Perceptions of Effectiveness of Nurse-Managed Clinics: A Cross-Cultural Study

The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care

BACKGROUND

This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare.

METHODS

We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare.

RESULTS

Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles.

CONCLUSIONS

While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners.

Practitioner perspectives on best practice in non-treatment factors that support the delivery of repetitive transcranial magnetic stimulation (rTMS) for depression

WHAT IS KNOWN ABOUT THE SUBJECT?: The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomes To date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment. There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insights into service and personalized non-treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patients It reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The need to apply findings for the development of best practice guidance Factors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff.

Establishing a nurse-managed health center for the urban poor in Dhaka, Bangladesh

OBJECTIVES

Despite the rise in community health problems in populations living in urban slums, activities of community health nurses are limited in Bangladesh. This study aimed to describe how a nurse-managed health center (NMHC) was developed in Dhaka, Bangladesh.

DESIGN

An exploratory-descriptive research design was used.

SAMPLE AND MEASUREMENTS

The commitment phase was conducted to establish partnerships in the community. Involvement of community leaders and members and partnerships with various organizations were established successfully in the commitment phase. The assessment phase was completed by implementing personal interviews, community site visits, and household surveys of 172 households in the community. Action plans were developed and strategies were followed to change the community during the planning phase.

RESULTS

Household survey results showed that community people suffered from non-communicable diseases, risk behaviors, and inadequate housing conditions. The high-priority community needs included nutrition and chronic management services, behavior change programs, and a clean environment. Action plans for health programs based on community needs and strategies such as securing manpower and equipment were developed.

CONCLUSIONS

The systematic process of creating a NMHC, and the necessity of the community health nurse's role in responding to health needs of the urban poor in Dhaka, Bangladesh was confirmed.

Capturing treatment decision making among patients with solid tumors and their caregivers

PURPOSE/OBJECTIVES

To examine the feasibility and acceptability of using a decision aid with an interactive decision-making process in patients with solid tumors and their caregivers during cancer-related treatment.

RESEARCH APPROACH

A phenomenologic approach was used to analyze qualitative data, with a focus on the meaning of participants' lived experiences. Interviews were conducted by telephone or in person.

SETTING

Outpatient clinics at two regional cancer centers.

PARTICIPANTS

160 total individuals; 80 patients with newly diagnosed breast (n = 22), advanced-stage prostate (n = 19), or advanced-stage lung (n = 39) cancer, and their caregivers (n = 80).

METHODOLOGIC APPROACH

Twenty-seven of the 80 pairs engaged in audio recorded interviews that were conducted using a semistructured interview guide. Continuous text immersion revealed themes. Validity of qualitative analysis was achieved by member checking.

FINDINGS

Significant findings included three themes: (a) the decision aid helped patients and caregivers understand treatment decisions better, (b) the decision aid helped patients and caregivers to be more involved in treatment decisions, and (c) frequent contact with the study nurse was valuable.

CONCLUSIONS

Decision making was more complex than participants expected. The decision aid helped patients and caregivers make satisfying treatment decisions and become integral in a shared treatment decision-making process.

INTERPRETATION

Decision aids can help patients and their caregivers make difficult treatment decisions affecting quantity and quality of life during cancer treatment. The findings provide valuable information for healthcare providers helping patients and their caregivers make treatment decisions through a shared, informed, decision-making process.

KNOWLEDGE TRANSLATION

Decision aids can be helpful with treatment choices. Caregivers' understanding about treatment is just as important in the decision-making process as the patients' understanding. Incorporating decision aids that are delivered by healthcare providers or trained personnel has the potential to improve patients' decision satisfaction.

Quality of care in nurse-managed health centers

PURPOSE

The purposes of this article are to: (a) describe the first, national, collection of quality measures for nurse-managed health centers (NMHCs); (b) present the quality findings; (c) compare findings with national ambulatory care benchmarks; and (d) discuss the feasibility of national quality data collection, including NMHCs' experiences with data submission and the utilization of findings.

METHODS

Quality outcomes appropriate for aggregated assessment of NMHC quality were proposed by a committee of the National Institute for Nursing Centers. Quality measures related to these outcomes were developed for breast cancer screening, cervical cancer screening, diabetes care, hypertension management, and smoking cessation based on protocols of the Health care Effectiveness Data and Information Set. Nine NMHCs were recruited to participate in retrospective data collection, manually from record audits or electronically from the submission of data files.

RESULTS

Overall, quality measure findings compared favorably with national benchmarks, with particularly high quality demonstrated for chronic disease care management.

CONCLUSIONS

Good to very good quality of care was documented across NMHCs, and NMHCs compared favorably with national benchmarks. Data were useful to NMHCs in identifying quality strengths and areas for improvement. National data collection proved to be feasible.

Mental Health Nurse Incentive Program: contributing to positive client outcomes

Mental health conditions are likely to affect almost half of the population at some stage in their lives. Despite the magnitude and potentially serious consequences of mental illness and disorders, access to services is a significant problem. In 2007, the Mental Health Nurse Incentive Program (MHNIP) was implemented to improve access to mental health care in Australia. Mental health nurses are engaged under the MHNIP to work with general practitioners, psychiatrists, and other mental health professionals to treat clients experiencing a mental health condition. This paper presents findings from a qualitative exploration of nurses working under the MHNIP in Australia. In-depth interviews were conducted with 10 nurses currently working under the MHNIP to gain an understanding of their roles and their perceptions of the effectiveness of this new programme. Data were analysed using NVivo. Four major themes emerged: developing the role, a holistic approach, working collaboratively, and benefits to clients. The findings suggest that mental health nurses have the potential to make a significant contribution to enhancing access to, and the quality of, mental health care through flexible and innovative approaches.

A Psychiatric Nurse's Perspective: Helping Patients Undergo Repetitive Transcranial Magnetic Stimulation (rTMS) for Depression

With the October 2008 Food and Drug Administration approval of repetitive transcranial magnetic stimulation (rTMS) for depression treatment, the establishment and administration of rTMS clinical treatment programs are critically important and emerging areas for psychiatric nursing leadership. There is growing recognition that many patients are unable to tolerate antidepressant medications and require alternative antidepressant treatment approaches. The enormous growth in the field of brain stimulation creates exciting new therapeutic options for patients with treatment-resistant depression. As with any clinical breakthrough, new treatments offer exciting possibilities but also require growth in psychiatric nursing knowledge, different practice competencies, and new ways of organizing care. This article discusses current practice guidelines, psychiatric nursing qualifications, and essential details about developing an rTMS clinical service. This is the first article to describe the role of a psychiatric nurse establishing a clinical rTMS service, administering rTMS, and helping patients undergo the treatment. The authors share the progress made and the lessons learned.

Assessing quality of care for African Americans with hypertension

African Americans bear a disproportionate burden of hypertension. A causal-modeling design, using Donabedian's Quality Framework, tested hypothesized relationships among structure, process, and outcome variables to assess quality of care provided to this population. Structural assessment revealed that administrative and staff organization affected patients' trust in their provider and satisfaction with their care. Interpersonal process factors of racism, cultural mistrust, and trust in providers had a significant effect on satisfaction, and perceived racism had a negative effect on blood pressure (BP). Poorer quality in technical processes of care was associated with higher BP. Findings support the utility of Donabedian's framework for assessing quality of care in a disease-specific population.