Implementing two nurse practitioner models of service at an Australian male prison: A quality assurance study

Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review

BACKGROUND

High rates of health inequalities and chronic non-communicable diseases exist amongst the prison population. This places people in and/or released from prison at heightened risk of multimorbidity, premature mortality, and reduced quality of life. Ensuring appropriate healthcare for people in prison to improve their health outcomes is an important aspect of social justice. This review examines the global literature on healthcare interventions to detect, monitor and manage chronic non-communicable diseases amongst the prison population and people recently released from prison.

METHODS

Systematic searches of EMBASE, MEDLINE, CINAHL, Web of Science, Scopus, and the Cochrane Library were conducted and supplemented by citation searching and review of the grey literature. The literature searches attempted to identify all articles describing any healthcare intervention for adults in prison, or released from prison in the past 1 year, to detect, monitor, or manage any chronic non-communicable illness. 19,061 articles were identified, of which 1058 articles were screened by abstract and 203 articles were reviewed by full text.

RESULTS

Sixty-five studies were included in the review, involving 18,311 participants from multiple countries. Most studies were quasi-experimental and/or low to moderate in quality. Numerous healthcare interventions were described in the literature including chronic disease screening, telemedicine, health education, integrated care systems, implementing specialist equipment and staff roles to manage chronic diseases in prisons, and providing enhanced primary care contact and/or support from community health workers for people recently released from prison. These interventions were associated with improvement in various measures of clinical and cost effectiveness, although comparison between different care models was not possible due to high levels of clinical heterogeneity.

CONCLUSIONS

It is currently unclear which interventions are most effective at monitoring and managing chronic non-communicable diseases in prison. More research is needed to determine the most effective interventions for improving chronic disease management in prisons and how these should be implemented to ensure optimal success. Future research should examine interventions for addressing multimorbidity within prisons, since most studies tested interventions for a singular non-communicable disease.

Nursing services as perceived by inmates in correctional facilities in Jakarta, Indonesia: A qualitative study

Background

Nursing services play a crucial role in addressing the healthcare needs of inmates in correctional facilities while upholding their human rights. However, delivering nursing services in this context is challenging. Unfortunately, there is a dearth of research on this topic in Indonesia.

Objective

This study aimed to explore the experiences of inmates in receiving nursing services in order to provide insights into professional nursing services in the correctional context in Indonesia.

Methods

A qualitative phenomenological approach was used in this study. Twenty inmates were selected purposively from four prisons, three jails, and one child penitentiary in Jakarta, Indonesia. Semi-structured in-depth interviews were conducted from August to October 2021, and thematic analysis was used to analyze the data.

Results

Five themes were generated: (1) conditions requiring nursing services, (2) types of nursing services received, (3) nurse competence, (4) barriers to receiving nursing services, and (5) expectations for nursing services in the future.

Conclusion

This study highlights the importance of nursing services in correctional facilities and the unique challenges that correctional nurses face in providing services professionally and ethically. Strategies to enhance nursing services, advance nurse competence, and reduce barriers to accessing care are needed to improve inmates' health outcomes.

Nurse practitioner integration: Conceptual development to enhance application in policy and research

BACKGROUND

Nurse practitioners (NPs) have been introduced across the world to improve care quality and solve provider shortages. Realizing these benefits relies on their successful integration into health care systems. Although NP integration has been discussed extensively, the concept is defined inconsistently. Literature, therefore, cannot be synthesized to create policy recommendations for management and policymakers to plan for and advance NP integration.

OBJECTIVES

To describe and define NP integration and enhance its applicability in research and policy.

DATA SOURCES

A modified Walker and Avant concept analysis was used to develop a conceptual model of NP integration. Data were extracted and synthesized from 78 sources referencing the concept.

CONCLUSIONS

Nurse practitioner integration was operationally defined as the multilevel process of incorporating NPs into the health care system so that NPs can practice to their full scope, education, and training and contribute to patient, system, and population needs. The attributes of NP integration are: 1) achievable goal; 2) process; 3) introduction of the role; 4) incorporation into organizational care models; 5) challenging traditional ideologies; 6) ability to function; 7) provide high-quality care; and 8) improve outcomes, sustainability, and health system transformation. Seventeen facilitators/barriers affecting NP integration were identified. Three health care system levels at which integration occurs were identified- macro , meso , and micro .

IMPLICATIONS FOR PRACTICE

Findings will inform managers, policymakers, and stakeholders about NP integration to aid in planning and policy development. Results can be used to inform research on barriers and facilitators to NP integration.

Implementation of the Nurse Practitioner as Most Responsible Provider model of care in a Specialised Mental Health setting in Canada

Globally, mental health systems have failed to adequately respond to the growing demands of mental health services resulting in a disparity between the need and provision of treatment. Paucity of mental health care providers contributes to the aforementioned disparity. This can be addressed by engaging Nurse Practitioners (NPs) in an integrated model within healthcare teams. This paper describes the implementation of NPs as Most Responsible Provider (MRP) care of model in a specialised mental health hospital in Ontario, Canada. Guided by the participatory, evidence-based, patient-focused process for advanced practise nursing (APN) role development, implementation, and evaluation (PEPPA) framework, authors developed a model of care and implemented the first seven steps of the PEPPA framework - (a) define the population and describe the current model of care, (b) identify stakeholders, (c) determine the need for a new model of care (d) identify priority areas and goals of improvement, (e) define the new model of care, and (f) plan and implement the NP as MRP model of care. Within these steps, different strategies were implemented: (a) revising policies and procedures (b) harmonising reporting structures, (c) developing and implementing a collaborative practise structure for NPs, (d) standardised and transparent compensation (e) performance standards and monitoring (f) Self-Assessment Competency frameworks, education, and development opportunities. This paper contributes to the state of the knowledge by implementing NPs as MRP model of care in a specialised mental health care setting in Ontario, Canada; and advocates the need for incorporating mental health programmes within the Ontario nursing curriculum.

Structure evaluation of the implementation of geriatric models in primary care: a multiple-case study of models involving advanced geriatric nurses in five municipalities in Norway

Background

The Advanced Geriatric Nurse role recently has been introduced into Norway’s primary healthcare system, and our study’s purpose was to examine the implementation of models of care developed for Advanced Geriatric Nurse in primary care. With a structure evaluation, we tried to identify conditions that affect the implementation of different models of care and understand how these conditions affected the realisation of each model’s intentions and goals.

Methods

An embedded multiple-case study was used that included five Norwegian municipalities and seven AGNs. The study included data from August 2014 through September 2018. We used data from 25 semi-structured face-to-face interviews with AGNs and stakeholders, documents and statistical information. We used a cross-case procedure with an emphasis on case findings for the analysis of the multiple case study.

Results

We analysed the structure-related conditions on two levels: the meso-level and the micro-level. On the meso-level, we found that the conditions that affected the implementation of the different models of care were related to each municipality’s structure characteristics, stakeholders’ involvement in the design of the models of care, the clarity of the models and their goals, the evaluation of the models and their adaptation. At the micro-level, we found that the conditions that affected the models’ implementation were related to the collaboration within the implemented models of care, the role clarity of Advanced Geriatric Nurses themselves and adjustments within the models.

Conclusions

The implementation of the AGN role in Norway seems to have been implemented in ways that can impact patients and municipalities positively. Potential improvements include extensive stakeholder involvement, improved roles, goal clarity and better documentation of structures and outcomes. The models’ dynamic nature seemed to be a beneficial characteristic, but adaptation should be systematic and a necessary time should be considered for a new model of care to be integrated and produce results.