Chronic Care Management for the Elderly: An Opportunity for Gerontological Nurse Practitioners

Competencies of nurse practitioners in family practices: A scoping review

AIMS AND OBJECTIVE

To explore the existing literature related to nurse practitioner (NP) competencies in family practices and to examine the evidence and develop a list of competencies.

BACKGROUND

The integration of NPs into the healthcare system is at different stages of progress around the world. Therefore, an overview and clarification of competencies are important to ensure successful implementation of new roles in existing healthcare systems. However, detailed knowledge is lacking about the competencies of NPs in adult care in family practices.

DESIGN AND METHODS

We conducted a scoping review in accordance with the JBI methodology for scoping reviews and the PRISMA-ScR guidelines. We considered studies published in English, German or French from 1965 to the present. Databases searched included MEDLINE, CINAHL, Web of Science and PsycINFO. Sources of grey literature that were searched included ProQuest Dissertations and Theses, OpenGrey and websites of national NP organisations. Two reviewers retrieved full-text studies and extracted data independently. We described the competencies using Hamric's model of advanced practice nursing.

RESULTS

We included 23 publications. Competencies in direct clinical practice were described most often particularly pertaining to nursing or medical tasks. Indirect care activities were frequently mentioned. Less information was found regarding competencies in leadership, ethical decision-making and evidence-based practice. We found elementary and extended competencies required to perform the role in family practices. Depending on the country, the role was either emerging or already well-established.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

This review provides insight into current knowledge about competencies of NP in family practices. The identified competencies can be used to develop job descriptions or to conceptualise professional development programmes in countries where such roles are just recently emerging. A list of competencies will promote a common understanding of the NP role and to help clarify interprofessional collaboration in clinical practice.

Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

Background

Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in Swiss primary care.

Methods

This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively.

Results

Data from 5210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70–4.36), multimorbid (OR 1.37; 95%-CI 1.24–1.51; p < 0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15–1.42; p < 0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72–3.42; p < 0.001) and anthropometric data (OR 1.33; 95%-CI 1.09–1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04–1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30–0.41; p < 0.001) were prescribed or changed less frequently in NP consultations.

Conclusions

Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care.

Policy Approaches to Chronic Disease Management

As health care costs continue rising and the elderly population steadily grows, our health care system's ability to cost-effectively care for the nation's elderly population with chronic disease presents a daunting challenge to the country's health care system. Our government is searching for the most costefficient and quality-driven methods to effectively manage the complex health care needs of a growing elder population with chronic disease states. The Medicare Prescription, Drug, Improvement, and Modernization Act of 2003 provided for phased-in development, testing, evaluation, and implementation of chronic care improvement programs in the traditional Medicare fee-for-service program meeting specific criteria. This article reviews the limitations of the current demonstration project and the policy changes necessary to facilitate and promote the home care industry's and the nursing profession's participation and provision of chronic disease management services in our nation.

Rural geriatric glue: a nurse practitioner-led model of care for enhancing primary care for frail older adults within an ecosystem approach

OBJECTIVES

This article describes the implementation of the Care for Seniors model of care, an innovative approach to improving care coordination and integration, and provides preliminary evidence of effective use of specialist resources and acute care services.

DESIGN

Retrospective.

SETTING

Primary care; cross-sector.

PARTICIPANTS

Older adults living in a rural area in southwestern Ontario, Canada.

MEASUREMENTS

Number of new geriatrician referrals and follow-up visits before and after the launch of the Care for Seniors program, number of Nurse Practitioner visits in a primary care setting, in-home, retirement home and hospital, number of discharges home from hospital and length of hospital stay between.

RESULTS

In the 2 years before the launch of the program, the total number of visits to the geriatrician for individuals from this FHT was relatively low, 21 and 15, respectively for 2005-06 and 2006-07, increasing to 73 for the 2011-12 year. Although the absolute number of individuals supported by the NP-Geri has remained relatively the same, the numbers seen in the primary care office or in the senior's clinic has declined over time, and the number of home visits has increased, as have visits in the retirement homes. The percentage of individuals discharged home increased from 19% in 2008-09 to 31% in 2009-10 and 26% in 2011-12 and the average length of stay decreased over time.

CONCLUSIONS

This model of care represents a promising collaboration between primary care and specialist care for improving care to frail older adults living in rural communities, potentially improving timely access to health care and crisis intervention.

Back to basics: importance of nursing interventions in the elderly critical care patient

The global population is aging, and with that comes new challenges. Optimal care must be delivered to minimize the time spent in the acute care setting. Avoiding costly complications and focusing on health promotion rather than disease management will be key. Geriatrics is a complex patient population and basic nursing care is essential to prevent unnecessary complications if our health care system is to survive. Our profession is ill prepared to optimally care for this patient population.

Gerontological nurses' perceptions of their rights in Finland

BACKGROUND

These are challenging times for gerontological nurses, due to the increasing need for older people care services and nursing expertise and to the burdensome nature of older people care. These changes also challenge professional ethics. Traditionally, literature has focused more on nurses' duties and responsibilities, rather than on their rights.

AIM

The aim was to explore the concept of nurses' rights from the perspective of nurses in gerontological care.

METHODS

A qualitative study conducted among gerontological nurses (n = 29) in the older people care of two publicly provided municipal older people care organisations in two mid-range towns in Finland. Participation in the study was voluntary, and the participants were recruited in collaboration with a nurse executive. The data, collected in 11 interviews (1-4 participants in each) using open-ended interview method, were analysed by inductive content analysis.

FINDINGS

Based on our findings, nurses' rights are an integral part of everyday nursing. As professionals, nurses pointed out that their rights are based on legislation and ethics, and their rights involve colleagues, managers, organisation, and patients and relatives. Their rights were connected to nurses' professional expertise and their well-being at work, but at the end, they were a factor to improving quality of older people care. This required that nurses' rights were taken as visible and elementary part of management.

CONCLUSION

On the basis of our findings, especially in very demanding areas of nursing, like older people care, nurses' rights deserve major visibility and should be taken into consideration when planning care.

[Task analysis of the job description of gerontological nurse practitioners based on DACUM]

PURPOSE

The aim of this study was to develop and to analyze the task of gerontological nurse practitioners (GNPs) in Korea.

METHODS

The definition of GNP and job description was developed based on developing a curriculum (DACUM) by 7 panels who have experienced in DACUM analysis and gerontological nursing. One hundred sixty nurses who were working at long term care facilities were participated. The questionnaire included frequency, importance, and difficulty of duties, tasks, and task elements. The data were collected in November 2006, analyzed by descriptive statistics.

RESULTS

The job description of GNPs in Korea revealed 5 duties, 23 tasks, and 86 task elements. On the all five duties, the highest duty in frequency and in importance was professional nursing care (3.25+/-0.35, 3.49+/-0.29). But the highest duty in difficulty was research (3.24+/-0.46). 'Prevent health problem (3.42+/-0.43, 3.56+/-0.33)', 'Teach other staffs (2.83+/-0.77, 3.39+/-0.43)', 'Develop the evidence-based standards (2.43+/-0.76, 3.22+/-0.43)', 'Develop the self (2.81+/-0.65, 3.26+/-0.42)', and 'Participate the team activities' were the highest score in frequency and in criticality of tasks. 'Provide emotional support to older adults and families (3.16+/-0.41)', 'Counsel older adults and their families (3.14+/-0.49)', 'Do clinical research (3.32+/-0.49)', 'Quality insurance (3.25+/-0.49)', and 'Build collaborative system (3.18+/-0.47)' were perceived the most difficult tasks.

CONCLUSION

The political efforts for the legislation of role and task of GNPs were needed.