliefs About Team Effectiveness In Inter-Professional Teams: Questionnaire Development And Validation. J Multidiscip Healthc 2019; 12:827-839. [PMID: 31632051 PMCID: PMC6781853 DOI: 10.2147/jmdh.s218540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Few validated instruments are available to measure team functioning in acute and primary care teams. To address this, we developed a questionnaire measuring healthcare provider perceptions of team effectiveness (Provider-PTE) and assessed its psychometric properties. Patients and methods Empirical evidence and a conceptual model were used for item generation. The 41-item self-completed questionnaire was developed. A cross-sectional survey of healthcare providers (n=283) across a range of settings was performed. Psychometric properties were assessed for French and English language questionnaires using Cronbach alpha (α) for reliability, the feedback form for face validity, expert opinion for content validity, and the known-group technique for construct validity. Responsiveness was examined by comparing scores in high and low functioning teams. Results The mean time needed to complete the questionnaire was less than 9 mins. Respondents were typically female (84%), and employed full time (80%) in urban settings (82%). Cronbach α values were as follows: Team Processes = 0.88; PTE-Overall = 0.91; Outcomes = 0.72. Significant differences were found by professional group (p = 0.017), length of time in the team (p = 0.025), and presence of nurse practitioners. Responses to Outcomes varied by employment status (p = 0.017). Differences were identified in high and low functioning teams (p<0.001). Feedback indicated that two questions related to team meetings needed to be added. Conclusion The study produced evidence of validity for English and French language Provider-PTE questionnaires. The revised 43-item instrument represents an important contribution by providing a validated questionnaire to measure team functioning across a range of settings that is consistent with a conceptual framework.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital Site, Montréal, Quebec, Canada
| | - Lysane Paquette
- Faculty of Nursing, Université de Montreal, Montréal, Quebec, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital Site, Montréal, Quebec, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), Saint-Jérôme, Quebec, Canada
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Doody O, Slevin E, Taggart L. A survey of nursing and multidisciplinary team members' perspectives on the perceived contribution of intellectual disability clinical nurse specialists. J Clin Nurs 2019; 28:3879-3889. [DOI: 10.1111/jocn.14990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Doody
- Health Research Institute, Department of Nursing and Midwifery University of Limerick Limerick Ireland
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Kilpatrick K, Jabbour M, Tchouaket É, Acorn M, Donald F, Hains S. Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study. J Adv Nurs 2019; 75:1306-1315. [DOI: 10.1111/jan.13962] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Kelley Kilpatrick
- Ingram School of Nursing McGill University Montreal QC Canada
- Centre intégré universitaire de santé et de services sociaux de l'Est‐de‐l’Ïle‐de‐Montréal Maisonneuve‐Rosemont Hospital Site Montreal QC Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l'Est‐de‐l’Ïle‐de‐Montréal Maisonneuve‐Rosemont Hospital Site Montreal QC Canada
| | - Éric Tchouaket
- Faculty of Nursing Université du Québec en Outaouais (UQO) Saint‐Jérôme QC Canada
| | - Michelle Acorn
- Faculty of Nursing University of Toronto Toronto ON Canada
| | - Faith Donald
- Daphne Cockwell School of Nursing Ryerson University Toronto ON Canada
| | - Sylvie Hains
- Ministère de la Santé et des Services sociaux Quebec QC Canada
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Kilpatrick K, Tchouaket É, Paquette L, Guillemette C, Jabbour M, Desmeules F, Landry V, Fernandez N. Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation. BMC Health Serv Res 2019; 19:9. [PMID: 30612571 PMCID: PMC6322340 DOI: 10.1186/s12913-018-3808-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a lack of validated instruments examining dimensions of team functioning from the perspective of patients and families consistent with a conceptual framework. The study aimed to develop and assess the psychometric properties of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire. METHODS A cross-sectional survey was undertaken in three studies. Data were collected from May-October 2016 for Study 1, April 2018-ongoing for Study 2, and October 2016 to June 2017 for Study 3. Online and paper versions of the self-administered questionnaire were available in English and in French. The initial questionnaire included 41 items. Study 1 included 320 respondents. Reliability was assessed using Cronbach alpha. Face validity (n = 250) was assessed using a structured questionnaire. Content validity was examined using subject matter experts and Spearman's item-total correlations. Construct validity was examined using known group comparisons (i.e., clinical specialty, education, length of follow-up, reason of consultation). Content analysis was used for open-ended questions. RESULTS The questionnaire took 10 to 15 min to complete. Positive assessments were noted for instructions, formatting, font size and logical ordering of questions. In Study 1, reliability indices for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p < 0.001). Differences were noted between clinical specialties, education, length of follow-up, reason of consultation, low and high functioning teams. No differences were noted between English and French language respondents. Psychometric properties were re-assessed in Study 2 and 3 after unclear questions were reworked. Reliability indices for the subscales ranged from 0.76 to 0.94 and differences remained significant between low and high functioning teams. CONCLUSION The final 43-item instrument is easy to administer to patients and families. The studies provide evidence of validity to support the propositions in the conceptual framework. The patient-level measures can be aggregated to the team, organizational or system level. The information can be used to assess healthcare team functioning in acute and primary care and determine the role patients and families are playing in teams. Further testing is needed with patients and families who are hospitalized or receiving care from teams in rural areas.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | | | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Claudel Guillemette
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Stallinga HA, Dijkstra PU, Napel HT, Roodbol G, Peters JWB, Heerkens YF, Roodbol PF. Perceived usefulness of the International Classification of Functioning, Disability and Health (ICF) increases after a short training: A randomized controlled trial in master of advanced nursing practice students. Nurse Educ Pract 2018; 33:55-62. [PMID: 30243214 DOI: 10.1016/j.nepr.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
The Master program of Advanced Nursing Practice (MANP) educates nurses to become a nurse practitioner. Nurse practitioners are health care professionals focusing on the intersection of cure and care. However, a clear model covering that area is lacking. The use of the International Classification of Functioning, Disability and Health (ICF) may be considered for incorporation in curricula due to its focus on the integration of cure and care. The purpose of this study is to test the effects of a short (= 4-h instructor-led) ICF training on perceived usefulness of the ICF. In a randomized controlled trial, 76 MANP students were randomly allocated to intervention or control group. Data were collected using an 'ICF survey and learning assessment tool'. Data of 56 students were included for analysis. Perceived usefulness of the ICF increased significantly in the intervention group immediately after training (p = 0.001) but no longer at 3-months follow-up (p = 0.388). Attitude and knowledge related to the ICF were significantly increased in the intervention group at both post-training assessments (p < 0.001 and 0.02). The positive influence of the ICF training on perceived usefulness of the ICF is relevant for including ICF in MANP curriculum.
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Affiliation(s)
- Hillegonda A Stallinga
- University of Groningen, University Medical Center Groningen, Department of Health Science, Section of Nursing Research, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Pieter U Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Department of Oral and Maxillofacial Surgery, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Huib Ten Napel
- National Institute for Public Health and the Environment, World Health Organization-Family of International Classifications Collaborating Centre in the Netherlands, P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Gabriël Roodbol
- HAN University of Applied Sciences, Master Advanced Nursing Practice, P.O. Box 9029, 6500 JK, Nijmegen, the Netherlands.
| | - Jeroen W B Peters
- HAN University of Applied Sciences, Master Advanced Nursing Practice, P.O. Box 9029, 6500 JK, Nijmegen, the Netherlands.
| | - Yvonne F Heerkens
- Dutch Institute of Allied Health Care, Amersfoort, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503, GL, Nijmegen, the Netherlands.
| | - Petrie F Roodbol
- University of Groningen, University Medical Center Groningen, Department of Health Science, Section of Nursing Research, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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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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King O, Borthwick A, Nancarrow S, Grace S. Sociology of the professions: what it means for podiatry. J Foot Ankle Res 2018; 11:30. [PMID: 29942353 PMCID: PMC6000928 DOI: 10.1186/s13047-018-0275-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background The health professions have progressed and evolved considerably over the last few decades in response to demographic, technological, societal and political changes. They continue to do so as the volume and complexity of population health needs steadily increase. Role boundary expansion is among the key changes to the health professions, including podiatry to meet demand. Nonetheless podiatry’s role boundary expansion has not been achieved swiftly or without resistance from neighbouring and dominant professions. This paper seeks to explain the nature of this resistance with respect to the sociology of the professions literature and to shed light on some of the factors and processes at play when role boundary changes arise in health care. Discussion Six of the most contemporaneously relevant sociology of the professions theories are summarised: Taxonomic, Marxian, Bourdieusian, Foucauldian, Boundary Work and Neo-Weberian paradigms. Conclusion This review highlights that some paradigms are more relevant than others in the current socio-political landscape. It also illustrates that there is a common theme underlying each approach to defining the professions and their boundaries: competition. This may help health professionals, including podiatrists, to understand and manage the challenges and resistance experienced when professions attempt to expand role boundaries to meet increasing and changing population health needs.
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Affiliation(s)
- Olivia King
- 1Monash Centre for Scholarship in Health Education, Monash University, Clayton, 3800 Australia
| | - Alan Borthwick
- 2University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Susan Nancarrow
- 3Southern Cross University, Military Drive, Lismore, 2480 Australia
| | - Sandra Grace
- 3Southern Cross University, Military Drive, Lismore, 2480 Australia
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Feringa M, De Swardt H, Havenga Y. Registered nurses’ knowledge, attitude, practice and regulation regarding their scope of practice: A literature review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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21
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Lim AG, North N, Shaw J. Navigating professional and prescribing boundaries: Implementing nurse prescribing in New Zealand. Nurse Educ Pract 2017; 27:1-6. [DOI: 10.1016/j.nepr.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 02/27/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
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22
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Kvarnström S, Jangland E, Dahlgren MA. Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice. Scand J Caring Sci 2017; 32:765-771. [DOI: 10.1111/scs.12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susanne Kvarnström
- Region Östergötland; Linköping Sweden
- Department of Medicine and Health Sciences; Linköping University; Linköping Sweden
- Jönköping Academy for Improvement of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
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23
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Rattray NA, Damush TM, Luckhurst C, Bauer-Martinez CJ, Homoya BJ, Miech EJ. Prime movers: Advanced practice professionals in the role of stroke coordinator. J Am Assoc Nurse Pract 2017; 29:392-402. [PMID: 28440589 DOI: 10.1002/2327-6924.12462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. METHODS Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. CONCLUSION Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. IMPLICATIONS FOR PRACTICE The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities.
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Affiliation(s)
- Nicholas A Rattray
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Department of Anthropology, Indiana University-Purdue University, Indianapolis, Indiana.,VA HSRD Precision Monitoring (PRIS-M) QUERI, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Teresa M Damush
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,VA HSRD Precision Monitoring (PRIS-M) QUERI, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Regenstrief Institute Center for Health Services Research, Indianapolis, Indiana
| | - Cherie Luckhurst
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Catherine J Bauer-Martinez
- Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Barbara J Homoya
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,VA HSRD Precision Monitoring (PRIS-M) QUERI, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Edward J Miech
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,VA HSRD Precision Monitoring (PRIS-M) QUERI, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Regenstrief Institute Center for Health Services Research, Indianapolis, Indiana
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Valles JHH, Monsiváis MGM, Guzmán MGI, Arreola LV. Nursing care missed in patients at risk of or having pressure ulcers. Rev Lat Am Enfermagem 2016; 24:e2817. [PMID: 27878218 PMCID: PMC5173299 DOI: 10.1590/1518-8345.1462.2817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to determine the nursing care missed as perceived by the nursing staff and its
relation with the nursing care missed identified in the assessment of patients at
risk of or having pressur ulcers. Method: descriptive correlation study. The participants were 161 nurses and 483 patients
from a public hospital. The MISSCARE survey was used in combination with a Nursing
Care Assessment Form for Patients at Risk of or having pressure ulcers. For the
analysis, descriptive and inferential statistics were used. Results: the nursing staff indicated greater omission in skin care (38.5%), position change
(31.1%) and the registration of risk factors for the development of pressure
ulcers (33.5%). The nursing care missed identified in the assessment related to
the use of pressure relief on bony prominences and drainage tubes interfering in
the patient's movements (both with 58.6%) and the use of pneumatic mattresses
(57.6%). Conclusion: a high percentage of nursing care missed was found according to the staff's
perception. Nevertheless, the assessment of the nursing care missed was much
higher. No significant relation was found between both. Therefore, it is a
priority to reflect on the importance of objective patient assessments.
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Affiliation(s)
| | | | | | - Leticia Vázquez Arreola
- PhD, Professor, Facultad de Enfermería, Universidad Autónoma de Nuevo León, Monterrey, NL, México
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From boundaries to boundary work: middle managers creating inter-organizational change. J Health Organ Manag 2016; 30:1204-1220. [DOI: 10.1108/jhom-03-2016-0041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In healthcare, organizational boundaries are often viewed as barriers to change. The purpose of this paper is to show how middle managers create inter-organizational change by doing boundary work: the dual act of redrawing boundaries and coordinating work in new ways.
Design/methodology/approach
Theoretically, the paper draws on the concept of boundary work from Science and Technology Studies. Empirically, the paper is based on an ethnographic investigation of middle managers that participate in a Dutch reform program across health, social care, and housing.
Findings
The findings show how middle managers create a sense of urgency for inter-organizational change by emphasizing “fragmented” service provision due to professional, sectoral, financial, and geographical boundaries. Rather than eradicating these boundaries, middle managers change the status quo gradually by redrawing composite boundaries. They use boundary objects and a boundary-transcending vocabulary emphasizing the need for societal gains that go beyond production targets of individual organizations. As a result, work is coordinated in new ways in neighborhood teams and professional expertise is being reconfigured.
Research limitations/implications
Since boundary workers create incremental change, it is necessary to follow their work for a longer period to assess whether boundary work contributes to paradigm change.
Practical implications
Organizations should pay attention to conditions for boundary work, such as legitimacy of boundary workers and the availability of boundary spaces that function as communities of practice.
Originality/value
By shifting the focus from boundaries to boundary work, this paper gives valuable insights into “how” boundaries are redrawn and embodied in objects and language.
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Jangland E, Yngman Uhlin P, Arakelian E. Between two roles – Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews. Nurse Educ Pract 2016; 21:93-99. [DOI: 10.1016/j.nepr.2016.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/23/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
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Friberg K, Husebø SE, Olsen ØE, Saetre Hansen B. Interprofessional trust in emergency department - as experienced by nurses in charge and doctors on call. J Clin Nurs 2016; 25:3252-3260. [DOI: 10.1111/jocn.13359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Klara Friberg
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Stavanger University Hospital; Stavanger Norway
- Østfold Hospital in Kalnes; Sarpsborg Norway
| | - Sissel Eikeland Husebø
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Stavanger University Hospital; Stavanger Norway
| | - Øystein Evjen Olsen
- Stavanger University Hospital; Stavanger Norway
- Global Health Priorities Research Group; Department of Global Public Health and Primary Care; Center for International Health; University of Bergen; Bergen Norway
| | - Britt Saetre Hansen
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Stavanger University Hospital; Stavanger Norway
- Faculty of Health Sciences; Buskerud and Vestfold University College; Campus Vestfold Norway
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Reuter-Rice K, Madden MA, Gutknecht S, Foerster A. Acute Care Pediatric Nurse Practitioner: The 2014 Practice Analysis. J Pediatr Health Care 2016; 30:241-51. [PMID: 26878813 DOI: 10.1016/j.pedhc.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014. RESULTS Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices. DISCUSSION This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation.
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Stallinga HA, Jansen GJ, Kastermans MC, Pranger A, Dijkstra PU, Roodbol PF. Nurse practitioners' focus on health care in terms of cure and care: analysis of graduate theses using the International Classification of Functioning, Disability and Health. J Adv Nurs 2016; 72:1654-65. [PMID: 26940707 DOI: 10.1111/jan.12947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
Abstract
AIM To explore the focus of nurse practitioners on health care in terms of cure and care. BACKGROUND Nurse practitioners are expected to act on the intersection of cure and care. However, in clinical practice and education, a clear model covering this area is lacking; therefore, it is unknown to what extent nurse practitioners are focused on this specific area. Graduate theses may reflect the focus of nurse practitioners. DESIGN Sequential exploratory mixed method. METHODS In total, 413 published abstracts of graduate theses of a Dutch Master of Advanced Nursing Practice (2000-2015) were analysed using the International Classification of Functioning, Disability and Health. Data source included aim, question and outcome of each thesis and graduates' characteristics. A qualitative deductive approach was used for the analyses. Theses were classified as focused on cure, care, or on the intersection of cure and care. RESULTS A small majority of 53% (N = 219) of the graduate theses addressed patient's health status and could be classified in the International Classification of Functioning, Disability and Health. Of the classified theses, 48% were focused on cure, 39% on the intersection of cure and care and 13% on care. While the percentage of theses addressing health status increased significantly over the 15-year period, the percentage of theses focused on cure, care and on the intersection of cure and care remained the same. CONCLUSION The graduate theses reflected that nurse practitioners are increasingly oriented towards patients' health status. However, their focus is predominantly on cure rather than on the intersection of cure and care.
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Affiliation(s)
- Hillegonda A Stallinga
- University of Groningen, University Medical Center Groningen, School of Nursing & Health, The Netherlands
| | - Gerard J Jansen
- Hanze University of Applied Sciences Groningen, Master Advanced Nursing Practice, The Netherlands
| | | | - Albert Pranger
- Hanze University of Applied Sciences Groningen, Master Advanced Nursing Practice, The Netherlands
| | - Pieter U Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine/Department of Oral and Maxillofacial Surgery, The Netherlands
| | - Petrie F Roodbol
- University of Groningen, University Medical Center Groningen, School of Nursing & Health, The Netherlands
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Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Structural and Process Factors That Influence Clinical Nurse Specialist Role Implementation. CLIN NURSE SPEC 2016; 30:89-100. [DOI: 10.1097/nur.0000000000000182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aaron EM, Andrews CS. Integration of advanced practice providers into the Israeli healthcare system. Isr J Health Policy Res 2016; 5:7. [PMID: 26909141 PMCID: PMC4763450 DOI: 10.1186/s13584-016-0065-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.
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Affiliation(s)
| | - Caryn Scheinberg Andrews
- />Henrietta Szold School of Nursing, Hadassah Medical Organization, Hebrew University, POB 12000, Ein Kerem, Jerusalem Israel
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Kilpatrick K, Jabbour M, Fortin C. Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective? J Clin Nurs 2016; 25:619-30. [PMID: 26875841 DOI: 10.1111/jocn.13085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore patient and family perceptions of team effectiveness of teams those include nurse practitioners in acute and primary care. BACKGROUND Nurse practitioners provide safe and effective care. Patients are satisfied with the care provided by nurse practitioners. Research examining patient and family perceptions of team effectiveness following the implementation of nurse practitioners in teams is lacking. DESIGN A descriptive qualitative design was used. METHODS We used purposeful sampling to identify participants in four clinical specialties. We collected data from March 2014-January 2015 using semi-structured interviews and demographic questionnaires. Content analysis was used. Descriptive statistics were generated. RESULTS Participants (n = 49) believed that the teams were more effective after the implementation of a nurse practitioner and this was important to them. They described processes that teams with nurse practitioners used to effectively provide care. These processes included improved communication, involvement in decision-making, cohesion, care coordination, problem-solving, and a focus on the needs of patients and families. Participants highlighted the importance of interpersonal team dynamics. A human approach, trust, being open to discussion, listening to patient and family concerns and respect were particularly valued by participants. Different processes emerged as priorities when data were examined by speciality. However, communication, trust and taking the time to provide care were the most important processes. CONCLUSION The study provides new insights into the views of patients and families and micro-level processes in teams with nurse practitioners. The relative importance of each process varied according to the patient's health condition. Patients and providers identified similar team processes. Future research is needed to identify how team processes influence care outcomes. RELEVANCE TO CLINICAL PRACTICE The findings can support patients, clinicians and decision-makers to determine the processes to focus on to promote effective team functioning, and involve patients and families as team members.
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Affiliation(s)
- Kelley Kilpatrick
- Faculty of Nursing, Research Centre Maisonneuve-Rosemont Hospital, CSA-RC-Aile Bleue, Université de Montréal, Montréal, QC, Canada
| | - Mira Jabbour
- CSA-RC-Aile Bleue, Research Centre Maisonneuve-Rosemont Hospital, Montréal, QC, Canada
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Hurlock-Chorostecki C, van Soeren M, MacMillan K, Sidani S, Donald F, Reeves S. Nurse practitioner interactions in acute and long-term care: an exploration of the role of knotworking in supporting interprofessional collaboration. BMC Nurs 2015; 14:50. [PMID: 26472938 PMCID: PMC4606543 DOI: 10.1186/s12912-015-0102-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. METHOD Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of "knotworking" to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. RESULTS Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. CONCLUSIONS Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed.
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Affiliation(s)
| | | | | | - Souraya Sidani
- />School of Nursing, Ryerson University, Toronto, ON Canada
| | - Faith Donald
- />School of Nursing, Ryerson University, Toronto, ON Canada
| | - Scott Reeves
- />Health, Social Care & Education, Kingston University & St George’s, University of London, London, UK
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Contandriopoulos D, Brousselle A, Dubois CA, Perroux M, Beaulieu MD, Brault I, Kilpatrick K, D'Amour D, Sansgter-Gormley E. A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis. BMC Health Serv Res 2015; 15:78. [PMID: 25889415 PMCID: PMC4349481 DOI: 10.1186/s12913-015-0731-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/06/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations. METHODS In the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec. RESULTS Five core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support. The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes. CONCLUSION It concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.
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Affiliation(s)
- Damien Contandriopoulos
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Astrid Brousselle
- Department of Community Health Sciences, University of Sherbrooke, 150, place Charles-Le Moyne, Bureau 200, Longueuil, Québec, J4K 0A8, Canada.
| | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Mélanie Perroux
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Marie-Dominique Beaulieu
- Department of Family Medicine and Emergency Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900, boul Édouard Montpetit, Montréal, Québec, H3T 1J4, Canada.
| | - Isabelle Brault
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Kelley Kilpatrick
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Danielle D'Amour
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Esther Sansgter-Gormley
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
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Trueman G, Osuji J, El-Hussein MT. Baccalaureate Nursing Students’ Experience of Dyadic Learning in an Acute Care Setting. J Nurs Educ 2014; 53:S65-72. [DOI: 10.3928/01484834-20140821-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 01/29/2014] [Indexed: 11/20/2022]
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Abstract
RÉSUMÉDe plus en plus, les équipes interprofessionnelles sont chargées de fournir la prestation de services de soins de santé intégrés. Cependant, les équipes efficaces ne sont pas le fruit du hasard, mais nécessitent une planification minutieuse et une attention soutenue au processus de développer l’équipe. Basée sur une étude de cas portant sur des entretiens, l’observation participante, et une enquête, nous avons identifié les attributs clés pour le travail interprofessionnel efficace (TIE) dans le cadre de soins primaires à domicile (SPD). Reconnaissant l’importance d’un modèle théorique qui reflète la nature multi-dimensionnelle de la recherche sur l’efficacité de l’équipe, nous avons utilisé le modèle de l’efficacité de l’équipe integrée pour analyser nos résultats. Ces résultats indiquaient qu’une vision commune, des objectifs communs, le respect et la confiance entre les membres de l’équipe—ainsi que la communication continue, la direction efficace et des mécanismes de résolution des conflits—sont essentiels pour le développement d’une equipe de TIE qui fonctionne très bien. L’ambiguité et l’incertitude qui entoure le cadre de la prestation de services (à domicile), ainsi que la négociation des relations extérieures dans le domaine SPD, nécessitent la recherche plus approfondie.
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Andregård AC, Jangland E. The tortuous journey of introducing the nurse practitioner as a new member of the healthcare team: a meta-synthesis. Scand J Caring Sci 2014; 29:3-14. [PMID: 24580718 DOI: 10.1111/scs.12120] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to explore the obstacles to and the opportunities for achieving optimal interprofessional team collaboration with the introduction of the nurse practitioner (NP). A team approach can contribute importantly to sustainable and safe patient care, and NPs have been added to the healthcare team in many countries. Following the international trend towards the development of the acute care NP, the role has recently been initiated in surgical care in Sweden. The introduction of an advanced nursing role into existing organisations raises questions about how the role will be developed and what its effects will be on collaboration between the different professions. We conducted a systematic review of qualitative studies using the meta-ethnographic approach developed by Noblit and Hare. Literature in the field of nursing was searched on PubMed and CINAHL, and empirical qualitative studies from outpatient and inpatient care in seven countries were included. The studies were appraised according to national guidelines and templates and were analysed and synthesised according to the meta-ethnographic approach. A total of 26 studies were included in the synthesis. The analysis revealed four themes: (i) a threat to professional boundaries, (ii) a resource for the team, (iii) the quest for autonomy and control, and (iv) necessary properties of a developing interprofessional collaboration. Based on these themes, the synthesis was created and presented as a metaphorical journey. The implementation of a new nursing role in a traditional healthcare team is a complex process influenced by many factors and can be described as "a tortuous journey towards a partially unknown destination". The synthesised obstacles and opportunities drawn from international studies may help healthcare organisations and new NPs prepare for, and optimise, the implementation of a new nursing role.
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Affiliation(s)
- Anna-Carin Andregård
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
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Hurlock-Chorostecki C, Forchuk C, Orchard C, van Soeren M, Reeves S. Labour saver or building a cohesive interprofessional team? The role of the nurse practitioner within hospitals. J Interprof Care 2013; 28:260-6. [DOI: 10.3109/13561820.2013.867838] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hurlock-Chorostecki C, Forchuk C, Orchard C, van Soeren M, Reeves S. Hospital-based nurse practitioner roles and interprofessional practice: A scoping review. Nurs Health Sci 2013; 16:403-10. [DOI: 10.1111/nhs.12107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Cheryl Forchuk
- Arthur Labatt School of Nursing; Western University; London Ontario
| | - Carole Orchard
- Arthur Labatt School of Nursing; Western University; London Ontario
| | | | - Scott Reeves
- School of Nursing; University of California; San Francisco California USA
- Center for Innovation in Interprofessional Education; University of California; San Francisco California USA
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Nancarrow SA, Roots A, Grace S, Moran AM, Vanniekerk-Lyons K. Implementing large-scale workforce change: learning from 55 pilot sites of allied health workforce redesign in Queensland, Australia. HUMAN RESOURCES FOR HEALTH 2013; 11:66. [PMID: 24330616 PMCID: PMC3895764 DOI: 10.1186/1478-4491-11-66] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/29/2013] [Indexed: 05/21/2023]
Abstract
BACKGROUND Increasingly, health workforces are undergoing high-level 're-engineering' to help them better meet the needs of the population, workforce and service delivery. Queensland Health implemented a large scale 5-year workforce redesign program across more than 13 health-care disciplines. This study synthesized the findings from this program to identify and codify mechanisms associated with successful workforce redesign to help inform other large workforce projects. METHODS This study used Inductive Logic Reasoning (ILR), a process that uses logic models as the primary functional tool to develop theories of change, which are subsequently validated through proposition testing. Initial theories of change were developed from a systematic review of the literature and synthesized using a logic model. These theories of change were then developed into propositions and subsequently tested empirically against documentary, interview, and survey data from 55 projects in the workforce redesign program. RESULTS Three overarching principles were identified that optimized successful workforce redesign: (1) drivers for change need to be close to practice; (2) contexts need to be supportive both at the local levels and legislatively; and (3) mechanisms should include appropriate engagement, resources to facilitate change management, governance, and support structures. Attendance to these factors was uniformly associated with success of individual projects. CONCLUSIONS ILR is a transparent and reproducible method for developing and testing theories of workforce change. Despite the heterogeneity of projects, professions, and approaches used, a consistent set of overarching principles underpinned success of workforce change interventions. These concepts have been operationalized into a workforce change checklist.
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Affiliation(s)
- Susan A Nancarrow
- School of Health and Human Sciences, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia
| | - Alison Roots
- School of Health and Human Sciences, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia
| | - Anna M Moran
- School of Health and Human Sciences, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia
| | - Kerry Vanniekerk-Lyons
- School of Health and Human Sciences, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia
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MacNaughton K, Chreim S, Bourgeault IL. Role construction and boundaries in interprofessional primary health care teams: a qualitative study. BMC Health Serv Res 2013; 13:486. [PMID: 24267663 PMCID: PMC4222600 DOI: 10.1186/1472-6963-13-486] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 11/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. Methods A comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings. Results The findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed. Conclusions Based on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.
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Affiliation(s)
- Kate MacNaughton
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
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Hurlock-Chorostecki C, Forchuk C, Orchard C, Reeves S, van Soeren M. The value of the hospital-based nurse practitioner role: development of a team perspective framework. J Interprof Care 2013; 27:501-8. [DOI: 10.3109/13561820.2013.796915] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Begley C, Murphy K, Higgins A, Cooney A. Policy-makers' views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study. J Nurs Manag 2012; 22:410-22. [DOI: 10.1111/jonm.12018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Cecily Begley
- School of Nursing and Midwifery; Trinity College Dublin; Dublin
| | - Kathy Murphy
- School of Nursing and Midwifery; National University of Ireland; Galway Galway
| | - Agnes Higgins
- School of Nursing and Midwifery; Mental Health Nursing; Trinity College Dublin; Dublin
| | - Adeline Cooney
- School of Nursing and Midwifery; National University of Ireland Galway; Galway Ireland
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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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Kilpatrick K, Lavoie-Tremblay M, Lamothe L, Ritchie JA, Doran D. Conceptual framework of acute care nurse practitioner role enactment, boundary work, and perceptions of team effectiveness. J Adv Nurs 2012; 69:205-17. [PMID: 22632289 DOI: 10.1111/j.1365-2648.2012.06046.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness. BACKGROUND Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team structures and processes to desirable outcomes is needed. DATA SOURCES Literature was obtained by searching CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and Google Scholar from 1985-2010. A descriptive multiple-case study was completed from March 2009-May 2009. DISCUSSION A new conceptual framework describing how role enactment and boundary work affect perceptions of team effectiveness was developed by combining theoretical and empirical sources. The framework proposes proximal indicators used by team members to assess their team's performance. IMPLICATIONS FOR NURSING The framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that reflect the contributions of all providers to quality patient care, and explore the patients' and families' perceptions of team effectiveness following the introduction of acute care nurse practitioners. CONCLUSION The new framework can guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in healthcare teams.
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Affiliation(s)
- Kelley Kilpatrick
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada.
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