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Di Lodovico L. [The care team, from roots to new challenges]. Soins Psychiatr 2024; 45:10-13. [PMID: 39237212 DOI: 10.1016/j.spsy.2024.06.005] [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] [Indexed: 09/07/2024]
Abstract
The team is a fundamental and structuring dimension of care, founded on the principles of complementarity, interdependence, and shared objectives and responsibilities towards the patient. As a result of the pandemic and the rationalization of public hospitals, teams are faced with changes in the role of supervisors and the arrival of new figures such as advanced practice nurses. While these changes can bring new dynamism and questioning of practices, they can also be destabilizing. The institution must preserve the role of the team and its members.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des maladies mentales et de l'encéphale, GHU Paris psychiatrie et neurosciences, 1 rue Cabanis, 75014 Paris, France.
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De Rosis C, Duconget L, Jovic L, Bourmaud A, Dumas A. The deployment of advanced practice nurses in the French health system: From clinics to professional networks. Int Nurs Rev 2024; 71:362-374. [PMID: 38197737 DOI: 10.1111/inr.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
AIM The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. INTRODUCTION The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. BACKGROUND A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area. METHODS Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. RESULTS The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. DISCUSSION The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. CONCLUSION The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. IMPLICATIONS FOR NURSING POLICY APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.
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Affiliation(s)
- Carolina De Rosis
- University of Paris - INSERM ECEVE UMR1123; Université Paris Cité, Inserm, ECEVE, Paris, France
| | - Lisa Duconget
- University of Paris - INSERM ECEVE UMR1123; Université Paris Cité, Inserm, ECEVE, Paris, France
| | - Ljiljana Jovic
- Affiliated Member of the University of Paris - INSERM ECEVE UMR1123; Université Paris Cité, Inserm, ECEVE, Paris, France
| | - Aurélie Bourmaud
- Affiliated Member of the University of Paris - INSERM ECEVE UMR1123; Université Paris Cité, Inserm, ECEVE, Paris, France
- Unité d'Épidémiologie Clinique INSERM CIC 1426 Hôpital Robert Debré, Paris, France
| | - Agnès Dumas
- University of Paris - INSERM ECEVE UMR1123; Université Paris Cité, Inserm, ECEVE, Paris, France
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Damien C, Marion DH, Deborah S, Margot M. Professional identity and representations of advanced practice nurses specialising in psychiatry and mental health: A national study. Int J Ment Health Nurs 2024; 33:714-725. [PMID: 38240063 DOI: 10.1111/inm.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 03/06/2024]
Abstract
Advanced practice nurses constitute a new professional group within the French health care system. Advanced practice nurses specialise in one of five disciplines including Psychiatry/Mental-Health. This specific discipline is strongly marked by stigmatising representations by healthcare users and other health professionals (including other advanced practice nurses), whose consequences have a deleterious effect. The aim was to highlight all advanced practice nurses representation of Psychiatry/Mental-Health advanced practice nurses. An observational descriptive survey, based on an anonymous online questionnaire was conducted in April 2022 among qualified and student advanced practice nurses from the five specialist disciplines. Overall, 356 advanced practice nurses completed the survey questionnaire. No significant difference in stigmatising representations of Psychiatry/Mental-Health advanced practice nurses versus other advanced practice nurses was observed. Only 3.3% of other advanced practice nurses thought that Psychiatry/Mental-Health advanced practice nurses are often 'strange'. Psychiatry/Mental-Health advanced practice nurses and other advanced practice nurses appeared to have similar representations of the professional roles of advanced practice nurses in general and of advanced practice nurses APN specifically. Unlike other professionals in the psychiatric field (e.g. medical interns, nurses), very little stigmatisation of Psychiatry/Mental-Health advanced practice nurses by their colleagues (i.e. other advanced practice nurses) was observed. This could be partly due to the fact that advanced practice nurses professional identity appeared to be built collectively around the concept of advanced practice. Advanced practice nurses constitute a professional group that is fully involved in contemporary transformations in care and organisational innovation. The very low level of stigmatisation of Psychiatry/Mental-Health advanced practice nurses by other advanced practice nurses in our study suggests that these new healthcare actors could play a crucial role in the improvement of professional health practices, particularly in terms of improved coordination between psychiatric-care and physical-care.
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Affiliation(s)
- Croguennec Damien
- Pôle 94g16, Hôpitaux de St. Maurice, St. Maurice, France
- Université Paris Cité, Paris, France
| | - Darras-Hostens Marion
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille-Métropole, Hellemmes-Lille, France
| | - Sebbane Deborah
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille-Métropole, Hellemmes-Lille, France
- ECEVE, UMR 1123, Inserm, Université Paris Cité, Paris, France
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Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessière S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc 2024; 25:572-579.e1. [PMID: 38159914 DOI: 10.1016/j.jamda.2023.11.017] [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: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.
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Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; Regional Health Agency of Occitanie, Toulouse, France.
| | | | - Emilie Berard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; UMR 1295 CERPOP, INSERM-Université de Toulouse III, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France
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Goddaert C, Gérard PA, Kessler C, Leblanc M, Barbe C, Chrusciel J, Cormi C, Sanchez S. Perceptions of general practitioners towards the services provided by advanced practice nurses: a cross-sectional survey in France. BMC Health Serv Res 2023; 23:1442. [PMID: 38124027 PMCID: PMC10734111 DOI: 10.1186/s12913-023-10420-y] [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: 07/24/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Charles Goddaert
- Department of General Medicine, Faculty of Medicine, University of Reims Champagne Ardennes, Marne, France
| | - Pierre-Antoine Gérard
- Department of General Medicine, Faculty of Medicine, University of Reims Champagne Ardennes, Marne, France
| | - Charlotte Kessler
- Department of Advanced Practice, University of Reims Champagne Ardennes, Reims, Marne, France
| | - Mélaine Leblanc
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, Aube, France
| | - Coralie Barbe
- University Committee of Resources for Research in Health (CURRS), University of Reims, Marne, France
| | - Jan Chrusciel
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, Aube, France
| | - Clément Cormi
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, Aube, France
| | - Stéphane Sanchez
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, Aube, France.
- University Committee of Resources for Research in Health (CURRS), University of Reims, Marne, France.
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Duconget L, De Rosis C, Jovic L, Bourmaud A, Dumas A. Deployment of advanced nursing practice in Île-de-France. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:55-59. [PMID: 38070985 DOI: 10.1016/j.soin.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Advanced practice nurses (APNs) are finding it difficult to establish themselves once they have completed their training. Nearly half (49%) of graduates interviewed in a survey said they were not working as APNs, which raises real questions about the future of new graduates and their establishment in local areas. Under such conditions, the future of IPAs sometimes seems compromised, especially those in private practice.
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Affiliation(s)
- Lisa Duconget
- Unité Eceve (Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables), UMR 1123, Inserm, 10 avenue de Verdun, 75010 Paris, France.
| | - Carolina De Rosis
- Unité Eceve (Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables), UMR 1123, Inserm, 10 avenue de Verdun, 75010 Paris, France
| | - Ljiljana Jovic
- Unité Eceve (Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables), UMR 1123, Inserm, 10 avenue de Verdun, 75010 Paris, France
| | - Aurélie Bourmaud
- Unité Eceve (Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables), UMR 1123, Inserm, 10 avenue de Verdun, 75010 Paris, France
| | - Agnès Dumas
- Unité Eceve (Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables), UMR 1123, Inserm, 10 avenue de Verdun, 75010 Paris, France
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