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Liptrott SJ, Saliquni A, Giau L, Pecora R, Cimino C, Lo Piccolo A, Palermo A, Vidovic B, Cheda E, Imhof S, Tolotti A, Guastamacchia I, Cavatorti S. Nurse performed bladder ultrasound: a clinical quality improvement initiative. Contemp Nurse 2024:1-17. [PMID: 39321322 DOI: 10.1080/10376178.2024.2406350] [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: 02/09/2024] [Accepted: 09/13/2024] [Indexed: 09/27/2024]
Abstract
Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient's needs.Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative.Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively.Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course.Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.
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Affiliation(s)
- Sarah Jayne Liptrott
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Anduena Saliquni
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Letizia Giau
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Rosario Pecora
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Carmelo Cimino
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Antonio Lo Piccolo
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Antonio Palermo
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Branislav Vidovic
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Eveline Cheda
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Sally Imhof
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Angela Tolotti
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | | | - Shaila Cavatorti
- Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, via A. Gallino 12, 6500, Bellinzona, Switzerland
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Weise S, Steybe T, Thiel C, Frese T. Are Nurse-Led Patient Consultations and Nurse-Led Dose Adjustments of Permanent Medication Acceptable for Patients with Diabetes Mellitus and Hypertension in General Practice? - Results of a Focus Group Study. Patient Prefer Adherence 2023; 17:1501-1512. [PMID: 37383032 PMCID: PMC10296604 DOI: 10.2147/ppa.s411902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose Practice nurse (PN)-led patient consultations and PN-led dosage adjustments of permanent medication are uncommon and not well studied in general practice (GP) in Germany. We investigated the perspectives of patients with common chronic diseases in Germany, diabetes mellitus (DM) type 2 and/or arterial hypertension (AT), on PN-led patient consultations and dosage adjustments of permanent medications in GP. Patients and Methods In this exploratory qualitative study, online focus groups were conducted using a semi-structured interview guide. Patients were recruited from collaborating GPs according to a predefined sampling plan. Patients were eligible for this study if they had DM or AT treated by their GP, were on at least one permanent medication and were aged 18 years or older. Focus group transcripts were analyzed using thematic analyses. Results Analyses of two focus groups, involving a total of 17 patients, revealed four main themes: (1) openness to the PN-led care and perceived benefits, eg because of patients' confidence in PNs' skills, or patients' impression that PN-led care would better meet their needs and increase their compliance. Some patients had (2) reservations and perceived risks, especially for PN-led medication changes eg feeling that medication adjustments were a GP's issue. Patients identified (3) reasons for encounters where they were likely to accept PN-led consultation and medication advice, eg management of DM, AT and thyroid disease. Patients also saw several important general requirements for the implementation of PN-led care in German general practice (4). Conclusion There is a potential for openness towards PN-led consultation and PN-led medication adjustment for permanent medication in patients with DM or AT. This study is the first qualitative study to investigate PN-led consultations and medication advice in German general practice. If the implementation of PN-led care is planned, our findings add the patients' perspectives of acceptable reasons for encounter for PN-led care and their general requirements.
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Affiliation(s)
- Solveig Weise
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
| | - Tatjana Steybe
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
| | - Carolin Thiel
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
- SRH University of Applied Health Sciences, Gera, Thuringia, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
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Onaisi R, Dumont R, Hasselgard-Rowe J, Safar D, Haller DM, Maisonneuve H. Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France. Front Med (Lausanne) 2023; 9:1089050. [PMID: 36698814 PMCID: PMC9868625 DOI: 10.3389/fmed.2022.1089050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background Statins are a first line, evidence-based yet underprescribed treatment for cardiovascular primary prevention. In primary care settings, multimorbidity is a complex situation which makes it difficult to apply prevention guidelines. Aim To assess the associations between multimorbidity and prescription of statins in accordance with the 2016 ESC recommendations ("appropriate prescription"), and to identify the factors and conditions associated with these prescriptions. Design and setting Cross-sectional prospective study in the French region of Rhône-Alpes among 40 general practitioners and their patients. Methods We examined the association between appropriate statin prescription and several patient characteristics, including multimorbidity, using multivariate logistic regression models. Results Between August 2017 and February 2019, 327 patients were included in the study. Seventy-four (22.6%) were on statin medication and 199 (60.9%) exhibited multimorbidity, defined as ≥2 diseases. Only 22.5% of eligible patients were prescribed statins for primary prevention. Diabetes was most strongly associated with appropriate statin prescription (aOR 8.10, CI 95: 3.81-17.80). Multimorbidity was not associated with appropriate statin prescription (aOR 1.31, CI 95: 0.54-3.26), except in the presence of diabetes which defined diabetic multimorbidity (aOR 10.46, CI 95: 4.87-23.35). Conversely, non-diabetic multimorbidity was associated with lower odds of being appropriately prescribed a statin (aOR 0.26, CI 95: 0.12-0.56). Conclusion Multimorbidity, in itself, does not seem to be a determinant factor for appropriate statin prescription. The latter appears to be determined by a patient's type of multimorbidity, especially the presence or not of diabetes. Differentiating between diabetic and non-diabetic multimorbidity may be a pragmatic way for GPs to improve primary prevention in a patient-centered and shared decision-making approach.
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Affiliation(s)
- Racha Onaisi
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Roxane Dumont
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - David Safar
- University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Dagmar M. Haller
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
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Serra-Barril MA, Benito-Aracil L, Pla-Consuegra M, Ferro-García T. Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care. J Nurs Manag 2022; 30:4339-4353. [PMID: 36194472 PMCID: PMC10092559 DOI: 10.1111/jonm.13843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
AIM This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. BACKGROUND Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. METHODS Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. RESULTS Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. CONCLUSIONS The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. IMPLICATIONS FOR NURSING MANAGEMENT Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito-Aracil
- Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Margarida Pla-Consuegra
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tarsila Ferro-García
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Abstract
Interprofessional Collaboration in Health Care Abstract. Interprofessional collaboration is a hallmark of good and efficient patient care, where several healthcare professionals put their competencies together to care for patients. Interprofessional education is a necessary first step to prepare the different professions for collaborations in their later professional practices. Shared training courses help to empower collaborative healthcare teams so they can respond in an adapted and effective way to individual and local health needs.
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Affiliation(s)
- Claudia Huber
- Hochschule für Gesundheit Freiburg, HES-SO Fachhochschule Westschweiz, Freiburg
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Jokiniemi K, Heikkilä A, Meriläinen M, Junttila K, Peltokoski J, Tervo-Heikkinen T, Mattila E, Mikkonen S. Advanced practice role delineation within Finland: A comparative descriptive study. J Adv Nurs 2021; 78:1665-1675. [PMID: 34655100 DOI: 10.1111/jan.15074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/18/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023]
Abstract
AIM To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts. BACKGROUND In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known. DESIGN A descriptive comparative study. METHODS An online self-report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline. RESULTS A total of 1497 responses were obtained (response rate = 10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p < .001). CONCLUSION Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management. IMPACT The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Asta Heikkilä
- Development Services, Hospital District of Southwest Finland, Turku, Finland
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center (MRC) Oulu, Oulu, Finland
| | - Kristiina Junttila
- Nursing Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Tarja Tervo-Heikkinen
- Clinical Development, Education and Research Centre of Nursing, Kuopio University Hospital, Kuopio, Finland
| | | | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Filliettaz SS, Berchtold P, Koch U, Peytremann-Bridevaux I. Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System. Int J Integr Care 2021; 21:10. [PMID: 34754285 PMCID: PMC8555474 DOI: 10.5334/ijic.5668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Switzerland's fragmented healthcare system mirrors its federal structure and mix of cultures and languages. Although the Swiss have a higher life expectancy than most of their neighbours, their healthcare system faces similar challenges that call for more integrated care (IC). AIM/METHOD This article aims to provide insight into the specificities of and latest developments in Switzerland's healthcare system and how they may have influenced the development and implementation of IC there. DESCRIPTION/DISCUSSION The number of local IC initiatives has been growing steadily for 20 years. With a certain lag, various policies supporting IC have been established. Among them, a recent democratic debate on the federal mandatory health insurance law could either induce a radical move towards centralised support for IC or continue to support scattered local IC initiatives. CONCLUSION In the future, Switzerland's healthcare system will probably navigate between local IC initiatives and centralised, federal support for IC initiatives. This will be the reflection of a very Swiss way forward in a world without clear evidence on whether centralised or decentralised initiatives are more successful at developing IC.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, 1004 Lausanne, Switzerland
- Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
- Forum Managed Care (FMC), Zugerstrasse 193, 6314 Neuägeri, Switzerland
| | | | - Ursula Koch
- Forum Managed Care (FMC), Zugerstrasse 193, 6314 Neuägeri, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
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