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Brandon E, Green P, Palozzi L, Kassam-Lallani D, Lauzon A, Nenadovic V, Puthen R, Rudden L, Ballantyne M. Nurse Practitioners in a Canadian Pediatric Rehabilitation Hospital: A Description of Roles and Scope of Practice. J Pediatr Health Care 2023; 37:e1-e10. [PMID: 37245130 DOI: 10.1016/j.pedhc.2023.04.011] [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: 12/11/2022] [Revised: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 05/29/2023]
Abstract
The nurse practitioner role is strongly suited to meet the needs of children with complex developmental conditions in pediatric rehabilitation settings as they have a unique combination of clinical expertise. To meet the increasing demands in a large Canadian pediatric rehabilitation hospital, the NP role was implemented in several clinical program settings to improve access to care. This paper describes the contributions of NPs to nine specialized inpatient and outpatient programs in NP-led, collaborative NP and physician or interagency care team models of practice. The initial challenges of role implementation and implications for NP practice, research and leadership are discussed.
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Fox S, Breton M, Faria A, Kilpatrick K. When Bothering is Part of Professional Practice: Interprofessional Collaboration and Institutional Influences in Primary Care. HEALTH COMMUNICATION 2023; 38:1677-1687. [PMID: 35067106 DOI: 10.1080/10410236.2022.2028367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Western healthcare systems, increasing numbers of nurse practitioners are practicing in primary care organizations, and their integration onto interprofessional teams can be somewhat bumpy. In this article, we rely on the institutional theory of organizational communication to investigate the situated communication challenges faced by NPs as they integrate onto primary health care teams (RQ1), and how these local challenges manifested institutional features (RQ2). We analyze interview data from NPs, their physician partners, clinical nurses, and a network administrator for NPs at five family medicine clinics in Quebec, Canada. We found three main challenges to IP communication between NPs and physicians, namely a lack of time, the professional necessity of bothering, and talking to - and like - a doctor. We present the solutions that participants found to overcome or workaround these challenges. We also interpreted the institutional features that inflected - or "moored" - the situated communication practices and challenges reported by our participants to better understand how the local experience of IP communication is shaped by broader institutional forces.
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Affiliation(s)
| | - Mylaine Breton
- Department of Medicine and Health Sciences, Université de Sherbrooke
| | - Aline Faria
- Department of Social and Public Communication, Université de Québec à Montréal
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Blanco-Fraile C, Madrazo-Pérez M, Fradejas-Sastre V, Rayón-Valpuesta E. The evolution of the role of nursing in primary health care using Bourdieu’s concept of habitus. A grounded theory study. PLoS One 2022; 17:e0265378. [PMID: 35580088 PMCID: PMC9113590 DOI: 10.1371/journal.pone.0265378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
To analyse the global process by which Spanish nurses have acquired a differentiated role in primary health care and to develop a theory that explains the evolution of this role.
Design
Grounded Theory was selected, as proposed by Glaser and Strauss, following the theoretical framework of Bourdieu’s habitus.
Methods
Thirteen in-depth interviews were conducted between 2012 and 2015, using theoretical sampling and seeking maximum variability. The analysis of the data included progressive coding and categorization, constant comparative analysis and memo writing.
Results
A core category emerged, “Autonomy”, composed of three categories: "Between illusion and ignorance. Genesis of a habitus", "The recognisable and recognised habitus" and "Habitus called into question", showing the genesis of the nursing role in primary health care and the elements that influence the autonomy of the role: the ability to decide their training, assume their own leadership, configure teams and acquire independent skills. “Seeking autonomy” was the substantive theory that emerged from the data.
Conclusion
The results reveal the elements that strengthen the autonomous professional role and that this role is legitimated when two elements are identified: the acquisition of a habitus, based on practices carried out regularly and the recognition of this habitus by the population and others professionals.
Impact
The results of this study identify the elements that guide and strengthen the professional role and redefine the concept of autonomy. These are operational findings and could potentially be used to define new strategies for advancing the role of nursing in primary health care.
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Affiliation(s)
| | | | - Victor Fradejas-Sastre
- Faculty of Nursing, University of Cantabria, Santander, Cantabria, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
- * E-mail:
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Busca E, Savatteri A, Calafato TL, Mazzoleni B, Barisone M, Dal Molin A. Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review. BMC Nurs 2021; 20:171. [PMID: 34530813 PMCID: PMC8444166 DOI: 10.1186/s12912-021-00696-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The rapid evolution of the epidemiological picture and the recent SARS-COV-2 pandemic has expressed the vulnerabilities of health systems and focuses attention on the population’s needs. The nurse’s figure in the care teams is universally identified; however, the implementation of the role within some care settings turns out to be complex and challenging. This integrative review aims to identify the barriers and facilitators in implementing the role of the nurse in primary care settings. Methods An integrative review was conducted on the Medline and Cinahl databases until 9 June 2020. Qualitative, quantitative, and Mixed-method research studies were selected to identify studies related to the barriers and facilitators of the nurse’s role in nursing facilities’ primary care. For the extraction of the results, the Consolidating Framework for Research Implementation (CFIR) was used to identify the factors that influence implementation in health care. Results Following the duplicates’ removal, the search identified 18,257 articles, of which 56 were relevant to the inclusion criteria; therefore, they were included in the summary. The selected studies were conducted in thirteen countries, most from Oceania, Europe, North America, Latin America, and the Caribbean. The barriers reported most frequently concern the nursing profession’s regulatory and regulatory aspects within the contexts of care, cultural and organizational aspects, training, and the transfer of specific skills, which were previously designated to doctors. The facilitators are mainly linked to the nurse’s adaptability to the various contexts of care, recognizing the patient’s role, and the desire to develop multidisciplinary and effective working groups to respond to the health needs of the population in primary care contexts. Conclusion This review highlighted the main barriers and facilitators in implementing the nurse’s role in primary care settings. These results offer useful elements for stakeholders to identify effective strategies in preparing programs and activities for implementing the nurse’s role, acting on the elements identified as barriers and favouring the aspects that emerge as facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00696-y.
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Affiliation(s)
- Erica Busca
- Department of Translational Medicine, University of Piemonte Orientale, Via P. Solaroli, 17, 28100, Novara, Italy
| | - Alessia Savatteri
- Functional Oncology Department - Gastroenterology, Hospital "San Vincenzo" of Taormina, Contrada Sirina, 98039, Taormina, Italy
| | - Tania Lorenza Calafato
- Emergency-Urgency Department, Hospital "Sant'Elia" of Caltanissetta, Via Cusmano,1, 93100, Caltanissetta, Italy
| | - Beatrice Mazzoleni
- Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Michela Barisone
- Department of Translational Medicine, University of Piemonte Orientale, Via P. Solaroli, 17, 28100, Novara, Italy.
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Direzione delle Professioni Sanitarie - A.O.U. Maggiore della Carità di Novara, Via P. Solaroli, 17, 28100, Novara, Italy
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Knop M, Mueller M, Niehaves B. Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study. J Med Internet Res 2021; 23:e28151. [PMID: 34435959 PMCID: PMC8430853 DOI: 10.2196/28151] [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: 02/23/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven. Objective The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. Methods We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders’ perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results. Results Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. Conclusions Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients’ resistance toward using innovative technology and compensate for patients’ limited access to technology and care facilities.
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Affiliation(s)
- Michael Knop
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Marius Mueller
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Bjoern Niehaves
- Chair of Information Systems, University of Siegen, Siegen, Germany
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Magnago C, Pierantoni CR. Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare. HUMAN RESOURCES FOR HEALTH 2021; 19:90. [PMID: 34294088 PMCID: PMC8296671 DOI: 10.1186/s12960-021-00632-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The shortage of doctors and their unequal distribution serve as challenges to advancing primary healthcare (PHC) and achieving effective universal healthcare coverage in Brazil. In an effort to use nurses' potential more efficiently, the country is investigating the introduction of the advanced practice nurse (APN) into PHC. This paper presents a situational analysis of the practices of Brazilian nurses based on the following components: regulation, practice, and education. METHODS This is a national multi-method study with triangulated data from a documentary study, a scoping review, and an exploratory study. The regulation component involved the analysis of official normative documents on the regulation of nursing education and nurses' scope of practice. The practice component aimed to identify the practices performed by nurses in Brazilian PHC based on primary studies. The education component intended to identify the practices taught in nursing training based on a survey and interviews with directors of undergraduate nursing programs. RESULTS Federal legislation in Brazil authorizes nursing graduates to perform a set of advanced practices as part of the PHC nurse's daily routine. They can request and interpret complementary tests and prescribe medication. However, in the local context, municipalities define the scope of this assistance based on technical norms or nursing protocols. Furthermore, this study indicates that undergraduate nursing programs do not fully prepare students to adequately execute these tasks. CONCLUSIONS In the context of Brazilian PHC, advanced practices have already been implemented and respond to main healthcare demands. Therefore, it is unnecessary to introduce the APN as a new professional category. Upon detecting deficiencies in the training process, the current education model should undergo reforms that seek to incorporate the skills compatible with the regulated advanced practices and in-service training for practicing nurses. Regarding the introduction of APN along international lines, this article presents recommendations that may support the operationalization of a Brazilian APN model.
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Affiliation(s)
- Carinne Magnago
- Department of Policy, Management and Health, School of Public Health, University of São Paulo (FSP/USP), Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.
| | - Celia Regina Pierantoni
- Institute of Social Medicine, Rio de Janeiro State University (IMS/Uerj), Rio de Janeiro, Brazil
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Shangala Mwawaka J. Re-Engineering Collaborative Practice in Primary Care: Integrating Community Pharmacy to the Clinic; Creating a Pharmacy Referral and Quality Circle. Innov Pharm 2021; 12:10.24926/iip.v12i3.4210. [PMID: 35601592 PMCID: PMC9120010 DOI: 10.24926/iip.v12i3.4210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pharmacy practice is part of a value chain made up of suppliers(S), inputs(I), processes(P), outputs(O), and customers(C). The interface between community pharmacies and clinic-based prescribers is complicated by challenges related to gaps in the design of the chain. The supplier-input-process-outcome-customer (SIPOC) model can be used to re-engineer the chain: integrating an intervening clinical pharmacist in the interface creates a structure for interprofessional collaboration and communication across the interface. This innovation has important implications for patient referral between clinic and pharmacy, and the future role and scope of all patient-facing pharmacists.
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Affiliation(s)
- Jimmy Shangala Mwawaka
- Kenya Medical Research Institute, Student of Biotechnology, Innovation and Regulatory Science at Purdue University
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Denis JL, Côté N, Fleury C, Currie G, Spyridonidis D. Global health and innovation: A panoramic view on health human resources in the COVID-19 pandemic context. Int J Health Plann Manage 2021; 36:58-70. [PMID: 33647168 PMCID: PMC8014483 DOI: 10.1002/hpm.3129] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/11/2022] Open
Abstract
While policy‐makers in many jurisdictions are paying increasing attention to health workforce issues, human resources remain at best only partially aligned with population health needs. This paper explores the governance of human resources during the pandemic, looking at the Quebec health system as a revelatory case. We identify three issues related to health human resource (HHR) policies: working conditions, recognition at work and scope of practice. We empirically probe these issues based on an analysis of popular media, policy reports and participant observation by the lead authors in various forums and research projects. Using an integrated model of HHR, we identify major vulnerabilities in this domain. Persistent labour shortages, endemic deficiencies in working environments and inequity across occupational categories limit the ability to address critical HHR issues. We propose three ways to eliminate HHR vulnerabilities: reorganize work through participatory initiatives, implement joint policy making to rebalance power across the health workforce, and invest in the development of capacities at all system levels.
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Affiliation(s)
- Jean Louis Denis
- Département de gestion, d'évaluation et de politique de santé, School of Public Health, Université de Montréal-CRCHUM, Montreal, Quebec, Canada
| | - Nancy Côté
- Department of Sociology, Université Laval-Vitam, Quebec City, Quebec, Canada
| | - Charles Fleury
- Department of Industrial Relations, Université Laval, Quebec City, Quebec, Canada
| | - Graeme Currie
- Entrepreneurship and Innovation Group, Warwick Business School, University of Warwick', Public Management, Warwick Business School, Coventry, UK
| | - Dimitrios Spyridonidis
- Entrepreneurship and Innovation Group, Warwick Business School, University of Warwick', Public Management, Warwick Business School, Coventry, UK
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Experiences of Scope of Practice of the Taiwanese Nurse Practitioner. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shahsavari H, Bakhshi F, Khosravi A, Najafi Z, Ghorbani A. Perceived professional preparedness of senior nursing students' questionnaire: Development and psychometric evaluation. NURSE EDUCATION TODAY 2020; 93:104533. [PMID: 32745792 DOI: 10.1016/j.nedt.2020.104533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/29/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nursing students' perceptions of their professional preparedness help them perform their independent nursing role with self-confidence. OBJECTIVES To develop and psychometric testing of an instrument, the "Perceived Professional Preparedness of senior Nursing Students" questionnaire. DESIGN Mixed-method exploratory study. METHODS We conducted this study in two phases: (1) development of initial questionnaire through interview and literature review; (2) evaluation of psychometric properties of the instrument to introduce a reliable, valid tool. SETTINGS AND PARTICIPANTS We assessed qualitative and quantitative face validity of initial questionnaire by administering it to 10 nursing students. Then, a panel of 10 nursing specialists determined the Content Validity Index. After modifying items, we assessed the construct validity of the 45-item questionnaire. A sample of 159 senior nursing students completed the questionnaire, and we conducted exploratory and confirmatory factor analysis using this data. To assess the test-retest reliability, 30 students completed the instrument twice with a two-week time interval. RESULTS The Content Validity Index with the modified Kappa coefficient was calculated as ≥0.72, which is considered satisfactory. In exploratory factor analysis using the maximum likelihood method and varimax rotation, we extracted 19 items in four factors. This structure included 61.91% of the total variance. The factors were clinical competency, evidence-based practice, framework-oriented performance, and patient-centered care. Cronbach's alpha coefficient and McDonald's omega values higher than 0.70 and inter-class correlation coefficient above 0.90 for all factors confirmed reliability. Confirmatory factor analysis indicated a suitable fitting of the final developed model. CONCLUSION The developed questionnaire is a valid, reliable tool to assess the perceived preparedness of senior nursing students for transition to the clinical setting. Further psychometric testing for this questionnaire on larger populations and in different contexts is suggested.
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Affiliation(s)
- Hooman Shahsavari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Bakhshi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Afifeh Khosravi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Najafi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azam Ghorbani
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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