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Haslam-Larmer L, Krassikova A, Spengler C, Wills A, Keatings M, Babineau J, Robert B, Heer C, McAiney C, Bethell J, Kay K, Kaasalainen S, Feldman S, Martin-Misener R, Katz P, May K, McGilton KS. What Do We Know About Nurse Practitioner/Physician Care Models in Long-Term Care: Results of a Scoping Review. J Am Med Dir Assoc 2024; 25:105148. [PMID: 39009065 DOI: 10.1016/j.jamda.2024.105148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models. RESEARCH DESIGN AND METHODS Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers. RESULTS Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes. CONCLUSIONS AND IMPLICATIONS Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes.
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Affiliation(s)
- Lynn Haslam-Larmer
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Claudia Spengler
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Aria Wills
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Carrie Heer
- Brant Community Healthcare System, Brantford, Ontario, Canada
| | - Carrie McAiney
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Ontario, Canada
| | | | - Sid Feldman
- Baycrest Health Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Paul Katz
- Department of Geriatrics, Florida State University, Tallahassee, FL, USA
| | - Kathryn May
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
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Ljungbeck B, Sjögren-Forss K, Carlson E. Nurse practitioner in Swedish municipal elderly care: A Delphi study of challenges and opportunities. Scand J Caring Sci 2023; 37:216-228. [PMID: 35942613 DOI: 10.1111/scs.13116] [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: 12/27/2021] [Revised: 06/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Worldwide, countries are struggling with strained healthcare systems, especially due to the growing number of frail elderly. Developing the role of nurse practitioner in the care of the frail elderly is therefore of interest to make the care chain more efficient. In Sweden, the role is in an early development phase, but more research is needed. AIM The aim was to investigate how stakeholders at the national level express the challenges and opportunities of the evolving nurse practitioner role in Swedish municipal elderly care. METHOD A Delphi survey technique with three rounds of electronic questionnaires was used. Twenty-seven experts responded to the first questionnaire, containing two open questions; what opportunities respectively challenges do you see in developing and implementing the nurse practitioner role in municipal elderly care? The following questionnaires consisted of statements to rate using a four-grade Likert scale, and 20 and 17 responded to the second and third, respectively. The first round was analysed using content analysis, and the other two with descriptive statistics. RESULTS Thirty-four statements about challenges and opportunities related to the nurse practitioner role in municipal elderly care were identified and rated as important. CONCLUSION The findings provide knowledge that can contribute to discussions and decisions to refine the nurse practitioner role in Swedish municipal elderly care. The nurse practitioner role may contribute with much-needed competence to the elderly care. However, it is important to consider the challenges that need to be overcome before the development of the role. To solve this, it is necessary to have clear national guidelines concerning issues of education, title protection and the mandate and authority of the NP role.
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Affiliation(s)
- Birgitta Ljungbeck
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
| | - Katarina Sjögren-Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
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Buck D, Tucker S, Roe B, Hughes J, Challis D. Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta-analysis. J Adv Nurs 2021; 78:666-697. [PMID: 34532884 DOI: 10.1111/jan.15043] [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: 01/11/2021] [Revised: 08/09/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life. DESIGN Systematic review, without meta-analysis, with vote counting based on direction of effect. DATA SOURCES Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies. REVIEW METHODS Papers on the provision of specialist care home support that addressed older, long-term care home residents' physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness. RESULTS Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents' general health needs (p < .001), assessment and management services (p < .0001) and non-training initiatives involving medical staff (p < .0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p < .001), but the high number of weak-rated studies undermined confidence in this result. CONCLUSION This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed. IMPACT The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.
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Affiliation(s)
- Deborah Buck
- Social Care and Society, University of Manchester, Manchester, UK
| | - Sue Tucker
- Social Care and Society, University of Manchester, Manchester, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Reducing preventable patient transfers from long-term care facilities to emergency departments: a scoping review. CAN J EMERG MED 2021; 22:844-856. [PMID: 32741417 DOI: 10.1017/cem.2020.416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Canada, there were over 60,000 long-term care facility patient transfers to emergency departments (EDs) in 2014, with up to a quarter of them being potentially preventable. Each preventable transfer exposes the patient to transport- and hospital-related complications, contributes to ED crowding, and adds significant costs to the health care system. There have been many proposed and studied interventions aimed at alleviating the issue, but few attempts to assess and evaluate different interventions across institutions. METHODS A systematic search of MEDLINE, CINAHL, and EMBASE for studies describing the impact of interventions aimed at reducing preventable transfers from long-term care facilities to EDs on ED transfer rate. Two independent reviewers screened the studies for inclusion and completed a quality assessment. A tabular and narrative synthesis was then completed. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS A total of 26 studies were included (Cohen's k = 0.68). One was of low quality (Cohen's k = 0.58). Studies were summarized into five themes based on intervention type: Telemedicine, Outreach Teams, Interdisciplinary Care, Integrated Approaches, and Other. Effective interventions reported reductions in ED transfer rates post intervention ranging from 10 to 70%. Interdisciplinary health care teams staffed within long-term care facilities were the most effective interventions. CONCLUSION There are several promising interventions that have successfully reduced the number of preventable transfers from long-term care facilities to EDs in a variety of health care settings. Widespread implementation of these interventions has the potential to reduce ED crowding in Canada.
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Vellani S, Boscart V, Escrig-Pinol A, Cumal A, Krassikova A, Sidani S, Zheng N, Yeung L, McGilton KS. Complexity of Nurse Practitioners' Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic. J Pers Med 2021; 11:433. [PMID: 34069545 PMCID: PMC8161387 DOI: 10.3390/jpm11050433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.
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Affiliation(s)
- Shirin Vellani
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Veronique Boscart
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Canadian Institute for Seniors Care, Conestoga College, Kitchener, ON N2G 4M4, Canada
| | - Astrid Escrig-Pinol
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Mar Nursing School, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Alexia Cumal
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON M5B 1Z5, Canada;
| | - Nancy Zheng
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Lydia Yeung
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Katherine S. McGilton
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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El-Masri M, Bornais J, Omar A, Crawley J. Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. J Emerg Nurs 2020; 46:478-487. [DOI: 10.1016/j.jen.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
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Kilpatrick K, Tchouaket É, Jabbour M, Hains S. A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities. BMC Nurs 2020; 19:6. [PMID: 32015689 PMCID: PMC6990528 DOI: 10.1186/s12912-019-0395-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. METHODS Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. RESULTS Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. CONCLUSIONS The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
| | - Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada
| | | | - Sylvie Hains
- Retired, Ministère de la Santé et des services sociaux du Québec, Québec, Canada
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Kilpatrick K, Jabbour M, Tchouaket É, Acorn M, Donald F, Hains S. Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study. J Adv Nurs 2019; 75:1306-1315. [DOI: 10.1111/jan.13962] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Kelley Kilpatrick
- Ingram School of Nursing McGill University Montreal QC Canada
- Centre intégré universitaire de santé et de services sociaux de l'Est‐de‐l’Ïle‐de‐Montréal Maisonneuve‐Rosemont Hospital Site Montreal QC Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l'Est‐de‐l’Ïle‐de‐Montréal Maisonneuve‐Rosemont Hospital Site Montreal QC Canada
| | - Éric Tchouaket
- Faculty of Nursing Université du Québec en Outaouais (UQO) Saint‐Jérôme QC Canada
| | - Michelle Acorn
- Faculty of Nursing University of Toronto Toronto ON Canada
| | - Faith Donald
- Daphne Cockwell School of Nursing Ryerson University Toronto ON Canada
| | - Sylvie Hains
- Ministère de la Santé et des Services sociaux Quebec QC Canada
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