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Nilormi A, Heer C, Ziegler E. Developing a comprehensive curriculum program for nurse practitioners delivering primary care in the long-term care setting. Healthc Manage Forum 2024; 37:62S-67S. [PMID: 39194281 PMCID: PMC11360272 DOI: 10.1177/08404704241259900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.
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Affiliation(s)
| | - Carrier Heer
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Brant Community Healthcare System, Brantford, Ontario, Canada
| | - Erin Ziegler
- Toronto Metropolitan University, Toronto, Ontario, Canada
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Ohta R, Maejima S, Sano C. Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective. Cureus 2024; 16:e57015. [PMID: 38681408 PMCID: PMC11046255 DOI: 10.7759/cureus.57015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Rural hospitals, particularly those in geographically isolated regions like Shimane Prefecture, Japan, face significant healthcare delivery challenges. These include limited resources, an aging population, and a scarcity of healthcare professionals. Advanced practice nurses (APNs) have emerged as pivotal in addressing these gaps, offering specialized patient assessment, diagnosis, and management skills. This study aimed to evaluate the demand for APNs in rural community hospitals, focusing on the specific educational needs and clinical competencies required to improve healthcare outcomes in these settings. Method Employing a mixed-methods approach, this research combined qualitative insights from stakeholder interviews with quantitative data analysis of electronic health records (EHRs) at Unnan City Hospital. This sequential exploratory design aimed to capture comprehensive educational needs and outcomes, integrating the depth of qualitative data with the breadth of quantitative evidence to tailor a curriculum for APNs in rural healthcare contexts. Results The study revealed a critical demand for APNs skilled in managing common medical issues in rural settings, such as infections, circulatory failures, and respiratory problems. Stakeholder interviews highlighted the necessity for a curriculum that enhances clinical competencies and emphasizes soft skills like communication and leadership. An analysis of EHRs identified 21 specific diseases across six categories, underlining the importance of targeted education on these prevalent conditions. Conclusion The findings underscore the urgent need for specialized education programs for APNs in rural hospitals to address these communities' unique healthcare challenges. Developing a curriculum that focuses on clinical and soft skills essential for rural healthcare delivery can significantly enhance the quality of care. This study advocates for implementing such tailored educational programs to empower APNs, thereby contributing to healthcare equity and improving patient outcomes in rural settings.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Maymi M, Madden M, Bauer C, Reuter-Rice K. Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis. J Pediatr Health Care 2022; 36:e11-e21. [PMID: 34836734 DOI: 10.1016/j.pedhc.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). RESULTS Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%). DISCUSSION This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.
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Mori K, Tsukamoto Y, Makino S, Takabayashi T, Kurosawa M, Ohashi W, Okumura M, Fujita Y, Fujiwara Y. Effect of intensive care provided by nurse practitioners for postoperative patients: A retrospective observational before-and-after study. PLoS One 2022; 17:e0262605. [PMID: 35061830 PMCID: PMC8782326 DOI: 10.1371/journal.pone.0262605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022] Open
Abstract
Nurse practitioners are increasingly now members of intensive care teams in Japan, but no data exist about their effect on the outcomes for critically ill patients. This study aimed to compare the outcomes of postoperative patients on mechanical ventilators before and after the participation of nurse practitioners in intensive care teams. We retrospectively identified 387 patients who underwent postoperative mechanical ventilation at a University Hospital in Japan, using data from medical records from 1 April 2015 to 31 March 2017. We extracted data and compared patients' length of stay in the intensive care unit and the hospital, mechanical ventilation days, postoperative rehabilitation start date, rehabilitation prescription, intensive care unit and hospital mortality, and intensive care unit readmission. Multiple regression analysis was used to analyze the factors affecting length of stay in the intensive care unit. Patients who received care from nurse practitioners and physicians had significantly shorter stays in intensive care (4.8 ± 4.8 days versus 6.7 ± 10.3 days, p < 0.021). Mechanical ventilation days, total length of hospital stay, rehabilitation prescription, mortality in intensive care and hospital, and readmission to intensive care were all similar to those who received care only from physicians. The multiple regression analysis suggests that participation of nurse practitioners in intensive care reduced the length of stay in the unit by 2.6 days (p = 0.003). These findings could help to increase use of non-physician healthcare providers in intensive care. Our results demonstrated that it is both effective and safe for nurse practitioners to participate in intensive care teams that provide care for postoperative patients receiving mechanical ventilation.
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Affiliation(s)
- Kazunao Mori
- Division of Nursing, Aichi Medical University Hospital, Aichi, Japan
| | - Yoko Tsukamoto
- Department of Nursing and Social Sciences, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Satoshi Makino
- Division of Nursing, Aichi Medical University Hospital, Aichi, Japan
| | | | | | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Aichi, Japan
| | - Masatoshi Okumura
- Department of Anesthesiology, Aichi Medical University, Aichi, Japan
| | - Yoshihito Fujita
- Department of Anesthesiology, Aichi Medical University, Aichi, Japan
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Abstract
This article introduces key concepts of activity theory and expansive learning. Expansive learning builds on the foundational ideas of the cultural-historical activity theory (CHAT). It is a research approach designed for studying the complexities and contradictions in authentic workplace environments. Change Laboratory is a formative intervention method developed for studying workplaces in transition and for stimulating collaborative efforts to design improved patterns of activity. We present concrete examples of formative interventions in healthcare, where good patient care was compromised by the fragmentation of care and disturbances in collaboration between the healthcare experts. This implies that physicians are challenged to develop collaborative and transformative expertise. We present three spearheads into a zone of proximal development, representing opportunities for change of medical expertise: (1) reconceptualizing expertise as object-oriented and contradiction-driven activity systems, (2) pursuing expertise as negotiated knotworking, and (3) building expertise as expansive learning. While medical expertise needs to expand, medical education must also look for ways to evolve and meet the challenges of the surrounding society. We call for adopting an interventionist approach for developing medical education and intensifying collaboration with the practitioners in healthcare units, their patients, and target communities.
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Affiliation(s)
- Yrjö Engeström
- Center for Research on Activity, Development and Learning, University of Helsinki, Helsinki, Finland
| | - Eeva Pyörälä
- Center for University Teaching and Learning, University of Helsinki, Helsinki, Finland
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Boiko O, Edwards M, Zschaler S, Miles S, Rafferty AM. Interprofessional barriers in patient flow management: an interview study of the views of emergency department staff involved in patient admissions. J Interprof Care 2020; 35:334-342. [PMID: 32506989 DOI: 10.1080/13561820.2020.1760223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patient flow in emergency departments (EDs) is notoriously difficult to manage efficiently. While much of the attention has focused on the procedures, protocols and pathways in which patients receive their first hours of care, less attention has been paid to the relational factors that make it happen. Our study is the first, to our knowledge, to consider the role of interprofessional barriers, defined as suboptimal ways of working, as perceived by ED staff in patient flow management. Drawing on 19 interviews with hospital staff in an acute tertiary trauma center hospital in England, we established three flow-related types of interprofessional barriers: ED teamwork barriers, performance-driven coordination barriers, and referral-related collaborative barriers. Knotworking was recognized as a form of interactions and asset to teamworking, coordination, and collaboration. Identifying processes such as chasing, escalating, and advocating enabled our investigation to highlight a very complex set of interprofessional interactions, and signpost what the suboptimal practices of flow management are. Our analysis holds promise for hospitals beyond the National Health Service in England.
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Affiliation(s)
- Olga Boiko
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Edwards
- Academic Research Fellow, King's College Hospital Emergency Department, London, UK
| | - Steffen Zschaler
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, UK
| | - Simon Miles
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery and Palliative Care, Department of Adult Nursing, Kings' College London and Royal College of Nursing, London, UK
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Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2019; 34:332-342. [DOI: 10.1080/13561820.2019.1636007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Evert Schot
- School of Governance, Utrecht University, Utrecht, Netherlands
| | - Lars Tummers
- School of Governance, Utrecht University, Utrecht, Netherlands
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Shoham DA, Harris JK, Mundt M, McGaghie W. A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit. J Interprof Care 2016; 30:661-7. [PMID: 27436781 DOI: 10.1080/13561820.2016.1203296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01-2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.
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Affiliation(s)
- David A Shoham
- a Department of Public Health Sciences, School of Medicine , Loyola University Chicago , Chicago , Illinois , USA.,b Leischner Institute for Medical Education , Loyola University Chicago , Chicago , Illinois , USA
| | - Jenine K Harris
- c Brown School , Washington University in St. Louis , St. Louis , Missouri , USA
| | - Marlon Mundt
- d Department of Family Medicine, School of Medicine and Public Health , University of Wisconsin-Madison , Madison , Wisconsin , USA
| | - William McGaghie
- b Leischner Institute for Medical Education , Loyola University Chicago , Chicago , Illinois , USA
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