[Evolution of the nursing profession]

The choice of private practice is determined by a zoning of installation intended to distribute the professionals more equitably. While there are many administrative constraints, these nurses, who are both generalists and specialists in different fields, are increasingly involved in the co-development of care and health projects with other professionals. Not counting their hours and confronted with conflicts of values, they are not spared from suffering at work.

[A gender-based approach to the career paths of private practice nurses and their nursing practices]

The article explores the private practice nursing profession from the angle of gender. The methodology is based on cross-referencing data taken from statistical and field surveys. The results show that men and women practise differently. Training paths, careers and professional activities are shaped by the caregivers' gender.

[Training in haemophilia aimed at private practice nurses]

At the crossroads between the care delivered in the hospital and community nursing care, private practice nurses occupy a central role in supporting children with haemophilia and their family. Dedicated training helps to maintain the link with hospital structures and enables them to exchange with other professionals regarding practices, treatment difficulties and the contribution of new technologies in the care provision.

[Private practice nurses and support for patients' return home in cardiology]

The Prado Cardio programme is designed to support patients' return home and helps to identify the early warning signs of heart decompensation, thereby avoiding unscheduled hospitalisation. It also gives private practice nurses the chance to develop new expertise. The follow-up is personalised and established jointly with the patient and the multi-professional team.

[Private practice nurse and palliative care in the home]

The development of palliative care in the home, requested by patients and recommended in the 2015-2018 national plan, requires the home to be considered as a specific place of care. Private practice nurses have an important role to play with the patient and their relatives, in the assessment of needs, coordination, relational care as well as in providing the care required for maintaining and continuing life, an increasingly technical process.

[Follow-up care at home after outpatient surgery]

Private nurses have an important role to play in the healthcare system, notably within the framework of outpatient surgery. They are often underestimated, but they are on the front lines when it comes to informing patients, reassuring them and caring for them. They must therefore master the processes of outpatient surgery and those of enhanced recovery after surgery. Their skills need to be upgraded.

[The follow-up of patients with chronic pain by the private practice nurse]

The management of chronic pain in the home requires the integration of certain elements of the 'community' sector. Indeed, once back in their home environment, patients often find themselves having to cope with this pain alone. Thanks to her expertise, the community nurse can implement a coordinated, personalised and adapted follow-up of the patient with chronic pain.

[Health centres, a new mode of practice for private practice nurses]

Health centres group together health professionals within the same complex. They work in collaboration, have a shared information system and regularly come together around a common project, while being remunerated for treatments not covered by the French social security system by grants from regional health authorities. The advantage of health centres in terms of the multi-professional follow-up of patients is undeniable. Such centres represent a real opportunity for nurses.

[Maintaining the proper distance for nurses working in the home]

Health professionals must be able to respond to many different situations which require technical knowledge and self-control. Particularly when working in the patient's home, nurses must know how to maintain a proper distance to protect themselves from burnout. In this respect, the practice analysis constitutes an adapted support tool.

[Supervising student nurses in the provision of home care]

The private practice nurse may be required to supervise a student during their provision of care to patients in their home. These situations can be mutually rewarding and open the way for discussion around the quality of care.

[Private practice nursing, reacting in emergency situations. Private practice nursing, reacting in emergency situations]

Private practice professionals providing care in patients' homes are often isolated. The care is controlled by a multidisciplinary care network. In the event of a life-threatening emergency, the Aide Médicale Urgente control centre activates if necessary the rapid intervention of emergency services. An accurate assessment, the anticipation of an emergency transfer to hospital and knowledge of the regulatory framework ensure the patient is handled efficiently and respectfully.

[The importance of continuing training in the field of home care]

When delivering care in the patient's home, the nurse is often alone. Care procedures are becoming increasingly complex in contexts which are often mentally challenging. It is essential that nurses regularly update their knowledge through continuing training sessions in order to maintain their skills.

[An oncology nursing coordination platform for the return home]

The Onc'Idec platform created in the Auvergne region mobilizes coordinating private practice nurses to ensure a link between the various people intervening in homes and in hospitals. It has undertaken to describe the entire cancer patient pathway in the area in order to improve care. It meets the needs of professionals and patients in the field.

[Smartphone applications for choosing dressings, a survey of private practice nurses]

Nurses are often on the frontline regarding the choice of dressing for chronic wounds. In this age of connected health, numerous tools are available to help them or guide them in their choices. A study was carried out in 2015 to assess the perceptions and practices of private practice nurses with regard to the use of smartphone applications to help them choose a dressing when treating chronic wounds.

[End-of-life support from a private practice nurse]

Eighty-one per cent of people say they would prefer to die at home. Several elements contribute to improving end-of-life care at home: an evolving society, ethical questioning, legislative changes, new methods of organisation, specialised and interdisciplinary training. However, this remains difficult. The private practice nurse provides clinical support and plays a major role in this care.

[Follow-up of patients at home after outpatient surgery]

The patient's discharge and return home are important stages in outpatient surgery. In addition to the call the following day and the support of a family caregiver, a visit by a private practice nurse and a healthcare network can offer extra safeguards.

[Improving communication with the general practitioner]

Private practice nurses, in partnership with the general practitioner, provide the majority of home care and primary care of elderly people. They are therefore best placed to prevent and detect decompensation risk factors in their frail elderly patients. A pilot study aims to assess the impact of a tool on the quality of transmission of information with the general practitioner and of the global care management.

[The private nurse and medicines]

The procedures carried out by private practice nurses with regard to medicines are codified in order for them to be covered by French health insurance. However, the nomenclature ignores all the associated activities required to ensure the patient's global and safe nursing care. The preparation of medicines is part of these invisible but essential activities.

[Prospective study of private practice nurses' computer systems]

Working very closely with patients, often in their homes, private practice nurses are an essential link in the coordination of the care pathway. However, specialised IT tools are still poorly adapted to their practice. For this reason, ASIP Santé carried out in 2012 a prospective study of the IT systems of private practice nurses. The objective was to facilitate the rapid improvement of the software currently on the market.

[Trust at the heart of private nursing practice]

In order to obtain the state nursing diploma nurses must acquire a specific number of skills. Where does trust fit in? Although it is not implicit it forms the core of the nursing relationship with the patient and his or her family. This article presents the personal account of a private nurse practitioner.

Nurses take center stage in private duty home care

The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.

Private Duty Homecare Association. Private duty home care: what it means to real people across the nation

Private duty home care is growing rapidly to accommodate the needs of more and more seniors, disabled persons, and those with chronic conditions as these populations themselves are fast expanding and projected to continue to do so in the coming years and decades. The services that private duty/privately paid home care providers deliver each day to individuals across the United States can be absolutely essential to allowing them to remain in their own homes and communities leading as active and healthy lives as possible and continuing to contribute in the work force and to society as they are able. Requirements vary from state to state, and while most private duty agencies provide nonmedical companionship, homemaker, and personal care services--often described as assistance with activities of daily living--some incorporate licensed medical care as well.

[Job satisfaction: a comparative study between public and private practice]

The article describes the results of a study comparing job satisfacion in nurses working in public and private health structures in the same city, in the light of a wider study at national level.

BACKGROUND

Job satisfaction in nurses also affects patients, improving care and preventing stress that may cause burnout, increased turnover or even professional abandonment. Methods and instruments: a quantatitive-descriptive study was performed using a socio-demographical questionnaire composed of 44 items (Index of Work Satisfacion di Stamps, 1972) related to autonomy, professional status, tasks involved , retribution, interaction and organizational policy.

RESULTS

the outcome of the study confirmed previous findings and corresponded to national and international averages. The satisfaction/insatisfaction index was 12.75 (range 0.9-37.1) for the public sector and 13.08 (range 0.9-37.1)for the private one, indicating a low to medium job satisfaction rate.

Addressing the paradoxes of satisfaction with hospital care

PURPOSE

The purpose of this paper is to assess patient satisfaction in Greek public hospitals.

DESIGN/METHODOLOGY/APPROACH

In total, 367 patients participated in the study with a minimum of three days stay at the hospital. Measures included overall satisfaction, satisfaction with medical and nursing staff, satisfaction with room facilities, waiting times, extra costs. Information was also collected concerning sex, age, education, salary and length of stay in the hospital. Participants were also asked to indicate, in an open-ended question, the most positive and the most negative aspects of their care.

FINDINGS

Patients' bad experience with aspects of their care was not directly reflected in low levels of satisfaction. Patients had to wait long hours to get an appointment with a doctor or after their examination to be admitted to the hospital. Many patients had to rely on a personal nurse and to pay extra money to the medical and nursing staff. They considered lack of staff as the main drawback of the hospital. However, their overall satisfaction was very high.

RESEARCH LIMITATIONS/IMPLICATIONS

These results raise concerns about how patients evaluate. Patients are expected to act as consumers who carefully evaluate the aspects of care they receive. However, the aspects of care which patients take for granted when they evaluate their experience with health care providers needs to be illustrated further. Patients' relationship with health care providers may reflect trust rather than rational choice.

ORIGINALITY/VALUE

This paper provides useful information on assessing patient satisfaction in Greek public hospitals which could be used elsewhere.

Private duty home health care: unchartered water for researchers

The private duty home care industry is an extremely active sector of home health care provided in the United States. According to the National Health Expenditure Survey from the Centers for Medicare & Medicaid Services (CMS), Over $52.7 billion was spent on home care in 2006.

Connaissances et attitudes des infirmiers libéraux face à la douleur en fin de vie

BACKGROUND

Nurses play a crucial role in end-of-life care, especially for outpatients. It is important to assess their knowledge and attitudes regarding pain management during the end-of-life period.

METHODS

A random national sample of 602 French nurses providing home care responded to a telephone survey. The questionnaire included a scale of knowledge about pain and a short clinical case related to severe pain management, requiring WHO level 3 analgesia, for a dying patient.

RESULTS

The pain knowledge score depended on nurses' training and was higher for those living with another health professional. For the clinical case, only 60% of nurses favored the prescription of the analgesia recommended by international guidelines. This support depended on objective skills in pain management, but was less frequent for elderly or women patients.

DISCUSSION

Attitudes toward pain management at the end of life do not depend only on book learning. They are also influenced by more subjective factors that may cause inequality in care for women and the elderly. Nurse training programs should take such factors into account.

Assisted peritoneal dialysis. Experience in a French renal department

BACKGROUND

The French healthcare system offers the possibility of increasing the use of peritoneal dialysis (PD) by involving in patient care nurses who work in the private system.

OBJECTIVE

This study was conducted to evaluate the impact of a private home-nurse network on one dialysis program.

METHODS

This was a retrospective study of 239 dialysis patients who started dialysis in our center between 1 January 1998 and 31 December 2003.

RESULTS

Of these 239 patients, 142 were treated with hemodialysis and 97 with PD during the study period. Among the PD patients, 36 of 97 were treated with assisted PD and 61 of 97 with self-care PD. Assisted-PD patients were older (74 +/- 10 vs 52 +/- 18 years, p < 0.001) and presented more comorbidity (Charlson Comorbidity Index 7 +/- 2.5 vs 4.3 +/- 2.4, p < 0.05) compared with self-care patients. Continuous ambulatory PD was the modality of choice in the assisted group (32/36). Assisted patients were frequently hospitalized (31/36); actuarial survival free of hospitalization at 6 months was 46%. Patients with nurse assistance had a high risk of peritonitis (actuarial survival free of peritonitis: 52% at 1 year). Technique survival was 85% at 6 months and 58% at 1 year. Actuarial patient survival was 90% at 6 months and 83% at 1 year.

CONCLUSION

Assisted PD enables increased use of PD in incident dialysis patients. However, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.