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Vara-Ortiz MÁ, Marcos-Alonso S, Fabrellas-Padrés N. Experience of primary care nurses applying nurse-led management of patients with acute minor illnesses. Int J Nurs Pract 2023:e13216. [PMID: 37964496 DOI: 10.1111/ijn.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/25/2022] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of this study is to determine the experience of primary health care nurses regarding the application of nurse-led management in patients with acute minor illnesses. BACKGROUND Nursing leadership of care for acute minor illnesses is a new challenge faced by nurses in Spain. DESIGN Qualitative, hermeneutical, interpretive phenomenological approach is used. The Consolidated criteria for reporting qualitative research guidelines were applied. METHODS Twenty primary care nurses participated; three focus group discussions and nine semi-structured interviews were conducted between November 2019 and October 2020. All the focus group discussions and interviews were recorded, transcribed verbatim and analysed using content analysis. RESULTS Seven main themes emerged from the focus group discussions and interviews: concept, perception of the other actors, practice, history and social context, competencies, training, and legality. CONCLUSION The study shows the diversity and complexity of nurses' experience when applying nurse-led management in acute minor illnesses. This work has helped to show the gaps perceived by nurses, including the lack of training in the treatment of conditions historically attended by physicians, the lack of definition of the legal framework and the limitations on nurse prescribing. It also highlighted the power of the nursing profession in terms of autonomy, competencies and role expansion.
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Vara-Ortiz MÁ, Fabrellas Padrés N. [Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia]. Aten Primaria 2022; 54:102491. [PMID: 36272398 PMCID: PMC9586855 DOI: 10.1016/j.aprim.2022.102491] [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: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objetivo Conocer la experiencia de las enfermeras de atención primaria en la aplicación de la gestión enfermera de la demanda (GED). Diseño Estudio observacional, descriptivo y transversal. Emplazamiento Atención primaria de Cataluña. Participantes Enfermeras de atención primaria de Cataluña. Se estimó una muestra de 394 participantes alcanzando 405. La obtención de datos fue desde octubre de 2021 hasta enero de 2022. Mediciones principales Se realizó un cuestionario ad hoc, el cual exploraba aspectos referentes a la experiencia de aplicación de la GED: definición y manejo del programa, formación y aspectos legales del programa. Resultados Las enfermeras entienden la GED como un triaje. Además, consideran que la implantación de la prescripción enfermera no mejora la aplicación de la GED. Manifiestan una falta de formación especialmente las enfermeras más noveles. La formación ideal en GED, consideran, debería incluir fisiopatología y supuestos prácticos. Siete de cada 10 enfermeras desconocen el marco legal que ampara la GED y les provoca inseguridad no conocerlo. Seis de cada 10 han dejado de ser resolutivas por miedo a las repercusiones legales. Las enfermeras que sí conocen el marco legal son las que han dejado de resolver en menor proporción. Conclusiones Se constata la necesidad de formación general en la GED y en los aspectos legales que dan cobertura al programa especialmente en las enfermeras más jóvenes y con menos experiencia en atención primaria. De esta manera se mejorará la aplicación y aceptación del rol autónomo enfermero en la gestión de enfermedades agudas leves.
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Affiliation(s)
- María Ángeles Vara-Ortiz
- Escola d'Infermeria, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, España; Centro de Atención Primaria Barri Llatí, Santa Coloma de Gramenet, Barcelona, España.
| | - Núria Fabrellas Padrés
- Escola d'Infermeria, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, España
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Fernández Molero S, Laserna Jiménez C, Baiget Ortega A, Flayeh Beneyto S, Ríos Jiménez A, Fabrellas Padrés N. Treatment of minor health problems by primary care nurses: A cross-sectional study. J Clin Nurs 2022; 32:2913-2921. [PMID: 35844060 DOI: 10.1111/jocn.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
AIMS To assess the results of a nursing-led program to treatment of minor health issues from Catalan health institute primary care teams during 2019 and 2020. BACKGROUND In 2009, the Catalan health institute implemented a nursing program to deal with minor health problems. This nursing-led program includes an algorithm for each of the minor health problems and arose as a strategy to reorganise the flow of demand for care in primary care. DESIGN A cross-sectional design. METHODS Multicentric cross-sectional study. 392 primary care teams from the Catalan health institute participated in the study. STROBE guideline was followed in reporting this study. Patients attending any of the participating centres requesting a same-day consultation for minor health issues were registered. RESULTS A total of 21,215,278 consultations were recorded: 18,284,105 for adult and 2,931,173 for paediatric patients. Minor health issue resolved by the nurse was achieved in 50.9% of adult patients and 55.4% of paediatric patients. The highest rates of resolution in adults (>85%) were as follows: burns, emergency contraception and injuries. The highest resolution rates (>84%) were as follows: burns, breastfeeding difficulties and infant colic. 87.7% of prescriptions issued by nurses were accepted by the family physician. CONCLUSIONS The nursing-led program to treat minor health issues has been shown to present acceptable resolution for nurses in a large primary care setting. Nurses have been carrying out prescription activities with very favourable results. RELEVANCE TO CLINICAL PRACTICE This study demonstrates that care provided to patients by nurses for minor health issues requiring preferential resolution is effective. Our results are useful in that they confirm both the effectiveness of the nursing-led program for minor health issues and the pharmacological prescriptions produced during patient appointments. PATIENT OR PUBLIC CONTRIBUTION Patient's data were obtained through a program records system after the minor health issues appointments.
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Affiliation(s)
- Sonia Fernández Molero
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Cristina Laserna Jiménez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Andreu Baiget Ortega
- Informatic of Can Bou Primary Care Center, CASAP, Castelldefels, Barcelona, Spain
| | - Souhel Flayeh Beneyto
- EAP Badalona, Institut Català de la Salut, Barcelona, Spain.,Nursing of Information System of Primary Care Services, Barcelona, Spain
| | - Ana Ríos Jiménez
- Nursing Coordinating of Primary Care, Institut Català de la Salut, Barcelona, Spain
| | - Núria Fabrellas Padrés
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
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Dall'Oglio I, Rosati GV, Biagioli V, Tiozzo E, Gawronski O, Ricci R, Garofalo A, Piga S, Gramaccioni S, Di Maria C, Vanzi V, Querciati A, Alvaro R, Biancalani L, Buonomo E, Doria M, Villani A. Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians. BMC FAMILY PRACTICE 2021; 22:136. [PMID: 34187392 PMCID: PMC8243477 DOI: 10.1186/s12875-021-01457-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices. METHODS An online survey with pediatricians working in primary care in Italy was conducted between April-December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. RESULTS Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician's office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians 'with less working experience', 'having their office in a small town', and 'collaborating with a secretary and other workers in the office' rated the nurse's activities significantly more useful. CONCLUSIONS A pediatric nurse in the pediatrician's office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting.
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Affiliation(s)
- Immacolata Dall'Oglio
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Vitali Rosati
- Italian Pediatric Society, Rome, Italy
- Italian Federation of Pediatric Physicians, Rome, Italy
| | - Valentina Biagioli
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Emanuela Tiozzo
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Orsola Gawronski
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Riccardo Ricci
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Antonio Garofalo
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Gramaccioni
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Claudio Di Maria
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Valentina Vanzi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Alessandra Querciati
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatric Physicians, Rome, Italy
| | - Alberto Villani
- Italian Pediatric Society, Rome, Italy
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Nurses in Family Pediatric Practices: A Survey of the Health Protection Agency of the Metropolitan City of Milan. J Pediatr Nurs 2021; 56:1-6. [PMID: 33181366 DOI: 10.1016/j.pedn.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Primary pediatric care in Italy is guaranteed by family pediatricians, who may have their own private offices or work in group clinics that also have nurses/pediatric nurses in order to enrich their offer of services. The aim of this study was to investigate the activities of nurses working in pediatric practices in order to identify and classify the nursing healthcare services offered by the practices themselves. DESIGN AND STUDY An observational study was conducted including nurses working in the pediatricians' offices who voluntarily agreed to undergo a semi-structured interview. The investigated variables were individual, institutional and organizational. The study sample consisted of 22 nurses with a mean age of 39 ± 13.3 years, 16 of whom were pediatric nurses. RESULTS All of the nurses stated that they had not received suitable training for working outside a hospital, and that they carried out educational, diagnostic/therapeutic, and bureaucratic administrative/support activities. Nine of the nurses working in group pediatric clinics carried out educational activities autonomously, something that the nurses working in individual or associated clinics did not perform. Twenty of the interviewees also provided telephone consultancy, and 11 of the clinics used algorithms as guides. CONCLUSIONS/PRACTICE IMPLICATIONS The findings of this study underline the potential of developing the nursing profession at community level. Further studies are desirable in order to extend the investigation of the pediatric nurses' activities implemented at community level in other Italian provinces.
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Vara Ortiz MÁ, Fabrellas Padrés N. [Concept analysis: Nurse demand management]. Aten Primaria 2018; 51:230-235. [PMID: 29706300 PMCID: PMC6836944 DOI: 10.1016/j.aprim.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/01/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
La gestión enfermera de la demanda (GED) es un concepto emergente que requiere una clarificación útil no solo para los profesionales y usuarios sino también para gestores. La GED nació en 2009 tras la necesidad de reorganizar los flujos de la demanda, pero se ha convertido en algo más que en eso. Se entiende la GED como un programa liderado por la enfermera de Atención Primaria para atender a personas con enfermedades agudas leves. La enfermera, bajo un protocolo consensuado y dentro de su ámbito competencial, puede ser autónoma en la atención al paciente y en la resolución de problemas agudos leves. Por tanto, siguiendo la filosofía de Atención Primaria, tanto el médico como la enfermera son los profesionales que darán continuidad en el proceso salud-enfermedad del usuario a lo largo de su vida. Este artículo ha sido escrito según la metodología descrita por Wilson.
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Affiliation(s)
- María Ángeles Vara Ortiz
- EAP El Fondo, Institut Català de la Salut, Santa Coloma de Gramenet (Barcelona), España; EAP Barri Llatí, Institut Català de la Salut, Santa Coloma de Gramenet (Barcelona), España.
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