Effectiveness of registered nurses on patient outcomes in primary care: a systematic review

Facilitators and barriers to AI adoption in nursing practice: a qualitative study of registered nurses' perspectives

BACKGROUND

Integrating Artificial Intelligence (AI) in nursing practice is revolutionising healthcare by enhancing clinical decision-making and patient care. However, the adoption of AI by registered nurses, especially in varied healthcare settings such as Saudi Arabia, remains underexplored. Understanding the facilitators and barriers from the perspective of frontline nurses is crucial for successful AI implementation.

AIM

This study aimed to explore registered nurses' perspectives on the facilitators and barriers to AI adoption in nursing practice in Saudi Arabia and to propose an extended Technology Acceptance Model for AI in Nursing (TAM-AIN).

METHODS

A qualitative study utilising focus group discussions was conducted with 48 registered nurses from four major healthcare facilities in Al-Kharj, Saudi Arabia. Thematic analysis, guided by the Technology Acceptance Model framework, was employed to analyse the data.

RESULTS

Key facilitators of AI adoption included perceived benefits to patient care (85%), strong organisational support (70%), and comprehensive training programs (75%). Primary barriers involved technical challenges (60%), ethical concerns regarding patient privacy (55%), and fears of job displacement (45%). These findings led to the development of TAM-AIN, an extended model that incorporates additional constructs such as ethical alignment, organisational readiness, and perceived threats to professional autonomy.

CONCLUSIONS

AI adoption in nursing practice requires a holistic approach that addresses technical, educational, ethical, and organisational challenges. The proposed TAM-AIN offers a comprehensive framework for optimising AI integration into nursing practice, emphasising the importance of nurse-centred implementation strategies. This model provides healthcare institutions and policymakers with a robust tool to facilitate successful AI adoption and enhance patient outcomes.

Integrating physiotherapy into primary care models: A scoping review protocol

INTRODUCTION

Physiotherapists (PTs) working in primary care settings within an interprofessional team can lead to favourable health outcomes and decreased burden on the healthcare system. Although PT models of care are important to primary care delivery, there is a lack of knowledge and evidence on the characteristics of these models of care, the differences and similarities between the models, and the barriers and facilitators to implementing these models. This scoping review protocol aims to fill this knowledge gap by synthesizing the evidence and characteristics of models of care that integrate physiotherapists within primary care teams, mapping the similarities and differences, and describing barriers and facilitators to implementing models of care that integrate physiotherapists within primary care teams.

METHODS

The scoping review is based on the Joanne Briggs Institute (JBI) framework. It is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRIMSA-ScR). A comprehensive search strategy will be used to find relevant papers in six databases: OVID MEDLINE, PubMed, Embase, CINAHL, Web of Science, and Scopus. Grey literature will be searched through OpenGrey, Theses Global, ProQuest Dissertation, and Google Scholar. Quantitative and qualitative study designs will be included, with two reviewers independently selecting each article on Covidence. Data will be extracted using a pre-piloted data extraction sheet and synthesized narratively to identify themes and patterns.

DISCUSSION

This scoping review will synthesize the evidence on models of care that integrate physiotherapists within primary care teams. It will provide evidence to inform the implementation of these models of care and identify research gaps that need to be addressed. The protocol is registered on Open Science Framework registries at https://osf.io/kh83r/.

Primary Care Clinician Perspectives on Team-Based Welcome Video Visits

BACKGROUND

Synchronous virtual visits aid in longitudinal primary care and fulfill unmet needs for patients and clinicians. Virtual visits are widely accepted for specialty consultation and follow-up; however, novel systems-based programs and processes may support earlier engagement.

AIM

Evaluate primary care clinician attitudes and perspectives on patient information obtained team-based, nurse-led virtual visits ahead of face to face visits.

SETTING

Study occurred in a large, regional, multispecialty group practice in Eastern Pennsylvania.

PARTICIPANTS

Participants included primary care physicians, nurse practitioners, and physician assistants.

PROGRAM DESCRIPTION

Virtual visits are a component of a large, unified network strategy called the Patient Partnership Model which incorporates technology and remote care to achieve improved access and patient satisfaction.

PROGRAM EVALUATION

Survey of participating primary care clinicians assessing impact of at-hand medical history, social history, and medications on delivering face to face primary care. Weighted mean of satisfied participants was 3.61 on a 5-point Likert scale.

DISCUSSION

Participants reported satisfaction and acceptability of team-based virtual visits, noting high satisfaction with information exchange and actionability of notes. Participants reported ongoing opportunities to enhance medication reconciliation. Virtual visits continue to evolve and may serve varying roles in primary care.

[Enhancing Chronic Pain Management: Exploring the Essential Contribution of Primary Care Nurses]

Introduction

L’expertise infirmière en soins primaires est cruciale pour répondre aux besoins des patients vivant avec une maladie chronique. Au Canada, une personne sur cinq vit avec de la de douleur chronique (DC), créant ainsi un fardeau socioéconomique majeur. Cependant, le rôle du personnel infirmier en soins primaires en DC reste sous-développé.

Objectifs

Cette revue narrative analyse l’adéquation du récent Plan d’action québécois en DC avec les modèles de soins reconnus pour la gestion des maladies chroniques et examine le rôle potentiel du personnel infirmier dans la mise en œuvre de ce plan.

Méthode

La synthèse de la littérature a été menée à partir de diverses bases de données (CINAHL, PubMed) et sources documentaires en français et en anglais. Les résultats ont été interprétés à travers le prisme du Chronic Care Model , un cadre reconnu pour améliorer les soins.

Résultats

Bien que le Plan d’action québécois en DC soit aligné sur les objectifs visés, sa mise en œuvre devra surmonter divers défis. Les constats indiquent des opportunités efficaces dans la gestion de la DC, comme le montrent des études sur la pratique infirmière en soins primaires. Elles révèlent que le personnel infirmier exerce déjà des activités de gestion des maladies chroniques applicables à la DC.

Conclusion

Il est important de reconnaître l’apport de l’expertise infirmière en soins primaires pour réévaluer les modèles d’organisation des soins, promouvoir un partage de responsabilités fondé sur les données probantes, et soutenir la recherche future ainsi que l’innovation clinique dans la gestion de la DC.

Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors

AIM

To explore the association between nurse education levels and patient-related factors with hypertension self-care.

BACKGROUND

Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed.

DESIGN

A cross-sectional study.

METHODS

Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty).

RESULTS

A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities.

CONCLUSIONS

Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.

Constructing a Competency Evaluation Index System for Nursing Positions in a Chronic Kidney Disease Management Centre

Objective

The Chronic Kidney Disease Management Centre (CKDMC) primarily focuses on developing a new system for early screening, standardised diagnosis, treatment, and the long-term follow-up management of patients with chronic kidney disease (CKD) to enhance CKD prevention and management. Nurses play a pivotal role in the comprehensive management of CKD, contributing considerably to the improvement of patient survival. Consequently, this study constructs an evaluation index system for nursing positions in the CKDMC, delineating the required competencies of nurses and providing a foundation for their targeted training.

Methods

A literature review and semi-structured interviews were used to develop the competency evaluation index system for nursing positions at the CKDMC. The Delphi method, involving expert correspondence, was employed over two rounds of inquiry with 16 experts, focusing on screening, modifying, and refining the indicators at all levels.

Results

The response rates for the first and second rounds of the questionnaire were 100% and 93.8%, respectively, with expert authority coefficients of 0.73 for both rounds. The finalised competency evaluation index system includes 3 primary indicators (theoretical knowledge, practical skills, and professional attitude), 10 secondary indicators, and 44 tertiary indicators.

Conclusion

The study successfully established a CKD specialist nurse competency evaluation index system comprising 3 primary, 10 secondary, and 44 tertiary indicators. The consensus among experts was high, rendering the results scientific, objective, and reliable. This system can serve as a basis for the training, selection, and competency evaluation of nursing professionals in CKDMCs.

Identifying Competencies of the ACT Program Nurse Using the DACUM Method

The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.

Nurses' Roles in Caring for Older People in Domiciliary Settings: A Scoping Review Protocol

Due to global shifts in demographics and advances in chronic illness management over the past few decades, domiciliary care has become the primary setting for caring for older people. In this regard, nurses play a crucial role, promoting quality care and minimizing hospital admissions and the need for institutionalization. However, historical and geographic variation in nursing titles and the multitude of labels for different roles have been obstacles to the creation of a clear map outlining specific nursing roles in home care for older people. The aim of this scoping review is to map the evidence on the different nurses' roles in caring for older people in domiciliary settings. This review will include primary, secondary, and gray literature on nurses' roles in domiciliary settings for older people, sourced through comprehensive searches of various databases (MEDLINE, Embase, CINAHL) and reference scanning. No language restrictions will be applied. Two independent reviewers will conduct screening and data extraction. The tabulated results will be informed by descriptive frequencies and content analysis, presenting comprehensive findings. The review protocol was retrospectively registered within OSF database on the 23 November 2023.

Nursing roles and responsibilities conducted by registered nurse/BSN student dyads across ambulatory clinical sites in medically underserved communities

BACKGROUND

Increasingly, registered nurses (RNs) are incorporated into ambulatory care teams. Yet, limited research exists on the roles of RNs across these settings.

PURPOSE

The purpose of this study was to examine the roles performed by RNs (and their senior BSN students) in primary care and public health settings.

METHODS

Working with nine RN preceptors, 15 students tracked all patient visits during a 150-h immersion experience using the Typhon™ clinical-tracking software.

RESULTS

The BSN student/RN dyads conducted 1218 patient visits completing 8536 RN roles in 15 distinct categories. Most patients were African American and female (n = 736; 60.1 %) with an average age of 38.4 (SD 22.12). Patient demographics varied by site. The most common roles performed by the RN/student dyad were health assessment, behavioral health screening, and telehealth. Roles of the RNs and the student level of independence were significantly different across sites (Fisher's Exact test [p < .001]).

CONCLUSIONS

Our results argue that RNs are providing substantial value to these FQHC and public heath settings. An academic/practice partnership, including a shared curricular review, can provide a strategic advantage for educators to ensure that health systems realize the unique roles for RNs and educators provide 21st century education.

Mentors Supporting Nurses Transitioning to Primary Healthcare Roles: A Practice Improvement Initiative

Introduction

Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021.

Method

A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time.

Results

Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC.

Conclusion

The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health.

Perceptions of general practitioners towards the services provided by advanced practice nurses: a cross-sectional survey in France

BACKGROUND

New healthcare professions are emerging due to scarce medical resources. The appearance of a new healthcare profession, advanced practice nurses (APNs), has raised questions about how general practitioners interrelate with them as primary care providers. The objective of this study was to explore the perceptions general practitioners have towards the services rendered by APNs to patients, to general practice and the role they play in the healthcare system.

METHODS

A survey-based, cross-sectional study was conducted throughout the Grand Est region of France which covers 57,333km2 and has a population of approximately 5,562,651. The survey was compiled using pre-existing questionnaires and was carried out from July to September 2022 via email. Variables collected were rate of acceptability and socio-demographic characteristics.

RESULTS

In total, 251 responses were included. The mean age of general practitioners was 41.7 years, most were women (58.2%) and worked in rural areas of the region (53.8%). Over 80% of respondents practiced in group structures (defined as either multi-professional health centers (n = 61) or in group practices (n = 143)). Most respondents (94.0%) were familiar with the APN profession and did not consider that APNs improved access to care (55.8%, percent of responders with score ≤ 3/10). Moreover, most did not believe that APNs were useful as a primary care provider for patients (61.8%). However, being a member of a territorialized healthcare community, known as Communautés Professionnelles Territoriales de Santé (CPTS), was associated with a positive appraisal of APNs' services (OR = 2.116, 95%CI: 1.223 to 3.712; p = 0.007).

CONCLUSIONS

Encouraging shared and networked practice within a healthcare community may promote a positive perception of new actors. Further studies need to be conducted to show whether the integration of APNs into healthcare networks improves quality of care.

Clinical and Organizational Nursing Innovations in Primary Care: Findings From a Stakeholders' Symposium

Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.

Universal health coverage in China part 2: addressing challenges and recommendations

This report analyses the underlying causes of China's achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China's ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Here, we used a health system conceptual framework and we propose a set of feasible policy recommendations that draw from international experiences and first-hand knowledge of China's unique institutional landscape. Our six recommendations are: instituting a primary care-focused integrated delivery system that restructures provider incentives and accountability mechanisms to prioritise prevention; leveraging digital tools to support health behaviour change; modernising information campaigns; improving financial protection through insurance reforms; promoting a health in all policy; and developing a domestic monitoring framework with refined tracer indicators that reflects China's disease burden.

Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review

BACKGROUND

Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes.

METHODS

Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction.

RESULTS

Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes.

CONCLUSIONS

There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.