Patient satisfaction with nurse practitioner-delivered primary healthcare services

Evaluation of the Nurse Practitioner Offsite Model

Rural older adults residing in assisted living (AL) (herein referred to as residents) have limited access to health care for urgent and chronic management of diseases. The current project aimed to assess rural residents, families, and staff satisfaction with the Nurse Practitioner (NP) Offsite Visit Program. Residents and their families were asked to complete the NP Satisfaction Survey. The survey comprised three subscales (satisfaction, communication, and accessibility) and measured residents' and families' satisfaction. AL staff attended a 1-hour focus interview. Mean survey scores were 81.5 for satisfaction, 26.4 for communication, and 16.9 for accessibility subscales. Focus interview themes included Care Coordination, Prevention of Acute Care Utilization, and Access to Care. Findings suggest that residents, families, and site staff believe the NP Offsite Visit Program was beneficial and improved care coordination between residents and the provider team. The next step is to evaluate the program's impact on residents' health outcomes and further evaluate the Offsite team membership. [Journal of Gerontological Nursing, 49(7), 25-30.].

Aboriginal children and family connections to primary health care whilst homeless and in high housing mobility: observations from a Nurse Practitioner-led service

Aim:

This article documents the impact of a Nurse Practitioner-led primary health service for disadvantaged children living in housing instability or homelessness. It identifies that First Nations children miss out on essential primary care, particularly immunisation, but have less severe health conditions than non-First Nations children living in housing insecurity.

Background:

Health services for homeless populations focus on the 11% of rough sleepers, little is done for the 22% of children in Australia living in housing instability; many of whom are from First Nations families. Little is known of the health status of these children or their connections to appropriate primary health care.

Methods:

This research implemented an innovative model of extended health care delivery, embedding a Nurse Practitioner in a homeless service to work with families providing health assessments and referrals, using clinically validated assessment tools. This article reports on proof of concept findings on the service that measured immunisation rates, developmental, medical, dental and mental health needs of children, particularly First Nations children, using a three-point severity level scale with Level 3 being the most severe and in need of immediate referral to a specialist medical service.

Findings:

Forty-three children were referred by the service to the Nurse Practitioner over a 6-month period, with nine identifying as First Nations children. Differences in severity levels between First Nations/non-First Nations children were Level 1, First Nations/non-First Nations 0/15%; Level 2, 10/17%; and Level 3, 45/29%. Forty-five percent of First Nations children had no health problems, as compared to 29% on non-First Nations children. Immunisation rates were low for both cohorts. No First Nations child was immunised and only 9% of the non-First Nations children. While numbers for both cohorts are too low for valid statistical analysis, the lower levels of severity for First Nations children suggest stronger extended family support and the positive impact of cultural norms of reciprocity.

Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS^®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey

AIM

The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice.

DESIGN

Cross-sectional survey; validity and reliability analysis.

METHODS

The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations.

RESULTS

A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement.

CONCLUSION

The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP.

IMPACT

Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.

Patients' experiences with the advanced practice nurse role in Swiss family practices: a qualitative study

Background

Considering shortages of general practitioners (GP) and strategies for improving the quality of health care provision, many countries have implemented interprofessional care models with advanced practice nurses (APN). International evidence suggests that APN care results in high patient satisfaction. In Switzerland, the role is still new, and the patient perspective has not yet been researched. Our aim was therefore to explore patients’ experiences with the APN role in Swiss family practices.

Methods

We conducted 22 semi-structured interviews in four different family practices with patients aged 18 to 97 suffering from minor acute to multiple chronic diseases, and who had at least one consultation with an APN. All interviews were audiotaped, transcribed verbatim, and analysed using qualitative content analysis.

Results

The analysis resulted in five themes: Despite the unfamiliarity, all patients were willing to be consulted by an APN because it was recommended by their GP (1); after several encounters, most participants perceived differences between the APN and the GP consultation in terms of the length and style of the consultations as well as the complexity of their tasks (2); the interviewees emphasised coaching, guidance, care coordination, and GP-assisting tasks as APN core competencies and attributed the characteristics empathetic, trustworthy, and competent to the APN role (3); most patients especially valued home visits and the holistic approach of the APNs, but they also noticed that in certain cases GP supervision was required (4); and due to the close collaboration between the APN and the GP, patients felt safe, well cared for and experienced improvements in physical and psychological well-being as well as in daily activities (5).

Conclusion

Our results suggested that patients value the APNs’ competencies, despite their initial lack of role knowledge. Trust in the GP seemed to be the most important factor for patients’ receptiveness toward the APN role. Overall, patients perceived an added value due to the enlargement of the scope of practice offered by APNs. The patient perspective might provide valuable insights for further APN role implementation in Swiss family practices.

Job satisfaction among oncology nurse practitioners

BACKGROUND

One proposed solution to the predicted shortage of oncology nurse practitioners (NPs) is expanding the role of the oncology NP. However, role expansion may lead to an increase in work-related stress and a decrease in job satisfaction. It is important to understand oncology NPs' job satisfaction and stress and their intent to leave their job or profession in order to further develop and potentially expand the role.

PURPOSE

The purpose of this study is to determine the main factors that affect job satisfaction, especially the relationship with stress and the intent to leave the oncology specialty.

METHODS

A convenience sample of responses to a series of surveys administered by the Oncology Nursing Society and residing in the ONS database was used for this analysis. Exploratory data analysis, principal component analysis, and regression models were applied to explore characteristics of the questionnaires, assess the reliability of the Coping Skills Questionnaire, and find out main factors for their intent to leave.

RESULTS

Items in the Coping Skills Questionnaire were internally consistent, and stress had a positive effect on NPs' intent to leave. Satisfaction and coping skills were also significant in some models; higher levels of satisfaction and coping skills resulted in lower levels of intent to leave. Moreover, several demographic factors such as having children, schedule days off, and patient population also affected the response significantly.

IMPLICATIONS FOR PRACTICE

This study provides nursing leaders with information to guide retention of NPs.

Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study

OBJECTIVES

To explore patient satisfaction, gout knowledge, medication adherence and flares among participants receiving nurse-led or general practitioner (GP)-led care of gout in the Nottingham Gout Treatment Trial phase-II (NGTT-II).

METHODS

A total of 438 participants of NGTT-II were sent a questionnaire enquiring about gout knowledge, satisfaction with health-care practitioner, urate-lowering treatment being undertaken, and gout flares ⩾1 year after their final visit. Nurse-led care participants were asked about their preference for receiving gout treatment from either a GP or a nurse.

RESULTS

Completed questionnaires were returned by 82% of participants. Participants previously receiving nurse-led care reported greater satisfaction with health-care practitioner (P < 0.001), had better gout knowledge (P = 0.02), were more likely to be taking urate-lowering treatment [adjusted relative risk (95% CI) 1.19 (1.09, 1.30)], and self-reported fewer flares in the previous 12 months [median (inter-quartile range) 0 (0-0) vs 1 (0-3), P < 0.001] than those receiving GP-led care. Of participants receiving nurse-led care, 41-63% indicated preference for receiving gout treatment from a nurse, while only 5-20% indicated preference for receiving treatment from GPs.

CONCLUSION

The results of this study favour nurse-led care, involving individualized patient education and engagement and a treat-to-target strategy, in terms of patient acceptability, long-term adherence, and flares. Further research is required to evaluate the feasibility of implementing such a model of care in clinical practice.

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling

The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.

Patient satisfaction: Concept analysis in the healthcare context

OBJECTIVE

Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.

METHODS

The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.

RESULTS

The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.

CONCLUSION

As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.

PRACTICE IMPLICATIONS

To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction.

Nurse practitioner consultations in primary health care: a case study-based survey of patients' pre-consultation expectations, and post-consultation satisfaction and enablement

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.

Collaborative communication: learning from advanced clinical practice patient consultations

Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations.

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse

INTRODUCTION

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system.

AIM

To describe patients' experiences of health care provided by an APN in primary health care.

METHODS

An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze.

RESULTS

The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care.

CONCLUSION

The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context.

Patient Perspectives on Nurse Practitioner Care in Oncology in Canada

PURPOSE

The purpose of this study was to add to what is known about patient satisfaction with nurse practitioner (NP) care, from the perspective of breast cancer patients who were followed by an NP.

METHODS AND DESIGN

This study utilized Interpretive Description, a qualitative method aimed at making sense of the experiential aspects of health care and developing practical knowledge for improved care. Nine patients receiving NP-led care in an outpatient breast cancer clinic were interviewed about their perspectives on and experiences with NP-led care. Interview transcripts were thematically analyzed.

FINDINGS

The NP role has long been regarded as a way of addressing many contemporary health system problems, although there continue to be barriers to the effective utilization of the role, including public and patient misunderstandings. This study revealed that, despite persistent traditional role understandings about health professionals, the patient participants appreciated the benefits of NP care and were highly satisfied with both the physical care and holistic support they received during the course of their treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

Today's healthcare system is characterized by accessibility issues, unmet patient need, workforce issues, and funding pressures. This research supports and enriches what is known about the benefits and usefulness of NP-provided care from the viewpoint of those receiving the care. The findings offer guidance to NPs in the clinical setting regarding patient needs and optimal care strategies.

Integration of advanced practice providers into the Israeli healthcare system

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.

Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses

BACKGROUND

In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction.

OBJECTIVES

The aim of this study was to investigate the effect of emergency department (ED) nurses' job specialization on their job satisfaction and the length of patient stay in the ED.

PATIENTS AND METHODS

This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses' job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses' job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests.

RESULTS

There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P < 0.001). Moreover, compared with the pretest readings, nurses had greater job satisfaction after the study (P < 0.001).

CONCLUSIONS

The job specialization intervention can improve nurses' satisfaction and relieve the crowdedness of the EDs.

Nurse practitioner perceptions of the impact of physician oversight on quality and safety of nurse practitioner practice

PURPOSE

Nurse practitioner (NP) regulation and physician oversight (PO) of NP practice are inextricably intertwined. A flexible, well-prepared workforce is needed to meet consumer healthcare needs. All outcome studies have revealed that NPs provide safe, effective, quality care with outcomes equal to or better than that of physicians or physician assistants. Variability in state regulation of NP practice limits the full deployment of these proven healthcare providers, threatens the quality and safety of NP-delivered care, and limits consumer choice in healthcare access. The purpose of this study was to document NP perceptions of the impact of PO on the safety and quality of NP practice.

DATA SOURCES

A total of 1139 NP respondents completed an exploratory survey, Impact of Regulatory Requirements for Physician Oversight on Nurse Practitioner Practice. Participants were asked their perceptions of the impact of PO on patient care and NP practice. Descriptive statistics on the state of residence regulatory requirements and personal demographics were also collected.

CONCLUSIONS

NP perceptions of the impact of PO on the safety and quality of NP practice were predicted by NP experience and state regulatory environment ranking.

IMPLICATIONS FOR PRACTICE

The results of this study have implications for educators, policy makers, and nursing advocacy groups seeking to increase access to care in U.S.

POPULATIONS

Study participants perceived that requirements for PO impacted their practice and may jeopardize patient safety. An understanding of the impact of influences on regulatory processes is critical to ensuring full deployment of NPs as interprofessional leaders to meet current and future healthcare access.

Scoping study into wound management nurse practitioner models of practice

OBJECTIVES

The primary objective of this research was to investigate wound management nurse practitioner (WMNP) models of service for the purposes of identifying parameters of practice and how patient outcomes are measured.

METHODS

A scoping study was conducted with all authorised WMNPs in Australia from October to December 2012 using survey methodology. A questionnaire was developed to obtain data on the role and practice parameters of authorised WMNPs in Australia. The tool comprised seven sections and included a total of 59 questions. The questionnaire was distributed to all members of the WMNP Online Peer Review Group, to which it was anticipated the majority of WMNPs belonged.

RESULTS

Twenty-one WMNPs responded (response rate 87%), with the results based on a subset of respondents who stated that, at the time of the questionnaire, they were employed as a WMNP, therefore yielding a response rate of 71% (n=15). Most respondents (93%; n=14) were employed in the public sector, with an average of 64 occasions of service per month. The typical length of a new case consultation was 60 min, with 32 min for follow ups. The most frequently performed activity was wound photography (83%; n=12), patient, family or carer education (75%; n=12), Doppler ankle-brachial pressure index assessment (58%; n=12), conservative sharp wound debridement (58%; n=12) and counselling (50%; n=12). The most routinely prescribed medications were local anaesthetics (25%; n=12) and oral antibiotics (25%; n=12). Data were routinely collected by 91% of respondents on service-related and wound-related parameters to monitor patient outcomes, to justify and improve health services provided.

CONCLUSION

This study yielded important baseline information on this professional group, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are measured.

HIGH PATIENT SATISFACTION WITH NURSE PRACTITIONER DELIVERED SERVICES AT TWO HEALTH CENTRES IN URBAN JAMAICA

Abstract Background: Nurse practitioners are playing an increasing role in the delivery of primary healthcare. Patient satisfaction with their services patients is an important factor to the expansion of their role in the health services. Objective: To explore the level of patient satisfaction with nurse practitioner delivered services at two health centres in urban Jamaica. Method: A cross sectional survey of 120 adult clients (age ≥18 years old) seen by Nurse Practitioner at a Type 3 or Type 5 health centre in Kingston, Jamaica was conducted using a modified self-administered Nurse Practitioner Satisfaction Survey questionnaire. Data were analyzed using SPSS® version 18 for Windows®. Results: The study achieved response rate of 91.6% (n=120). The majority were females (77%) with an average age of 40 ± 16 years. Most (63%) were from the Type 5 health centre and the rest (37%) were from a Type 3 facility. The mean general satisfaction score was 81 out of a possible 90 and 83% of the respondents reported they were very satisfied with another 17% expressing that they were satisfied with the nurse practitioner services at both facilities. No respondent was dissatisfied. The mean satisfaction score was significantly higher among respondents 40 years and older than that of their younger counterparts. Socio demographic and organization characteristics were not associated with the mean satisfaction score. Conclusions: A high level of satisfaction exists among patients seen by nurse practitioners at two facilities in Kingston, Jamaica. This may represent an opportunity for expanded role of Nurse practitioners in the delivery of primary in Jamaica.

Patients' satisfaction with the care offered by advanced practice nurses: a new role in Swedish primary care

The aim of this study is to describe patients' satisfaction with the new role of advanced practice nurses (APNs) in Swedish primary care. A questionnaire pertaining to patient satisfaction with the care offered by APNs was sent to respondents. Descriptive statistics, a chi-squared test and manifest qualitative content analysis were used during analysis. Although the results show an overall high level of patient satisfaction as regards APN-led care, those patients informed of the APN role prior to a consultation were significantly more satisfied. Respondents' comments indicate that professional treatment and competence are characteristic of the care offered by APNs and also relate the concepts of increased availability of and continuity in health care to the APN role. In order to guarantee the positive development of the APN role in Sweden, continued research is needed from patient, organizational and interprofessional perspectives, including intervention studies of cost effectiveness and the quality of care.

Developing a public health policy-research nexus: an evaluation of Nurse Practitioner models in aged care

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.

Using the Donabedian framework to examine the quality and safety of nursing service innovation

AIMS AND OBJECTIVES

To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome.

BACKGROUND

Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation.

DESIGN

A mixed-methods design within the Donabedian evaluation framework was used.

METHODS

The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes.

RESULTS

The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients.

CONCLUSIONS

This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components.

RELEVANCE TO CLINICAL PRACTICE

Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.

Aged care nurse practitioners in Australia: evidence for the development of their role

Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings. Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required. What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner. There is international evidence that nurse practitioners provide high-quality healthcare. Despite being established in the United States for nearly 50 years, nurse practitioners are a relatively recent addition to the Australian health workforce. What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations. What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.

Advanced practice nursing for enduring health needs management: a global perspective

Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.

The patient satisfaction with nursing care quality: the psychometric study of the Serbian version of PSNCQ questionnaire

INTRODUCTION

Patient satisfaction with nursing is the most important predictor of patients' overall satisfaction with their hospital care. According to the Law of Health Care of Republic of Serbia monitoring of patients' satisfaction with hospital service is mandatory; however, the questionnaire applied to that purpose includes only several questions directly addressing the nursing care issue.

AIM

The aim of the present study was to evaluate psychometric properties of the Serbian version Patient Satisfaction Nursing Care Quality Questionnaire (PSNCQQ) and explore patients' satisfaction of nursing care they received and assess the relationship between patient satisfaction and patient characteristics.

METHODS

This cross-sectional study included a sample population of 240 patients who were discharged from surgical clinics of the Clinical Center of Vojvodina in Novi Sad. The PSNCQQ was translated into Serbian according to standard procedures for forward and backward translation. Factor analysis was used to determine the construct validity, and predictive validity of the questionnaire was previously assessed. Cronbach's α coefficient and item analysis was conducted to evaluate reliability of the scale.

RESULTS

The Serbian version Patient Satisfaction Nursing Care Quality Questionnaire (PSNCQQ) showed a one-factor structure, Cronbach's α reliability coefficient was excellent 0.94 and was similar across hospital categories. The correlation coefficient between 19 items and the total scale was high, and ranged from 0.56 to 0.76. Patients' age, educational level and previous hospitalization period were important factors that affected their satisfaction with nursing care.

CONCLUSION

The study provides a new tool for measuring patient satisfaction with nursing care in Serbia that may present a useful instrument for nursing care managers in improving the nursing care process.