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Langlois S, Goudreau J. "From Health Experts to Health Guides": Motivational Interviewing Learning Processes and Influencing Factors. HEALTH EDUCATION & BEHAVIOR 2024; 51:251-259. [PMID: 35343256 PMCID: PMC10981192 DOI: 10.1177/10901981221084271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Motivational interviewing is an evidence-based counseling approach. However, its learning processes and their influencing factors are understudied, failing to address the suboptimal use of motivational interviewing in clinical practice. A participatory action research was conducted in collaboration with 16 primary care clinicians, who encountered similar challenges through their previous counseling approaches. The study aimed to facilitate and describe the clinicians' professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI). Data were collected using the principal investigator's research journal and participant observation of four independent ICP-MIs (76 h) followed by focus groups (8 h). The co-participants performed inductive qualitative data analysis. Results report that learning motivational interviewing requires a paradigm shift from health experts to health guides. The learning processes were initiated by the creation of an openness to the MI spirit and rapidly evolved into iterative processes of MI spirit embodiment and MI skill building. The intrinsic influencing factors involved the clinician's personal traits and professional background; the extrinsic influencing factor was the shared culture disseminating the expert care model. Previously described in a fragmented manner, motivational interviewing learning processes, and its influencing factors were presented as integrated findings. Considerations in elaborating effective MI training/implementation programs are discussed for clinicians, trainers, and decision-makers. Future areas of investigation are also highlighted calling forth the research community to contribute to knowledge advancement on health education in primary care.
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Affiliation(s)
- Sophie Langlois
- Université de Montréal, Montreal, Quebec, Canada
- Équipe de recherche en soins de première ligne de Laval, Laval, Quebec, Canada
| | - Johanne Goudreau
- Université de Montréal, Montreal, Quebec, Canada
- Équipe de recherche en soins de première ligne de Laval, Laval, Quebec, Canada
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2
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Morin A, Couturier Y, Poirier MD, T Vaillancourt V, Massé S, D Tardif A, Poitras ME. The impact of patients as trainers on registered nurses' patient engagement in primary care clinics: a qualitative study. BMC PRIMARY CARE 2023; 24:265. [PMID: 38087266 PMCID: PMC10717897 DOI: 10.1186/s12875-023-02210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND In Canada, primary care is usually the front door to health care for people with health issues. Among these primary care services are primary care clinics (PCC), where the competencies of registered nurses (RNs) are needed. However, nursing practice in PCCs is variable and sometimes suboptimal from one PCC to another. In 2019, the Quebec Ministry of Health and Social Services deployed a practical guide for RNs practicing in PCCs. This guide was intended to support best professional and interprofessional practices and enhance the quality of services offered according to a physical-social vision of care, interprofessional collaboration and partnership with the patient. The Formation de formateurs en première ligne (F2PL) project team developed a train-the-trainer educational intervention to support RNs in assimilating the content of this guide. This educational intervention is uncommon because it includes patients as trainers (PTs). PTs developed and provided andragogic content about patient's experience to enhance patient engagement. OBJECTIVE To describe the impacts of the educational intervention provided by the PTs in nurses' patient engagement practices in PCCs. METHODS A descriptive qualitative approach was used to describe in-depth changes in RNs' practices. Individual interviews were conducted with 10 RNs and 3 PTs to explore the changes in RNs' practice and the barriers and facilitators to adopting this new practice. An inductive and deductive thematic analysis was carried out according to a conceptual model of patient engagement (the Montreal Model), and emerging themes were condensed into propositions. To ensure credibility, a peer review was conducted with the F2PL team, which includes a patient co-leader. RESULTS The educational intervention provided by PTs has impacted RNs' practice in 3 ways: awareness or reminding of general principles, updating commitment to already known principles and enhancing the development of new professional skills. CONCLUSIONS PTs could effectively support the RNs' motivation to use patient engagement practices in primary care.
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Affiliation(s)
- A Morin
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - Y Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - M-D Poirier
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - V T Vaillancourt
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - S Massé
- School of Nursing, Université du Québec À Chicoutimi, Chicoutimi, Canada
| | - A D Tardif
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - M-E Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada.
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada.
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada.
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Dufour E, Bolduc J, Leclerc-Loiselle J, Charette M, Dufour I, Roy D, Poirier AA, Duhoux A. Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review. BMC PRIMARY CARE 2023; 24:176. [PMID: 37661248 PMCID: PMC10476383 DOI: 10.1186/s12875-023-02089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND While there is clear evidence that nurses can play a significant role in responding to the needs of populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a specific type of nurses. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum. This systematic overview aims to provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model (CCM) conceptual approach. METHODS We conducted an umbrella review of systematic reviews published between 2005 and 2021 based on the recommendations of the Joanna Briggs Institute. The methodological quality was assessed independently by two reviewers using the AMSTAR 2 tool. RESULTS Twenty-six systematic reviews and meta-analyses were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with little mention of the decision support and clinical information systems components. CONCLUSIONS Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources need to be designed to support contributions from all providers to optimize the full range of services available to patients with chronic conditions. PROSPERO REGISTRATION CRD42021220004.
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Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Canada.
| | - Jolianne Bolduc
- École de santé publique, Université de Montréal, Montréal, Canada
| | | | - Martin Charette
- School of Nursing, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dufour
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être, Gouvernement du Québec, Montréal, Canada
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Canada
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Mathews M, Spencer S, Hedden L, Lukewich J, Poitras ME, Marshall EG, Brown JB, Sibbald S, Norful AA. The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada. BMC PRIMARY CARE 2022; 23:290. [PMID: 36402965 PMCID: PMC9675973 DOI: 10.1186/s12875-022-01900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St John's, NL, Canada
| | - Marie-Eve Poitras
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | - Shannon Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
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Brenne BA, Hedlund M, Ingstad K. Exploring home-based care nurses' mindset for nursing practices: a phenomenological study. BMC Nurs 2022; 21:291. [PMID: 36316738 PMCID: PMC9623960 DOI: 10.1186/s12912-022-01068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. Methods This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. Results The analysis revealed three main patterns that characterise nursing practices in home care: ‘To be vigilant’, ‘To be an all-rounder’, and ‘To act with independence’. The content and distinction of these patterns are discussed through a theoretical framework of ‘clinical mindlines’. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. Conclusion Nurses’ vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses’ practical knowledge and the importance of mindlines.
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Affiliation(s)
- Bodil Aarmo Brenne
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
| | - Marianne Hedlund
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway ,grid.5947.f0000 0001 1516 2393Department of Social Work, NTNU, 7491 Trondheim, Norway
| | - Kari Ingstad
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
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Mathews M, Ryan D, Buote R, Parsons S, Lukewich J. Family Practice Nursing in Newfoundland and Labrador: Are Reported Roles Reflective of Professional Competencies for Registered Nurses in Primary Care? SAGE Open Nurs 2021; 7:23779608211053496. [PMID: 34734116 PMCID: PMC8559206 DOI: 10.1177/23779608211053496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/31/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Family practice nurses are Registered Nurses who work collaboratively in primary care and deliver a range of services. Professional competency statements have been developed to describe the skills and knowledge of family practice nurses as a distinct field. Purpose We conducted a secondary analysis of qualitative interview data to examine how family practice nurse roles/activities relate to recently developed professional competencies. Methods Family physicians and family practice nurses in Newfoundland and Labrador (NL) participated in semi-structured interviews, during which they discussed roles/activities and scope of practice surrounding family practice nursing. For this secondary analysis, we used competency statements to inform thematic coding of the transcribed interviews. Results For the initial study, a total of 8 participants (5 family practice nurses; 3 family physicians) were interviewed from diverse practices. All transcripts from the original study (n = 8) were included in the secondary analysis and analysed across 47 competencies encompassing 6 domains (Professionalism; Clinical Practice; Communication; Collaboration and Partnership; Quality Assurance, Evaluation and Research; Leadership). Roles/activities reported by participants were reflective of the competencies, but with substantial variation in expression. Conclusions Family practice nursing competency statements reflect the actual activities of family practice nurses in NL. The professional competencies can serve as a framework to examine contributions of family practice nurses and identify areas warranting further training. The use of competencies to explore family practice nurses' roles and activities can assist with optimizing scope of practice.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
| | - Richard Buote
- Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - Sandra Parsons
- Department of Health and Community Services, Government of Newfoundland and Labrador, St. John's, NL, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
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Girard A, Ellefsen É, Roberge P, Bernard-Hamel J, Hudon C. Adoption of care management activities by primary care nurses for people with common mental disorders and physical conditions: A multiple case study. J Psychiatr Ment Health Nurs 2021; 28:838-855. [PMID: 34288278 DOI: 10.1111/jpm.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/17/2020] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The collaborative care model is a well-known model to improve care quality for people with common mental disorders and physical conditions in primary care. The role of care manager is central to the collaborative care model, and primary care nurses are well-positioned to play that role. Adopting the role of care manager by primary care nurses is challenging due to several contextual factors; however, few implementation studies examined the context and current practices before implementing the role of care manager and the collaborative care model. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper contributes to the advancement of knowledge about the pre-assessment of current practices before implementing the collaborative care model and the role of care manager. The paper offers a better understanding of the relationships between the context and the performance of care management activities by primary care nurses. The paper describes an innovative analysis technique to assess the gap between care management activities recommended in the collaborative care model and actual nursing activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Primary care nurses would benefit from having timely access to clinical support from mental health nurse practitioners in order to build their competency. Determinants of practice and the analysis technique to assess current practices will help other researchers or quality improvement teams to develop their plan when implementing the role of care manager. ABSTRACT: Introduction Few studies assessed current nursing practices before implementing the collaborative care model and the role of care manager for people with common mental disorders (CMDs) and physical conditions in primary care settings. Aim Evaluate the main determinants of practice that influence the adoption of care management activities by primary care nurses for people with CMDs and physical conditions. Methods A qualitative multiple case study was conducted in three primary care clinics. A total of 33 participants were recruited. Various data sources were combined: interviews (n = 32), nurse-patient encounters' observations (n = 7), documents and summaries of meetings with stakeholders (n = 8). Results Seven determinants were identified (1) access to external mental health resources; (2) clarification of local CMD care trajectory; (3) compatibility between the coordination of nursing work and the role of care manager; (4) availability of mental health resources within the primary care clinic; (5) competency in care management and competency building; (6) responsibility sharing between the general practitioner and the primary care nurse; and (7) common understanding of the patient treatment plan. Implications for practice To build their competency in care management for people with CMDs, primary care nurses would benefit from having clinical support from mental health nurse practitioners.
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Affiliation(s)
- Ariane Girard
- École des Sciences infirmiéres, Faculté de Médecine et de Sciences de la Santé, École des Sciences Infirmières, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Édith Ellefsen
- École des Sciences infirmiéres, Faculté de Médecine et de Sciences de la Santé, École des Sciences Infirmières, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pasquale Roberge
- Département de Médecine de Famille et de Médecine d'urgence, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Joëlle Bernard-Hamel
- École des Sciences infirmiéres, Faculté de Médecine et de Sciences de la Santé, École des Sciences Infirmières, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'urgence, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Svenningsson I, Hange D, Udo C, Törnbom K, Björkelund C, Petersson EL. The care manager meeting the patients' unique needs using the care manager model-A qualitative study of experienced care managers. BMC FAMILY PRACTICE 2021; 22:175. [PMID: 34474682 PMCID: PMC8414763 DOI: 10.1186/s12875-021-01523-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).
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Affiliation(s)
- Irene Svenningsson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
| | - Dominique Hange
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research, Dalarna, Sweden
| | - Karin Törnbom
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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Guillaumie L, Therrien D, Bujold M, Pelletier J, Bujold L, Lauzier S. Perspectives of Quebec Primary Health Care Nurse Practitioners on Their Role and Challenges in Chronic Disease Management: A Qualitative Study. Can J Nurs Res 2019; 52:317-327. [PMID: 31530000 DOI: 10.1177/0844562119862735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face. PURPOSE The study aimed to describe PHCNPs' perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors. METHODS A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec. RESULTS PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs' practice, and a more flexible legislative framework. CONCLUSIONS The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.
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Affiliation(s)
| | - Dominique Therrien
- Department of Nursing, University of Quebec in Outaouais, Gatineau, Québec, Canada
| | - Mathieu Bujold
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Jérôme Pelletier
- Department of Nursing, University of Quebec at Rimouski, Rimouski, Québec, Canada
| | - Louise Bujold
- Faculty of Nursing, Laval University, Quebec City, Québec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
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