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Schlunegger MC, Zumstein-Shaha M, Palm R. Methodologic and Data-Analysis Triangulation in Case Studies: A Scoping Review. West J Nurs Res 2024; 46:611-622. [PMID: 39076135 PMCID: PMC11334375 DOI: 10.1177/01939459241263011] [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] [Indexed: 07/31/2024]
Abstract
AIM We sought to explore the processes of methodologic and data-analysis triangulation in case studies using the example of research on nurse practitioners in primary health care. DESIGN AND METHODS We conducted a scoping review within Arksey and O'Malley's methodological framework, considering studies that defined a case study design and used 2 or more data sources, published in English or German before August 2023. DATA SOURCES The databases searched were MEDLINE and CINAHL, supplemented with hand searching of relevant nursing journals. We also examined the reference list of all the included studies. RESULTS In total, 63 reports were assessed for eligibility. Ultimately, we included 8 articles. Five studies described within-method triangulation, whereas 3 provided information on between/across-method triangulation. No study reported within-method triangulation of 2 or more quantitative data-collection procedures. The data-collection procedures were interviews, observation, documentation/documents, service records, and questionnaires/assessments. The data-analysis triangulation involved various qualitative and quantitative methods of analysis. Details about comparing or contrasting results from different qualitative and mixed-methods data were lacking. CONCLUSIONS Various processes for methodologic and data-analysis triangulation are described in this scoping review but lack detail, thus hampering standardization in case study research, potentially affecting research traceability. Triangulation is complicated by terminological confusion. To advance case study research in nursing, authors should reflect critically on the processes of triangulation and employ existing tools, like a protocol or mixed-methods matrix, for transparent reporting. The only existing reporting guideline should be complemented with directions on methodologic and data-analysis triangulation.
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Affiliation(s)
- Margarithe Charlotte Schlunegger
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Maya Zumstein-Shaha
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
- Department of Health Care Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Kjær LA, Tøien M, Førsund LH. Exploring nurse practitioners' collaboration with general practitioners in Norwegian homecare services: a qualitative study. Scand J Prim Health Care 2024:1-10. [PMID: 39034711 DOI: 10.1080/02813432.2024.2381064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 07/04/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration. DESIGN The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation. FINDINGS The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces. CONCLUSION Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.
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Affiliation(s)
| | - Mette Tøien
- University of South-Eastern Norway, Drammen, Norway
| | - Linn Hege Førsund
- University of South-Eastern Norway, Drammen, Norway
- Western Norway University of Applied Sciences, Førde, Norway
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Gkiouleka A, Wong G, Sowden S, Kuhn I, Moseley A, Manji S, Harmston RR, Siersbaek R, Bambra C, Ford JA. Reducing health inequalities through general practice: a realist review and action framework. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-104. [PMID: 38551093 DOI: 10.3310/ytww7032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences and Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annie Moseley
- Patient and Public Involvement Representative, Norwich, UK
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | - Rikke Siersbaek
- Health System Foundations for Sláintecare Implementation, Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John A Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kornelsen J, Ho H, Williams K, Skinner T. Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme. J Interprof Care 2023:1-9. [PMID: 38038596 DOI: 10.1080/13561820.2023.2280586] [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: 11/28/2022] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018-2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.
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Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Hilary Ho
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, Canada
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Chaves ACC, Scherer MDDA, Conill EM. What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020. CIENCIA & SAUDE COLETIVA 2023; 28:2537-2551. [PMID: 37672445 DOI: 10.1590/1413-81232023289.15342022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/11/2023] [Indexed: 09/08/2023] Open
Abstract
Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term "resolvability", commonly used in Brazil, for "effectiveness".
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Gkiouleka A, Wong G, Sowden S, Bambra C, Siersbaek R, Manji S, Moseley A, Harmston R, Kuhn I, Ford J. Reducing health inequalities through general practice. Lancet Public Health 2023; 8:e463-e472. [PMID: 37244675 DOI: 10.1016/s2468-2667(23)00093-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/29/2023]
Abstract
Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved. We reviewed interventions influencing health and care inequalities in general practice and developed an action framework for health professionals and decision makers. We conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. We then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus (Cochrane Equity Methods Group) categories. 159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, we found that to reduce health inequalities, general practice needs to be informed by five key principles: involving coordinated services across the system (ie, connected), accounting for differences within patient groups (ie, intersectional), making allowances for different patient needs and preferences (ie, flexible), integrating patient worldviews and cultural references (ie, inclusive), and engaging communities with service design and delivery (ie, community-centred). Future work should explore how these principles can inform the organisational development of general practice.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, Cambridge, UK
| | - Geoff Wong
- University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | | | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, Cambridge, UK
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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Schlunegger MC, Aeschlimann S, Palm R, Zumstein-Shaha M. Competencies of nurse practitioners in family practices: A scoping review. J Clin Nurs 2022; 32:2521-2532. [PMID: 35642084 DOI: 10.1111/jocn.16382] [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: 03/10/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE To explore the existing literature related to nurse practitioner (NP) competencies in family practices and to examine the evidence and develop a list of competencies. BACKGROUND The integration of NPs into the healthcare system is at different stages of progress around the world. Therefore, an overview and clarification of competencies are important to ensure successful implementation of new roles in existing healthcare systems. However, detailed knowledge is lacking about the competencies of NPs in adult care in family practices. DESIGN AND METHODS We conducted a scoping review in accordance with the JBI methodology for scoping reviews and the PRISMA-ScR guidelines. We considered studies published in English, German or French from 1965 to the present. Databases searched included MEDLINE, CINAHL, Web of Science and PsycINFO. Sources of grey literature that were searched included ProQuest Dissertations and Theses, OpenGrey and websites of national NP organisations. Two reviewers retrieved full-text studies and extracted data independently. We described the competencies using Hamric's model of advanced practice nursing. RESULTS We included 23 publications. Competencies in direct clinical practice were described most often particularly pertaining to nursing or medical tasks. Indirect care activities were frequently mentioned. Less information was found regarding competencies in leadership, ethical decision-making and evidence-based practice. We found elementary and extended competencies required to perform the role in family practices. Depending on the country, the role was either emerging or already well-established. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE This review provides insight into current knowledge about competencies of NP in family practices. The identified competencies can be used to develop job descriptions or to conceptualise professional development programmes in countries where such roles are just recently emerging. A list of competencies will promote a common understanding of the NP role and to help clarify interprofessional collaboration in clinical practice.
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Affiliation(s)
- Margarithe Charlotte Schlunegger
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland.,School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Simona Aeschlimann
- Tilia Köniz, Tilia Foundation for Long-Term Care, Ostermundigen, Switzerland
| | - Rebecca Palm
- School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Maya Zumstein-Shaha
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland.,School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
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Integrating Nurse Practitioners Into Long-term Care: A Call for Action. J Nurse Pract 2022; 18:488-492. [PMID: 35287369 PMCID: PMC8906654 DOI: 10.1016/j.nurpra.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The coronavirus disease 2019 pandemic exposed the devastating effects of inadequate primary care in long-term care (LTC) settings, both nationally and internationally. Deaths in LTC were compounded by the global shortage of physicians and limitations in existing funding models for these facilities. Nurse practitioners (NPs) can provide similar services as general practice physicians in LTC while meeting residents’ needs in a more timely, cost-effective manner. It is critical that NPs be integrated into LTC, particularly in the wake of the coronavirus disease 2019 pandemic. This article provides relevant literature and evidence to substantiate the effectiveness of integrating NPs into the Canadian LTC and highlights the urgent need for improved funding models and policy reform.
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Kiran T, Rodrigues JJ, Aratangy T, Devotta K, Sava N, O'Campo P. Awareness and Use of Community Services among Primary Care Physicians. ACTA ACUST UNITED AC 2021; 16:58-77. [PMID: 32813640 DOI: 10.12927/hcpol.2020.26290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary care physicians play an important role in care coordination, including initiating referrals to community resources. Yet, it is unclear how awareness and use of community resources vary between physicians practising with and without an extended healthcare team. We conducted a cross-sectional survey of primary care physicians practising in Toronto, Canada, to compare awareness and use of community services between physicians practising in team- and non-team-based practice models. Team-based models included Community Health Centres and Family Health Teams - settings in which the government provides funding for the practice to hire non-physician health professionals, such as social workers, pharmacists, nurse practitioners, registered nurses and others. The survey was mailed to physicians, and reminders were done by phone, fax and e-mail. We used logistic regression to compare awareness between physicians in team-based (N = 89) and non-team-based (N = 138) models after controlling for confounders. We found that fewer than half of the physicians were aware of five of eight centralized intake services (e.g., ConnexOntario, Telehomecare). For most services, team-based physicians had at least twice the odds of being aware of the service compared to non-team-based physicians. Our findings suggest that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources.
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Affiliation(s)
- Tara Kiran
- Family Physician, St. Michael's Hospital, Associate Professor, Department of Family and Community Medicine, Faculty of Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, Scientist, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Jessica J Rodrigues
- Research Coordinator, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Tatiana Aratangy
- Manager, Survey Research Unit, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Kimberly Devotta
- Research Coordinator, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Nathalie Sava
- Senior Planner, Health Analytics and Innovation, Toronto Central Local Health Integration Network, Toronto, ON
| | - Patricia O'Campo
- Scientist, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Connolly M, Ryder M, Frazer K, Furlong E, Escribano TP, Larkin P, Carruthers E, McGuigan E. Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study. BMC Palliat Care 2021; 20:134. [PMID: 34479521 PMCID: PMC8418028 DOI: 10.1186/s12904-021-00834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.
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Affiliation(s)
- Michael Connolly
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland.
| | - Mary Ryder
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Teresa Plazo Escribano
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eileen Carruthers
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
| | - Eileen McGuigan
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
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Soh BFJR, Ang WHD, De Roza JG, Quek IP, Lim PS, Lau Y. They Are Partners in Care: A Qualitative Exploration of Physicians' Perceptions of Primary Care Advanced Practice Nurses. J Nurs Scholarsh 2021; 53:542-551. [PMID: 33870641 DOI: 10.1111/jnu.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE This study explores physicians' perceptions of the advanced practice nurse (APN) role in the primary care setting in Singapore. METHODS AND DESIGN A descriptive qualitative design utilizing face-to-face semistructured interviews was conducted on a purposive sample of 16 primary care physicians from six primary care clinics. Thematic analysis and constant comparative analysis were used. FINDINGS Three themes were identified: a collaborative partner in primary care, a conduit for specialist care and information, and a leader in community care. Physicians generally reported positivity about the clinical role of APNs and their potential in leading community care. However, they verbalized role ambiguity beyond clinical practice. CONCLUSIONS Physicians viewed primary care APNs as competent healthcare professionals. They viewed APNs as specialists in their fields, with the potential for expanding their services into the community. However, there remains gaps in physicians' understanding of the primary care APNs' nonclinical roles. The findings from this study indicate a need for nursing schools and nurse leaders to increase awareness of the complete APN role among physicians. APNs' roles in educating healthcare professionals and delivering care to the community can be further developed. CLINICAL RELEVANCE APNs are at the forefront in leading nursing care. There is a need to develop greater collaborative partnerships while delineating their respective roles in patient care.
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Affiliation(s)
| | - Wei How Darryl Ang
- PhD Student, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Imm Pin Quek
- Advanced Practice Nurse, National Healthcare Group Polyclinic, Singapore
| | - Pui San Lim
- Family Physician Principal Staff, National Healthcare Group Polyclinic, Singapore
| | - Ying Lau
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wilson EC, Pammett R, McKenzie F, Bourque H. Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study. CMAJ Open 2021; 9:E288-E294. [PMID: 33785476 PMCID: PMC8096393 DOI: 10.9778/cmajo.20200075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC. METHODS This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively. RESULTS In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care. INTERPRETATION In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.
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Affiliation(s)
- Erin C Wilson
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Robert Pammett
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Farah McKenzie
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Helen Bourque
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
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Luo F, Zou P, Zhang H, Pang S. Exploration of village health centres in Northern and Central China: A qualitative study. Aust J Rural Health 2020; 28:271-280. [PMID: 32558026 DOI: 10.1111/ajr.12635] [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: 10/26/2019] [Revised: 01/25/2020] [Accepted: 05/03/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE China faces issues associated with urban-rural health inequities. This study explores functions of village health centres through a community perspective. Four research questions were asked, including: (a) What are the functions of village health centres? (b) How is medication administered in village health centres? (c) What are the roles of village doctors? (d) What are the evaluation mechanisms of village health centres? DESIGN In-depth interviews and field observations are used in the study. SETTING Nine rural villages in two provinces in Northern and Central China. PARTICIPANTS A total of 93 people across were interviewed. RESULTS Village health centres are primarily responsible for providing public health services and essential medical care. In addition, village health centres also function as a social venue of a rural community. A centralised medication scheme augments these processes through supplying health centres with affordable medications. Village doctors are expected to take the needs and preferences of their patients into consideration when creating care plans, and must establish trusting rapport with patients by upholding their unique values. This results in care that is convenient, accessible, and person-centred. Village health centres are evaluated through a 2-step process which has direct effects on the amount of government subsidy received. CONCLUSION Village health centres have multi-faceted functions in rural Chinese communities. Overall, the benefits of village health centres include convenient and timely access to care for rural residents. Improvements can be made in certain areas, such as streamlining provincial medication schemes and adopting a strengths-based model of evaluation.
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Affiliation(s)
- Feng Luo
- Department of Sociology, Humanities and Social Sciences College, Huazhong Agricultural University, Wuhan, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, ON, Canada
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
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14
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Burrows KE, Abelson J, Miller PA, Levine M, Vanstone M. Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada. BMC Health Serv Res 2020; 20:365. [PMID: 32349738 PMCID: PMC7189743 DOI: 10.1186/s12913-020-05087-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 with the goal of helping to increase access to care, decrease wait times, improve continuity of care and provide a flexible addition to the healthcare workforce. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems. METHODS An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases including an inductive thematic analysis within each of the four cases, a cross-case thematic analysis, and a broader, deductive exploration of cross-case patterns pertaining to specific complexity theory principles of interest. RESULTS Forty-six health care providers were interviewed across 19 different healthcare sites. Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability are interconnected and dynamic. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PAs willingness to work and ability to build relationships allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e., health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. CONCLUSIONS By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in hospital and community settings, PAs are making a significant contribution to Ontario healthcare settings.
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Affiliation(s)
- Kristen E Burrows
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
- Michael G. DeGroote School of Medicine, Physician Assistant Education Program, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Patricia A Miller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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15
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Bruhl EJ, MacLaughlin KL, Allen SV, Horn JL, Angstman KB, Garrison GM, Maxson JA, McCauley DK, Lampman MA, Thacher TD. Association of Primary Care Team Composition and Clinician Burnout in a Primary Care Practice Network. Mayo Clin Proc Innov Qual Outcomes 2020; 4:135-142. [PMID: 32280923 PMCID: PMC7139989 DOI: 10.1016/j.mayocpiqo.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the relationship of the emotional exhaustion domain of burnout with care team composition in a Midwestern primary care practice network. Participants and Methods We studied 420 family medicine clinicians (253 physicians and 167 nurse practitioners/physician assistants [NP/PAs]) within a large integrated health system throughout 59 Midwestern communities. The observational cross-sectional study utilized a single-question clinician self-assessment of the emotional exhaustion domain of burnout on a scale of 0 (never) to 6 (daily) conducted between March 1 and April 2, 2018, and administrative data collected between January 1, 2017, and December 31, 2017. We used a multivariable linear mixed model for data analysis, adjusted for clinical- and team-level factors, including clinician sex, panel size and complexity, clinician type (physician or NP/PA), clinician full-time equivalent (FTE), total care team panel size, and number of clinicians on the care team. Results Among 217 survey respondents (51.7%), the median frequency of the emotional exhaustion domain of burnout was once per week. Adjusted analyses revealed that a greater proportion of physician FTE on the care team was associated with a lower emotional exhaustion domain of burnout among individual clinicians (P=.05). Female clinicians had a higher emotional exhaustion domain of burnout than male clinicians (P=.05). None of the other variables in the model were associated with emotional exhaustion. Conclusion Primary care teams containing both physicians and NP/PAs had lower levels of emotional exhaustion with increasing proportion of physician FTE. More work is needed to explore what other variables may be associated with burnout in primary care team-based practices.
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Affiliation(s)
- Elliot J Bruhl
- Department of Family Medicine, Mayo Clinic, Rochester, MN.,SouthEast Alaska Regional Health Consortium, Juneau, AK
| | | | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Julie A Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN
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16
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Côté N, Freeman A, Jean E, Denis JL. New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning. BMC Health Serv Res 2019; 19:882. [PMID: 31752860 PMCID: PMC6873448 DOI: 10.1186/s12913-019-4731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada). METHODS We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017. RESULTS Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity). CONCLUSION Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.
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Affiliation(s)
- Nancy Côté
- Faculty of Social Sciences, Université Laval, Quebec City, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
| | - Andrew Freeman
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Emmanuelle Jean
- Department of Nursing Sciences, Université du Québec à Rimouski, Rimouski, Canada
| | - Jean-Louis Denis
- Département de gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, Canada
- Chaire de recherche du Canada sur la transformation, le design et l’amélioration des systèmes de santé, Montréal, Canada
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Campbell TD, Bayly M, Peacock S. Provision of Resident-Centered Care by Nurse Practitioners in Saskatchewan Long-Term Care Facilities: Qualitative Findings From a Mixed Methods Study. Res Gerontol Nurs 2019; 13:73-81. [PMID: 31697397 DOI: 10.3928/19404921-20191022-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
With their education and skill set, nurse practitioners (NPs) are ideally situated to provide primary care to long-term care (LTC) residents, and this is a timely development as physician presence in LTC has been decreasing. A sequential follow-up explanatory mixed methods design was used for the current study, which focused on the interviews that followed the initial survey. The sample included seven NPs who work with LTC residents in urban and rural settings in a western Canadian province. The interviews provided an opportunity for in-depth discussion regarding survey results. Interpretive description guided the data analysis. NPs provide timely access to primary care, address medication reconciliation, decrease transfers to hospitals, and take part in collaborative practice. NPs promote the health care goals of LTC residents. Departments of health would benefit from the inclusion of a wider range of health providers, including NPs, to provide timely access to quality care in LTC facilities. [Research in Gerontological Nursing, 13(2), 73-81.].
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Abstract
BACKGROUND AND OBJECTIVE Patients with abnormal uterine bleeding (AUB) often require hysteroscopy as part of the diagnostic workup. The purpose of this study was to improve efficiency by shortening the time to patient appointment for office hysteroscopy. INTERVENTIONS Preintervention, nurse practitioners (NPs) and gynecologists saw patients with abnormal uterine bleeding (AUB) separately. This created inefficiency for the patients, frequently requiring second visits for hysteroscopy. A new hysteroscopy clinic was designed to increase practice efficiency. A collaborative team model was created including consecutive visits with NPs and gynecologists. Each patient with AUB was first evaluated by an NP, followed immediately by a shorter visit with a gynecologist for office hysteroscopy as indicated. NPs managed other diagnostic evaluation and bleeding treatment if hysteroscopy was not warranted. Collaborative clinic staffing consisted of two NPs seeing patients with AUB paired with one gynecologist for procedural support. MEASUREMENTS AND RESULTS Electronic records of 393 patients scheduled for AUB visits from January to June 2015 were evaluated for preintervention data. Postintervention, 647 patient records were reviewed from January to June of 2016. During the preintervention period, 30% of patients had a hysteroscopy appointment scheduled within 0-13 days from the initial visit for AUB. Postintervention, the wait time for appointments decreased, with 63% of patients scheduled within 0-13 days. Clinic redesign also resulted in an increase of 57.5% in appointment slots. No-show rates and appointment fill rates were not adversely affected. CONCLUSIONS A collaborative team-based care model using NPs and gynecologists improved efficiency and access to office hysteroscopy services.
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Smith T, McNeil K, Mitchell R, Boyle B, Ries N. A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nurs 2019; 18:14. [PMID: 30976197 PMCID: PMC6444450 DOI: 10.1186/s12912-019-0337-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shortages of skills needed to deliver optimal health care in rural and remote locations raises questions about using extended scopes of practice or advanced practice models in a range of health professions. The nurse practitioner (NP) model was introduced to address health service gaps; however, its sustainability has been questioned, while other extended scope of practice roles have not progressed in Australia. This study aimed to explore the experiences and perceptions of NPs and their colleagues about barriers to and enablers of extended scope of practice and consider the relevance of the findings to other health professions. METHODS Semi-structured, in-depth interviews were conducted with primary, nurse practitioner informants, who were also invited to nominate up to two colleagues, as secondary informants. Data analysis was guided by a multi-level, socio-institutional lens of macro-, meso- and micro-perspectives. RESULTS Fifteen primary informants and five colleagues were interviewed from various rural and remote locations. There was a fairly even distribution of informants across primary, aged, chronic and emergency or critical care roles. Key barriers and enablers at each level of analysis were identified. At the macro-level were legal, regulatory, and economic barriers and enablers, as well as job availability. The meso-level concerned local health service and community factors, such as attitudes and support from managers and patients. The micro-level relates to day-to-day practice. Role clarity was of considerable importance, along with embedded professional hierarchies and traditional role expectations influencing interactions with individual colleagues. Given a lack of understanding of NP scope of practice, NPs often had to expend effort promoting and advocating for their roles. CONCLUSIONS For communities to benefit from extended scope of practice models of health service delivery, energy needs to be directed towards addressing legislative and regulatory barriers. To be successful, extended scope of practice roles must be promoted with managers and decision-makers, who may have limited understanding of the clinical importance. Support is also important from other members of the interprofessional health care team.
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Affiliation(s)
- Tony Smith
- Department of Rural Health, The University of Newcastle, 69A High Street, Taree, NSW 2430 Australia
| | - Karen McNeil
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Rebecca Mitchell
- Faculty of Business and Law, University of Newcastle, Callaghan, Australia
| | - Brendan Boyle
- Faculty of Business and Law, University of Newcastle, Callaghan, Australia
| | - Nola Ries
- Faculty of Law, University of Technology Sydney, Ultimo, Australia
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20
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Dawson J, Rigby-Brown A, Adams L, Baker R, Fernando J, Forrest A, Kirkwood A, Murray R, West M, Wike P, Wilde M. Developing and evaluating a tool to measure general practice productivity: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Systems for measuring the performance of general practices are extremely limited.
Objectives
The aim was to develop, pilot test and evaluate a measure of productivity that can be applied across all typical general practices in England, and that may result in improvements in practice, thereby leading to better patient outcomes.
Methods
Stage 1 – the approach used was based on the Productivity Measurement and Enhancement System (ProMES). Through 16 workshops with 80 general practice staff and 72 patient representatives, the objectives of general practices were identified, as were indicators that could measure these objectives and systems to convert the indicators into an effectiveness score and a productivity index. This was followed by a consensus exercise involving a face-to-face meeting with 16 stakeholders and an online survey with 27 respondents. An online version of the tool [termed the General Practice Effectiveness Tool (GPET)] and detailed guidance were created. Stage 2 – 51 practices were trained to use the GPET for up to 6 months, entering data on each indicator monthly and getting automated feedback on changes in effectiveness over time. The feasibility and acceptability of the GPET were examined via 38 telephone interviews with practice representatives, an online survey of practice managers and two focus groups with patient representatives.
Results
The workshops resulted in 11 objectives across four performance areas: (1) clinical care, (2) practice management, (3) patient focus and (4) external focus. These were measured by 52 indicators, gathered from clinical information systems, practice records, checklists, a short patient questionnaire and a short staff questionnaire. The consensus exercise suggested that this model was appropriate, but that the tool would be of more benefit in tracking productivity within practices than in performance management. Thirty-eight out of 51 practices provided monthly data, but only 28 practices did so for the full period. Limited time and personnel changes made participation difficult for some. Over the pilot period, practice effectiveness increased significantly. Perceptions of the GPET were varied. Usefulness was given an average rating of 4.5 out of 10.0. Ease of use was more positive, scoring 5.6 out of 10.0. Five indicators were highlighted as problematic to gather, and 27% of practices had difficulties entering data. Feedback from interviews suggested difficulties using the online system and finding time to make use of feedback. Most practices could not provide sufficient monthly financial data to calculate a conventional productivity index.
Limitations
It was not possible to create a measure that provides comparability between all practices, and most practices could not provide sufficient financial data to create a productivity index, leaving an effectiveness measure instead. Having a relatively small number of practices, with no control group, limited this study, and there was a limited timescale for the testing and evaluation.
Implications
The GPET has demonstrated some viability as a tool to aid practice improvement. The model devised could serve as a basis for measuring effectiveness in general practice more widely.
Future work
Some additional research is needed to refine the GPET. Enhanced testing with a control sample would evaluate whether or not it is the use of the GPET that leads to improved performance.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jeremy Dawson
- Sheffield University Management School, The University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Rigby-Brown
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Lee Adams
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Amanda Forrest
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Kirkwood
- The Medical School, The University of Sheffield, Sheffield, UK
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Maier CB, Budde H, Buchan J. Nurses in expanded roles to strengthen community-based health promotion and chronic care: policy implications from an international perspective; A commentary. Isr J Health Policy Res 2018; 7:64. [PMID: 30314532 PMCID: PMC6182781 DOI: 10.1186/s13584-018-0257-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
Chronic conditions and health inequalities are increasing worldwide. Against this backdrop, several countries, including Israel, have expanded the roles of nurses as one measure to strengthen the primary care workforce. In Israel, community nurses work in expanded roles with increased responsibilities for patients with chronic conditions. They also work increasingly in the field of health promotion and disease prevention. Common barriers to role change in Israel are mirrored by other countries. Barriers include legal and financial restrictions, resistance by professional associations, inflexible labor markets and lack of resources. Policies should be revisited and aligned across education, financing and labor markets, to enable nurses to practice in the expanded roles. Financial incentives can accelerate the uptake of new, expanded roles so that all patients including vulnerable population groups, benefit from equitable and patient-centered service delivery in the communities.
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Affiliation(s)
- Claudia B. Maier
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, Germany
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Senior Fellow, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104-4217 USA
| | - Hannah Budde
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, Germany
| | - James Buchan
- WHO Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, PO BOX 123, Broadway NSW, Sydney, 2007 Australia
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Improving Provider Experience and Increasing Patient Access Through Nurse Practitioner–Physician Primary Care Teams. J Ambul Care Manage 2018; 41:308-313. [DOI: 10.1097/jac.0000000000000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pasyar N, Rambod M, Gholamzadeh S, Sharif F. Correlation between Nurse /Manager Professional Collaborative Behaviors and Nurses’ Job Satisfaction. IRAN JOURNAL OF NURSING 2018. [DOI: 10.29252/ijn.31.112.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Delvin ME, Braithwaite S, Camargo Plazas P. Canadian nurse practitioner's quest for identity: A philosophical perspective. Int J Nurs Sci 2018; 5:110-114. [PMID: 31406811 PMCID: PMC6626291 DOI: 10.1016/j.ijnss.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/06/2022] Open
Abstract
The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare settings to the provision of comprehensive care. The context in which the role has been established positions nurse practitioners' practice within medical and nursing paradigms. As the healthcare system evolves, nurse practitioners must define their identity to advocate for roles that reflect their professional values. A historical overview highlighting the context in which the NP role expanded will guide a philosophical discussion regarding role identity. After exposing tensions between the nursing and medicine disciplines, Abbots' theory of profession will be utilized to understand the foundations leading to initial research on nurse practitioner integration within the healthcare system. Feminist philosopher bell hooks' discourse on marginality will serve as a platform to reflect on the nurse practitioner identity within the current social context. Foucault's notions of governmentality, parrhesia and care of the self will then guide reflections regarding ways for nurse practitioners to locate themselves as a profession.
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Affiliation(s)
- Marie-Elaine Delvin
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
| | - Suzanne Braithwaite
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
| | - Pilar Camargo Plazas
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
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25
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How do nurse practitioners work in primary health care settings? A scoping review. Int J Nurs Stud 2017; 75:51-57. [DOI: 10.1016/j.ijnurstu.2017.06.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022]
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26
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Wong I, Wright E, Santomauro D, How R, Leary C, Harris M. Implementing two nurse practitioner models of service at an Australian male prison: A quality assurance study. J Clin Nurs 2017. [PMID: 28639389 DOI: 10.1111/jocn.13935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. BACKGROUND Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. DESIGN A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. METHODS Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models (n = 21 staff), consultation records describing clinical processes and time use (n = 289 consultations), and a patient satisfaction survey (n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. RESULTS Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. CONCLUSIONS Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. RELEVANCE TO CLINICAL PRACTICE Results suggest that nurse practitioner models can be successfully integrated into a prison setting and could provide a nursing career pathway.
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Affiliation(s)
- Ides Wong
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Eryn Wright
- School of Public Health, The University of Queensland, Herston, Qld, Australia.,Queensland Centre for Mental Health Research, Wacol, Qld, Australia
| | - Damian Santomauro
- School of Public Health, The University of Queensland, Herston, Qld, Australia.,Queensland Centre for Mental Health Research, Wacol, Qld, Australia
| | - Raquel How
- Prison Health Services, West Moreton Hospital and Health Services, Department of Health, Queensland Government, Archerfield, Qld, Australia
| | - Christopher Leary
- Prison Health Services, West Moreton Hospital and Health Services, Department of Health, Queensland Government, Archerfield, Qld, Australia
| | - Meredith Harris
- School of Public Health, The University of Queensland, Herston, Qld, Australia.,Queensland Centre for Mental Health Research, Wacol, Qld, Australia
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27
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Lambert LK, Housden LM. Les infirmières praticiennes et la recherche. Can Oncol Nurs J 2017; 27:111-114. [PMID: 31148720 PMCID: PMC6516373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Leah K Lambert
- School of Nursing, Université de la Colombie-Britannique, T201-2211 Wesbrook Mall, Vancouver (C.-B.) V6T 2B5
| | - Laura M Housden
- School of Nursing, Université de la Colombie-Britannique, T201-2211 Wesbrook Mall, Vancouver (C.-B.) V6T 2B5
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28
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Lambert LK, Housden LM. Nurse practitioner engagement in research. Can Oncol Nurs J 2017; 27:107-110. [PMID: 31148783 PMCID: PMC6516367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Leah K Lambert
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5
| | - Laura M Housden
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5
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Bryant-Lukosius D, Valaitis R, Martin-Misener R, Donald F, Peña LM, Brousseau L. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health. Rev Lat Am Enfermagem 2017; 25:e2826. [PMID: 28146177 PMCID: PMC5288863 DOI: 10.1590/1518-8345.1677.2826] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: to examine advanced practice nursing (APN) roles internationally to inform role
development in Latin America and the Caribbean to support universal health
coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN
effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally
suited as part of a primary health care workforce strategy in Latin America to
enhance universal health coverage and access to health. Brazil, Chile, Colombia,
and Mexico are well positioned to build this workforce. Role implementation
barriers include lack of role clarity, legislation/regulation, education, funding,
and physician resistance. Strong nursing leadership to align APN roles with policy
priorities, and to work in partnership with primary care providers and policy
makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically
assess country and population health needs to introduce the most appropriate
complement and mix of APN roles and inform implementation. Successful APN role
introduction in Latin America and the Caribbean could provide a roadmap for
similar roles in other low/middle income countries.
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Affiliation(s)
| | - Ruta Valaitis
- PhD, Associate Professor, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Ruth Martin-Misener
- PhD, Professor, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Faith Donald
- PhD, Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Laura Morán Peña
- PhD, Professor, Escuela Nacional de Enfermería y Obstetricia de la Universidad Nacional Autónoma de México, Ciudad de México, DF, Mexico
| | - Linda Brousseau
- MSc, Nurse Practitioner (NP), Halton Region Health Unit, Oakville, ON, Canada
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Alcusky M, Ferrari L, Rossi G, Liu M, Hojat M, Maio V. Attitudes Toward Collaboration Among Practitioners in Newly Established Medical Homes: A Survey of Nurses, General Practitioners, and Specialists. Am J Med Qual 2015; 31:526-535. [PMID: 26228578 DOI: 10.1177/1062860615597744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to evaluate the attitudes toward collaboration of nurses, general practitioners (GPs), and specialists practicing in newly established Medical Homes (MHs) in Parma Local Health Authority (LHA), Emilia-Romagna region, Italy. The 15-item Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered electronically to 172 physicians (66 GPs, 106 specialists) and 113 nurses practicing in 12 MHs. In all, 191 surveys (45 GPs, 59 specialists, 87 nurses) were completed (67% response rate). The mean total score among nurses (51.5, standard deviation [SD] = 3.7) reflected a significantly (P < .01) more positive attitude toward collaboration compared with GPs (47.8, SD = 4.6) and specialists (45.3, SD = 7.7). Discrepancies in attitudes are concerning because conflicting perceptions of professional roles may impede a successful transition to integrated care within MHs in Parma LHA. Internationally, further research into understanding interprofessional relationships within MHs is needed to inform policy and build a necessary culture of team-based care.
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Affiliation(s)
| | | | | | - Mengdan Liu
- Thomas Jefferson University, Philadelphia, PA
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