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Bomholt KB, Nebsbjerg MA, Burau V, Mygind A, Christensen MB, Huibers L. Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting. Eur J Gen Pract 2024; 30:2351807. [PMID: 38779917 PMCID: PMC11123461 DOI: 10.1080/13814788.2024.2351807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC). OBJECTIVES To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC. METHODS Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary. RESULTS The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive. CONCLUSION The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.
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Affiliation(s)
| | | | - Viola Burau
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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IJsselhof R, Hintjens A, Pelzer A, Nieuwenhuis E. Position Paper: fragmented youth healthcare services in the Netherlands endanger treatment of teenage boys with psychiatric disorders. Eur Child Adolesc Psychiatry 2024; 33:3287-3292. [PMID: 38363390 PMCID: PMC11424670 DOI: 10.1007/s00787-024-02378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
For children who show strongly deviant behaviour in the Netherlands, a distinction is made between behavioural problems and psychiatric problems. As a result, two different domains have emerged over time, each with its own legal frameworks and inclusion and exclusion criteria. Consequently, there is no well-organized, coherent system for youth mental health care in the Netherlands. This strong dichotomy raises the question whether patients are being admitted to facilities where they are receiving appropriate care. In addition, referral bias can arise, because the type of complaint with which a young person presents is often dependent on the type of coping of the individual and thus, in turn, the gender of the patient. In this Position Paper, we examined the gender distribution at a youth psychiatric high and intensive care (HIC-Y) and other streams of youth care in the Netherlands to explore possible inequities in access to psychiatric care among children and adolescents. Results show that girls are significantly more likely than boys to be admitted to the HIC-Y for suicidal thoughts, self-harm and emotional dysregulation. In fact, girls account for 80% of all admissions, while boys account for only 20%. In contrast, regional and national reports from youth services and probation show a majority of boys being admitted (56-89%). The way care is organized (lack of cross-domain collaboration and the interplay between gender-dependent coping and exclusion criteria) seems to play a role in the underrepresentation of boys in acute psychiatry and their overrepresentation in secure youth care. Based on our research results, the concern is raised whether boys have a greater chance of undertreatment for psychiatric problems. Further research is needed to better understand the underlying factors that contribute to gender bias in psychiatric admissions, and to develop interventions that promote gender equality in healthcare.
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Affiliation(s)
- Rinske IJsselhof
- Department of Primary and Long-Term Care, University Medical Center Groningen, Zwolle, The Netherlands.
- Department of Child and Adolescent Psychiatry, Reinier Van Arkel, Herlaarhof, Vught, The Netherlands.
| | - Amy Hintjens
- University College Roosevelt, Middelburg, The Netherlands
| | - Anne Pelzer
- Department of Child and Adolescent Psychiatry, Reinier Van Arkel, Herlaarhof, Vught, The Netherlands
| | - Edward Nieuwenhuis
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Saiki M, Nishimiya G, Gotoh T, Hirota K, Sakai I. Experiences and attitudes of task-shifting and task-sharing of physicians, nurses, and nursing assistants in hospitals: a qualitative systematic review protocol. JBI Evid Synth 2024; 22:856-863. [PMID: 37997847 DOI: 10.11124/jbies-23-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. INTRODUCTION Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. INCLUSION CRITERIA Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. METHODS PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Studies published in English or Japanese from the time each database was established to the present will be considered for inclusion. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. REVIEW REGISTRATION PROSPERO CRD42023409612.
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Affiliation(s)
- Masatoshi Saiki
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
| | - Gaku Nishimiya
- Nursing Department, Chiba University Hospital, Chiba, Japan
| | - Tomomi Gotoh
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | | | - Ikuko Sakai
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
- The Chiba University Centre for Evidence Based Practice: A JBI Centre for Excellence, Chiba University, Chiba, Japan
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Clarke V, Lehane E, Cotter P, Mulcahy H. Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis. J Adv Nurs 2024; 80:1559-1573. [PMID: 37950366 DOI: 10.1111/jan.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/02/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
AIM To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN A qualitative interpretative phenomenological analysis. METHODS A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Vanessa Clarke
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Nursing and Midwifery Planning and Development, Health Service Executive North East, Ardee, County Louth, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Patrick Cotter
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Ma L, Wang X, Zou S, Lin M, Qiu S, Li W. A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses. BMC Health Serv Res 2023; 23:327. [PMID: 37005581 PMCID: PMC10067220 DOI: 10.1186/s12913-023-09303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND With the advent of an ageing society and an increase in the prevalence of chronic diseases, the role of primary health care has become increasingly important and reliant on multidisciplinary collaboration. As members of this interprofessional cooperative team, community nurses play a dominant role. Thus, the post competencies of community nurses study deserve our attention. In addition, organizational career management can affect nurses in some ways. This study aims to examine the current situation and relationship among interprofessional team collaboration, organizational career management and post-competency of community nurses. METHODS A survey was conducted among 530 nurses in 28 community medical institutions from November 2021 to April 2022 in Chengdu, Sichuan Province, China. Descriptive analysis was used for analysis, and a structural equation model was used to hypothesize and verify the model. A total of 88.2% of respondents met the inclusion criteria and did not meet the exclusion criteria. The main reason nurses gave for not participating was that they were too busy. RESULTS Among the competencies on the questionnaire, ensuring quality and helping roles scored the lowest. The teaching-coaching and diagnostic functions played a mediating role. Nurses with greater seniority and those who were transferred to administrative departments had lower scores, and the difference was statistically significant (p < 0.05). In the structural equation model, CFI = 0.992 and RMSEA = 0.049, which shows that the model fit well, suggesting that organizational career management had no statistically significant effect on post competency (β = -0.006, p = 0.932) but that interprofessional team collaboration had a statistically significant effect on post competency (β = 1.146, p < 0.001) and organizational career management had a statistically significant effect on interprofessional team collaboration (β = 0.684, p < 0.001). CONCLUSIONS Attention should be given to the improvement of community nurses' post competency in ensuring quality and performing helping, teaching-coaching, and diagnostic roles. Moreover, researchers should focus on the decline in community nurses' abilities, particularly for those with greater seniority or in administrative roles. The structural equation model shows that interprofessional team collaboration is a complete intermediary between organizational career management and post competency.
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Affiliation(s)
- Li Ma
- Institute of Hospital Management, Outpatient Department, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinwei Wang
- School of Business, Sichuan University, Chengdu, Sichuan, China
| | - Shiyue Zou
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Min Lin
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Shi Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network/Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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van Venrooij LT, Barnhoorn PC, Barnhoorn-Bos AM, Vermeiren RRJM, Crone MR. General practitioners' everyday clinical decision-making on psychosocial problems of children and youth in the Netherlands. PLoS One 2022; 17:e0278314. [PMID: 36576906 PMCID: PMC9797081 DOI: 10.1371/journal.pone.0278314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Psychosocial problems in children and youth are common and may negatively impact their lives and the lives of their families. Since general practitioners (GPs) play a crucial role in detecting and intervening in such problems, it is clinically necessary to improve our insight into their clinical decision-making (CDM). The objective of this study was to explore which mechanisms underlie GPs' everyday CDM and their options for management or referral. MATERIAL AND METHODS This was a mixed methods study in which qualitative (interview substudy) and quantitative (online survey substudy) data were collected from GPs. Using a question framework and vignettes representative of clinical practice, GPs' CDM was explored. GPs were selected by means of an academic research network and purposive sampling. Data collection continued in constant comparison between both substudies. Using grounded theory, data from both substudies were triangulated into a flowchart consisting of mechanisms and management/referral options. RESULTS CDM-mechanisms were divided into three groups. GP-related mechanisms were GPs' primary approach of the problem (somatically or psychosocially) and their self-assessed competence to solve the problem based on interest in and knowledge about youth mental health care. Mechanisms related to the child and its social context included GPs' assessment whether there was psychiatric (co)morbidity, their sense of self-limitedness of the problem and assessed complexity of the problem. Whether GPs' had existing collaboration agreements with youth care providers and how they experienced their collaboration were collaboration-related mechanisms. CONCLUSION The current study contributes to a relatively unexplored research area by revealing GP's in-depth thought processes regarding their CDM. However, existing research in this area supports the identified CDM mechanisms. Future initiatives should focus on validating CDM mechanisms in a larger population. If confirmed, mechanisms could be integrated into GP training and may offer guidelines for regulating proper access to mental health care services.
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Affiliation(s)
- Lennard T. van Venrooij
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- * E-mail:
| | - Pieter C. Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | | | - Matty R. Crone
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Optimizing the productivity and placement of nurse practitioners and physician assistants in outpatient primary care sites. J Am Assoc Nurse Pract 2022; 34:1022-1032. [PMID: 36330553 DOI: 10.1097/jxx.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is increasingly imperative that organizational leaders continually assess nurse practitioners' (NPs) and physician assistants' (PAs) productivity, turnover, and vacancies. Optimizing the feasibility, impact, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. LOCAL PROBLEM A healthcare system needed a systematic, data-driven approach aimed at optimizing productivity and placement of NPs and PAs in outpatient primary care sites. METHOD Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence framework. After formation of a QI team, a gap analysis, and action plans were developed and implemented. INTERVENTION/RESULTS Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NPs' and PAs' placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation background, assessment, and recommendation communication tool. CONCLUSION Health care leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. Nurse practitioner and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.
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Zaletel CL, Madura B, Metzel JM, Lancaster RJ. Optimizing the productivity and placement of NPs and PAs in outpatient primary care sites. JAAPA 2022; 35:41-49. [PMID: 35881717 DOI: 10.1097/01.jaa.0000840496.00307.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Organizational leaders must continually assess the productivity, turnover, and vacancies of physician assistants (PAs) and NPs. Optimizing the feasibility, effect, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. This quality improvement project sought to develop a systematic, data-driven approach to optimize productivity and placement of NPs and PAs in outpatient primary care sites. METHODS Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) framework. Postformation of a quality improvement team, a gap analysis, and action plans were developed and implemented. RESULTS Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NP and PA placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation, background, assessment, and recommendation communication tool. CONCLUSIONS Healthcare leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. NP and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.
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Affiliation(s)
- Cynthia L Zaletel
- At Advocate Aurora Medical Group in Downers Grove, Ill., Cynthia L. Zaletel is a family NP and professional development specialist in the Office of Advanced Practice Clinicians, Brenda Madura is director of advanced practice clinicians for Illinois, and Julie Miyamasu Metzel is a family NP and advanced practice clinician consultant in primary care in the Office of Advanced Practice Clinicians. Rachelle J. Lancaster is nursing research manager and a nurse scientist in the Center for Nursing Research and Practice at Advocate Aurora Health. The author has disclosed no potential conflicts of interest, financial or otherwise
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Schoenwald A, Ponting B, How R, Mansfield Y, Meehan T. Consultation With Nurse Practitioners Over the Telephone in Prison Health. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies. BJGP Open 2021; 5:BJGPO.2021.0043. [PMID: 34158369 PMCID: PMC8450886 DOI: 10.3399/bjgpo.2021.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background The current GP workforce is insufficient to manage rising demand in patient care within out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care. Aim To synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting. Design & setting Systematic review of qualitative studies and thematic synthesis. Method Electronic searches were conducted across CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsychINFO, Cochrane, MEDLINE, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis. Results A total of 2497 studies were screened, of which six met the inclusion criteria. These included interviews with 15 advanced nurse practitioners (ANPs), three physician assistants (PAs), two paramedics, and a focus group of 22 GPs, and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs, and of building their confidence by appropriate training, support, and mentoring. Conclusion While NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes challenging cases presenting to OOH could enable more effective OOH services and better patient care.
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Wilson E, Hanson LC, Tori KE, Perrin BM. Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions. BMC Health Serv Res 2021; 21:819. [PMID: 34391412 PMCID: PMC8364439 DOI: 10.1186/s12913-021-06864-9] [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: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
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Affiliation(s)
- Elena Wilson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
| | - Lisa C Hanson
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Kathleen E Tori
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked Bag 1351, Launceston, Tasmania, 7250, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
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Schimith MD, Cezar-Vaz MR, Xavier DM, Cardoso LS. Communication in health and inter-professional collaboration in the care for children with chronic conditions. Rev Lat Am Enfermagem 2021; 29:e3390. [PMID: 34231783 PMCID: PMC8253343 DOI: 10.1590/1518-8345.4044.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to understand how health communication in the care of children with chronic
conditions interferes with inter-professional collaboration. Method: a multicentric qualitative research. Data collection, carried out through
interviews and observation, occurred from October 2017 to February 2018. For
data organization, the NVivo software, version 12, was used. These data were
analyzed from a dialectical perspective. Results: a total of 79 professionals were interviewed, including physicians and
nurses in the Family Health Strategy. Essential markers for
inter-professionality stand out, such as multi-institutional communication;
the historical and political context of the municipalities; the bond between
staff and families with children with chronic conditions; and active and
purposeful communication. Conclusion: inter-professional collaboration is strengthened when the therapeutic plan
of the child with a chronic condition is coordinated by the Family Health
Strategy, plus the intention of communicating with the secondary sector. It
is considered that the research included important issues, contributing to
planning the work process in the Family Health Strategy.
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Affiliation(s)
- Maria Denise Schimith
- Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil
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Wang Z, Cheng Y, Li J, Hu X. Effect of integrated medical and nursing intervention model on quality of life and unhealthy emotion of patients with esophageal cancer undergoing radiotherapy. Am J Transl Res 2021; 13:3780-3786. [PMID: 34017565 PMCID: PMC8129406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the application of integrated medical and nursing intervention model in radiotherapy for patients with esophageal cancer. METHODS A total of 78 patients with esophageal cancer undergoing radiotherapy were randomly divided into two groups: control group (n=39, receiving traditional separate medical and nursing management) and study group (n=39, receiving integrated medical and nursing intervention mode). Before and after intervention, the mental state, nutritional index, quality of life and self-efficacy were compared between the two groups, and the adverse reactions were recorded during radiotherapy. RESULTS Compared with those before intervention, the scores of hamilton anxiety rating scale (HAMA) and hamilton depression scale (HAMD) were lower in both groups when they were discharged from hospital, and the study group was lower than the control group (all P<0.05). The scores of comprehensive quality of life assessment questionnaire (GQOLI-74) and self-management efficacy scale (SUPPH) were increased in both groups, and the study group was higher than the control group (all P<0.05). After intervention for 3 weeks, the levels of Hb, TP and Alb in the two groups were higher than those before intervention, and the study group was higher than the control group (all P<0.05). During radiotherapy, the total incidence of adverse reactions in the study group was lower than that in the control group (P<0.05). CONCLUSION Integrated medical and nursing intervention can obviously relieve the unhealthy emotion and improve the nutritional status, quality of life and self-efficacy for patients with esophageal cancer undergoing radiotherapy.
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Affiliation(s)
- Zhengyun Wang
- Department of Oncology Surgery, Lu'an Hospital Affiliated to Anhui Medical University Lu'an, Anhui Province, China
| | - Yuqiao Cheng
- Department of Oncology Surgery, Lu'an Hospital Affiliated to Anhui Medical University Lu'an, Anhui Province, China
| | - Jijuan Li
- Department of Oncology Surgery, Lu'an Hospital Affiliated to Anhui Medical University Lu'an, Anhui Province, China
| | - Xuyun Hu
- Department of Oncology Surgery, Lu'an Hospital Affiliated to Anhui Medical University Lu'an, Anhui Province, China
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Costa M, Correard F, Montaleytang M, Baumstarck K, Loubière S, Amichi K, Villani P, Honore S, Daumas A, Verger P. Acceptability of a Novel Telemedication Review for Older Adults in Nursing Homes in France: A Qualitative Study. Clin Interv Aging 2021; 16:19-34. [PMID: 33442242 PMCID: PMC7800438 DOI: 10.2147/cia.s283496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners' (GP) and other NH healthcare professionals' (HP) acceptability of the proposed TMR before its implementation. Material and Methods A qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews. Results Four main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing. Conclusion This study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.
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Affiliation(s)
- Marie Costa
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Florian Correard
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France
| | - Maeva Montaleytang
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France
| | - Karine Baumstarck
- EA3279, Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille 13385, France
| | - Sandrine Loubière
- EA3279, Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille 13385, France
| | - Kahena Amichi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille 13354, France
| | - Patrick Villani
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille 13274, France
| | - Stephane Honore
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France.,Service de Pharmacie Clinique, Faculté de Pharmacie Timone, Aix-Marseille Université, Marseille F-13000, France
| | - Aurélie Daumas
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille 13274, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Schimith MD, Cezar-Vaz MR, Xavier DM, Cardoso LS. Communication in health and inter-professional collaboration in the care for children with chronic conditions. Rev Lat Am Enfermagem 2021. [DOI: 10.1590/1518.8345.4404.3390] [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
Objective: to understand how health communication in the care of children with chronic conditions interferes with inter-professional collaboration. Method: a multicentric qualitative research. Data collection, carried out through interviews and observation, occurred from October 2017 to February 2018. For data organization, the NVivo software, version 12, was used. These data were analyzed from a dialectical perspective. Results: a total of 79 professionals were interviewed, including physicians and nurses in the Family Health Strategy. Essential markers for inter-professionality stand out, such as multi-institutional communication; the historical and political context of the municipalities; the bond between staff and families with children with chronic conditions; and active and purposeful communication. Conclusion: inter-professional collaboration is strengthened when the therapeutic plan of the child with a chronic condition is coordinated by the Family Health Strategy, plus the intention of communicating with the secondary sector. It is considered that the research included important issues, contributing to planning the work process in the Family Health Strategy.
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Tonarelli A, Takeshi Yamamoto T, Foà C, Miraglia Raineri A, Artioli G, Baccarini E, Giampellegrini P, Masciangelo I, Moggi E, Toni D, Valcavi L, Sarli L. Italian Validation of the Chiba Interprofessional Competency Scale (CICS29). ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:58-66. [PMID: 32168314 PMCID: PMC7944661 DOI: 10.23750/abm.v91i2-s.9172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The Chiba Inter-professional Competency Scale (CICS29) validated in several languages, it is a self-report instrument that investigates the degree of interprofessional collaboration in six areas: attitudes and beliefs of the professional; ability to manage a work group; actions to achieve goals; providing assistance that respects the patient; attitudes and behaviours that improve the cohesion of the working group; fulfilling or performing the own professional role. In addition to being recent, the scale investigates collaboration among all health professionals, and is not limited to specific professionals. The aim of the study was to validate the Italian version of CICS29. METHOD A questionnaire-based study was conducted with an Italian sample consisting of 530 health professionals (419 women¸ mean age = 40 years, SD = 10.7; range 23- 58 years). The internal validity was measured using factor analysis. To verify the convergent validity, the Italian Version of Interprofessional Collaborative Competency Attainment Survey (ICCAS) was correlated with the CICS29; Results: The reliability and the internal validity of the CICS29 revealed 6 factors corresponding to the original subscales. The analysis presents an excellent sample adequacy measure (KMO = .933) with the scores ranging from 0.62 to 0.78 for the interclass correlation coefficients of the 6 domains. A significant level of correlation was found between the subscales of the CICS29 and the ICCAS. CONCLUSIONS In conclusion, the Italian version of CICS29 has a satisfactory level of reliability and validity and it is recommended for measuring interprofessional collaboration of the health professionals. (www.actabiomedica.it).
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Affiliation(s)
| | | | - Chiara Foà
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | | | | | | | - Itria Masciangelo
- Scientific Institute for for the study and treatment of tumors of Romagna, Meldola (FC), Italy.
| | - Elisa Moggi
- Medical Center Fisiomed - Fiorenzuola d'Arda (Piacenza), Italy.
| | | | - Luca Valcavi
- blic Company Services to the Person - Reggio Emilia, Italy.
| | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, Italy.
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Taranta E, Marcinowicz L. Collaboration between the family nurse and family doctor from the perspective of patients: a qualitative study. Fam Pract 2020; 37:118-123. [PMID: 31281923 DOI: 10.1093/fampra/cmz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is increasing focus on collaboration in primary health care, but there is insufficient patient perspective on collaboration between the family nurse and family doctor. OBJECTIVE To explore how patients perceive collaboration between the family nurse and family doctor in primary health care in Poland. METHODS A qualitative approach and an inductive, naturalistic inquiry strategy were used. Thirty-seven patients from eight general practice clinics in the north-eastern part of Poland participated in semi-structured, face-to-face interviews. The qualitative data were examined by means of thematic analysis. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS Four subthemes emerged in the context of nurse-doctor collaboration, namely: (i) carrying out the doctor's orders; (ii) visit preparation; (iii) the family nurse as a source of information and (iv) participants' perceptions of the status of the family nurse. Nurses performing instrumental activities connected with a doctor's orders was understood by the participants to be collaboration and prevailed in their responses. CONCLUSION The perception of collaboration (or lack thereof) between the family nurse and family doctor results from patients' varied experiences and observations during their visits to a primary care clinic. The traditional model of nursing care and the hierarchical relationship, in which the doctor has the dominant role, are evident in the patients' remarks. The autonomy of nursing could be strengthened by expanding, and highlighting, the primary care activities that a nurse can perform on her own.
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Affiliation(s)
- Ewa Taranta
- Department of Primary Health Care, Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Primary Health Care, Medical University of Bialystok, Bialystok, Poland
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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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Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands. J Am Assoc Nurse Pract 2019; 32:800-808. [PMID: 31584508 DOI: 10.1097/jxx.0000000000000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. PURPOSE To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. METHODOLOGICAL ORIENTATION Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. SAMPLE Twelve semi-structured interviews were conducted with NPs from two hospital settings. CONCLUSIONS The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. IMPLICATIONS FOR PRACTICE This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Dickman C, Miller T, Muchow L, Ward-Smith P. Israeli staff nurse knowledge and perception of the nurse practitioner role. Nurse Pract 2018; 43:42-48. [PMID: 30439774 DOI: 10.1097/01.npr.0000547553.01883.ac] [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] [Indexed: 06/09/2023]
Abstract
This study assessed Israeli nurses' knowledge of the emerging role of master's-prepared NPs. Based on an integrated review of the literature, a study-specific survey was developed, including dichotomous knowledge items, Likert scored perception items, and self-disclosed demographic data. Analyses of the 146 responses revealed that exposure to NPs was limited. Knowledge specific to the role or clinical competency was lacking, yet the assessment capabilities and overall perception of NPs were positive. Data demonstrate a willingness to include NPs in the care model and an awareness that doing so would positively contribute to the overall health of patients.
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Affiliation(s)
- Chaya Dickman
- Chaya Dickman is an RN at Terem Urgent Care, Beit Shemesh, Israel. Tamar Miller is a clinical nurse at Meuchedet Primary Care Clinic, Beitar, Israel. Lori Muchow is a charge nurse at Wake Forest Baptist Medical Center, Winston-Salem, N.C. Peggy Ward-Smith is an adjunct instructor at Simmons University, College of Nursing, Boston, Mass
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Primary care workforce development in Europe: An overview of health system responses and stakeholder views. Health Policy 2018; 122:1055-1062. [PMID: 30100528 DOI: 10.1016/j.healthpol.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/20/2022]
Abstract
Better primary care has become a key strategy for reforming health systems to respond effectively to increases in non-communicable diseases and changing population needs, yet the primary care workforce has received very little attention. This article aligns primary care policy and workforce development in European countries. The aim is to provide a comparative overview of the governance of workforce innovation and the views of the main stakeholders. Cross-country comparisons and an explorative case study design are applied. We combine material from different European projects to analyse health system responses to changing primary care workforce needs, transformations in the general practitioner workforce and patient views on workforce changes. The results reveal a lack of alignment between primary care reform policies and workforce policies and high variation in the governance of primary care workforce innovation. Transformations in the general practitioner workforce only partly follow changing population needs; countries vary considerably in supporting and achieving the goals of integration and community orientation. Yet patients who have experienced task shifting in their care express overall positive views on new models. In conclusion, synthesising available evidence from different projects contributes new knowledge on policy levers and reveals an urgent need for health system leadership in developing an integrated people-centred primary care workforce.
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