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Ljungbeck B, Carlson E, Forss KS. Swedish stakeholders' views of the preparatory work needed before introducing the nurse practitioner role in municipal healthcare-A focus group study. Scand J Caring Sci 2024; 38:284-293. [PMID: 37984433 DOI: 10.1111/scs.13224] [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: 02/03/2023] [Revised: 09/30/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The nurse practitioner role has become important globally in handling the growing healthcare needs of older adults with chronic diseases. Nevertheless, research shows that introducing the role is a complex process, and more studies are needed to prepare for its introduction into different healthcare contexts, such as municipal healthcare. AIM The aim is to investigate what Swedish stakeholders identify as the preparatory work needed before introducing the nurse practitioner role into municipal healthcare. METHODS Data were collected through four focus group interviews conducted virtually on the TEAMS digital platform, with three to six participants in each group and 18 participants total. The transcribed interviews were analysed using a six-step thematic approach: familiarisation with the data, coding the data, generating initial themes, reviewing themes, defining and naming the themes and producing the report. FINDINGS The findings are divided into two main themes, each with two sub-themes. In the first, clarifying why the nurse practitioner role is needed, participants stressed the importance of having a clear intention for introducing the role. The second, ensure a national framework to bolster the introduction at the local level, demonstrates the need for collaboration among national actors to clarify the role's mandate and authority before its introduction. CONCLUSIONS Adding the nurse practitioner role to municipal healthcare can help increase the supply of nursing competence and the quality of patient care, but preparation for introducing the role requires extensive work. The development of the nurse practitioner role requires decision-makers and leaders to take primary responsibility for its introduction. This study can support countries in the early phase of developing the nurse practitioner role by identifying both best practices and pitfalls.
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Affiliation(s)
- Birgitta Ljungbeck
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
- Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmo, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
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Søndergaard SF, Andersen AB, Frederiksen K. APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review. Scand J Caring Sci 2024; 38:258-272. [PMID: 38246856 DOI: 10.1111/scs.13235] [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: 08/06/2023] [Revised: 11/28/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The field of Advanced Practice Nursing (APN) has developed over the past six decades. However, the definition of roles and responsibilities of APN nurses seem to be contested due to both a lack of a clear definition of the concept and to institutional and cultural barriers that restrict the nurses' opportunities to practise to the full extent of their competencies. AIM The objective of this scoping review was to identify, examine and conceptually map the available literature on APN nurses' core competencies for general health assessment in primary health care. METHOD We performed a scoping review, following the methodological guidance for reporting as it is described by the Joanna Briggs Institute (JBI). Furthermore, the PRISMA-ScR statement and checklist for reporting scoping reviews were followed. Guiding the initial process for the search, we used the Population, Concept and Context mnemonic (PCC) to clarify the focus and context of the review. RESULTS We found three areas of core competencies on which APN nurse draw in performing general health assessments in primary health care: (1) 'Collaborative, leadership and management skills' (2) 'Person-centred nursing care skills' and (3) 'Academic and educational skills'. Furthermore, we found that the three areas are interrelated, because it is crucial that APN nurses draw on collaborative competencies related to leadership and management to meet the service users' needs and deliver high-quality and person-centred care. CONCLUSION There is a need for a more specific investigation into how APN nurses' core competencies play a role during general health assessments of patients in primary care. We suggest an evaluation of what works for whom in what circumstances looking into the interrelation between competencies, skills and knowledge when an APN nurse performs a general health assessment in a primary healthcare setting.
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Affiliation(s)
- Susanne Friis Søndergaard
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Bendix Andersen
- VIA University College, School of Nursing and Research Centre for Health and Welfare Technology, Viborg, Denmark
| | - Kirsten Frederiksen
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
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Unsworth J, Greene K, Ali P, Lillebø G, Mazilu DC. Advanced practice nurse roles in Europe: Implementation challenges, progress and lessons learnt. Int Nurs Rev 2024; 71:299-308. [PMID: 36094718 DOI: 10.1111/inr.12800] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advanced practice nursing (APN) roles offer improved access to care and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles. AIM To explore the implementation of APN roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles. METHODS A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well developed (Ireland, Spain, Norway and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, nursing associations and universities. The consolidated criteria for reporting qualitative research (CPREQ) has been used throughout. LIMITATIONS The small number of countries when considering the size of the region and key informants representing the view of only three to four people in each country. RESULTS Four themes were identified, including the rationale for the development of the roles, influence, the evolutionary nature of role development and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation. CONCLUSION Successful role implementation is dependent upon a tripartite approach between managers, practitioners and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation. IMPLICATIONS FOR NURSING POLICY APN policy should be based on patient needs rather than on the workforce or professional imperatives. The process of implementation can take 15-20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles.
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Affiliation(s)
- John Unsworth
- Professor of Nursing, Northumbria University, Newcastle-upon-Tyne, UK
| | - Karen Greene
- Deputy Chief Nursing Officer, Department of Health, Dublin, Ireland
| | - Parveen Ali
- Professor of Nursing, University of Sheffield and Doncaster and Bassetlaw NHS Teaching Hospitals Trust, Doncaster, UK
| | - Gro Lillebø
- Specialist Nurse and Executive Board Member St. Olav's Hospital, Trondheim, Norway
| | - Donia Carmen Mazilu
- Assistant Professor at the University of Medicine and Pharmacy 'Carol Davila', Faculty of Midwives and Nurses, Bucharest, Romania
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Tolotti A, Sari D, Valcarenghi D, Bonetti L, Liptrott S, Bianchi M. Interprofessional Collaboration in Palliative Care-The Need for an Advanced Practice Nurse: An Ethnographic Study. Semin Oncol Nurs 2024:151654. [PMID: 38763788 DOI: 10.1016/j.soncn.2024.151654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context. DATA SOURCES A focused ethnographic approach was taken involving participant observation and semistructured interviews. CONCLUSION From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments. IMPLICATIONS FOR NURSING PRACTICE The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.
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Affiliation(s)
- Angela Tolotti
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Davide Sari
- Head of Nursing, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Dario Valcarenghi
- Head of Nursing Research, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Loris Bonetti
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Sarah Liptrott
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Monica Bianchi
- Head of MSc of Science in Nursing, University of Applied Sciences and Arts of Southern Switzerland Department of Business, Economics, Health and Social Care, Manno, Switzerland.
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Martinsen R, Ahlin-Søvde S, Grov EK, Andersson EK, Gardulf A. Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study. BMC Nurs 2024; 23:301. [PMID: 38693531 PMCID: PMC11064386 DOI: 10.1186/s12912-024-01930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. AIM The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. METHODS A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. RESULTS The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. CONCLUSIONS The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.
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Affiliation(s)
- Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Section of Advanced Nursing, Inland Norway University of Applied Sciences, Elverum, P.B. 400, Norway.
| | - Sigrid Ahlin-Søvde
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Section of Advanced Nursing, Inland Norway University of Applied Sciences, Elverum, P.B. 400, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Oslo Metropolitan University, P.B. 4, St. Olavs plass, Oslo, Norway
| | - Ewa K Andersson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Ann Gardulf
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Section of Advanced Nursing, Inland Norway University of Applied Sciences, Elverum, P.B. 400, Norway
- Division of Clinical Immunology and Transfusion Medicine, The Unit for Clinical Research, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Contandriopoulos D, Bertoni K, McCracken R, Hedden L, Lavergne R, Randhawa GK. Evaluating the cost of NP-led vs GP-led primary care in British Columbia. Healthc Manage Forum 2024:8404704241229075. [PMID: 38291669 DOI: 10.1177/08404704241229075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC's Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.
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Affiliation(s)
| | | | - Rita McCracken
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
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von der Lühe V, Roos M, Löbberding M, Scholten N, Müller W, Hellmich M, Simic D, Köpke S, Dichter MN. Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation. BMC Geriatr 2023; 23:858. [PMID: 38097987 PMCID: PMC10722805 DOI: 10.1186/s12877-023-04560-3] [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: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care. METHODS We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective. DISCUSSION The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making. TRIAL REGISTRATION Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.
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Affiliation(s)
- Verena von der Lühe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Marcelina Roos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany.
| | - Mareike Löbberding
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Eupener Straße 129, Cologne, Germany
| | - Wiebke Müller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Martin Hellmich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Dusan Simic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, Cologne, Germany
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Martin N Dichter
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
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Kilpatrick K, Tchouaket E, Savard I, Chouinard MC, Bouabdillah N, Provost-Bazinet B, Costanzo G, Houle J, St-Louis G, Jabbour M, Atallah R. Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews. PLoS One 2023; 18:e0290977. [PMID: 37676878 PMCID: PMC10484467 DOI: 10.1371/journal.pone.0290977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
AIM To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER CRD42020198182.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Isabelle Savard
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), Montréal, Québec, Canada
| | - Naima Bouabdillah
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Geneviève St-Louis
- Support and Development of Professional Practices in Nursing and Assistance Care and Infection Prevention Associate Directorate, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Naughton C, Hayes N, Ezhova I, Fitzpatrick JM. Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses. Int J Older People Nurs 2023; 18:e12526. [PMID: 36658469 DOI: 10.1111/opn.12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply. OBJECTIVES To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles. METHODS A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data. RESULTS Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability. CONCLUSION Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies. IMPLICATIONS FOR PRACTICE Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.
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Affiliation(s)
- Corina Naughton
- Clinical Nursing in Older People's Healthcare, School of Nursing and Midwifery, College of Medicine and Health, South SouthWest Hospital Group (SSWHG), Cork, Ireland
| | - Nicky Hayes
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Joanne M Fitzpatrick
- Older People's Healthcare, Care for Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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10
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Ljungbeck B, Sjögren-Forss K, Carlson E. Nurse practitioner in Swedish municipal elderly care: A Delphi study of challenges and opportunities. Scand J Caring Sci 2023; 37:216-228. [PMID: 35942613 DOI: 10.1111/scs.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Worldwide, countries are struggling with strained healthcare systems, especially due to the growing number of frail elderly. Developing the role of nurse practitioner in the care of the frail elderly is therefore of interest to make the care chain more efficient. In Sweden, the role is in an early development phase, but more research is needed. AIM The aim was to investigate how stakeholders at the national level express the challenges and opportunities of the evolving nurse practitioner role in Swedish municipal elderly care. METHOD A Delphi survey technique with three rounds of electronic questionnaires was used. Twenty-seven experts responded to the first questionnaire, containing two open questions; what opportunities respectively challenges do you see in developing and implementing the nurse practitioner role in municipal elderly care? The following questionnaires consisted of statements to rate using a four-grade Likert scale, and 20 and 17 responded to the second and third, respectively. The first round was analysed using content analysis, and the other two with descriptive statistics. RESULTS Thirty-four statements about challenges and opportunities related to the nurse practitioner role in municipal elderly care were identified and rated as important. CONCLUSION The findings provide knowledge that can contribute to discussions and decisions to refine the nurse practitioner role in Swedish municipal elderly care. The nurse practitioner role may contribute with much-needed competence to the elderly care. However, it is important to consider the challenges that need to be overcome before the development of the role. To solve this, it is necessary to have clear national guidelines concerning issues of education, title protection and the mandate and authority of the NP role.
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Affiliation(s)
- Birgitta Ljungbeck
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
| | - Katarina Sjögren-Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö, Sweden
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McParland C, Johnston B, Cooper M. A mixed-methods systematic review of nurse-led interventions for people with multimorbidity. J Adv Nurs 2022; 78:3930-3951. [PMID: 36065516 PMCID: PMC9826481 DOI: 10.1111/jan.15427] [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: 04/29/2022] [Revised: 07/08/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
AIMS To identify types of nurse-led interventions for multimorbidity and which outcomes are positively affected by them. DESIGN Mixed-methods systematic review following the Joanna Briggs Institute (JBI) methods for convergent-integrated reviews. PROSPERO ID CRD42020197956. DATA SOURCES Cochrane CENTRAL, CINAHL, Embase and MEDLINE were searched in October 2020. Grey literature sources included OpenGrey, the Journal of Multimorbidity and Comorbidity and reference mining. REVIEW METHODS English-language reports of nurse-led interventions for people with multimorbidity were included based on author consensus. Two reviewers performed independent quality appraisal using JBI tools. Data were extracted and synthesized using a pre-existing taxonomy of interventions and core outcome set. RESULTS Twenty studies were included, with a median summary quality score of 77.5%. Interventions were mostly case-management or transitional care interventions, with nurses in advanced practice, support to self-manage conditions, and an emphasis on continuity of care featuring frequently. Patient-centred outcomes such as quality of healthcare and health-related quality of life were mostly improved, with mixed effects on healthcare utilization, costs, mortality and other outcomes. CONCLUSION Interventions such as case management are agreeable to patients and transitional care interventions may have a small positive impact on healthcare utilization. Interventions include long-term patient management or short-term interventions targeted at high-risk junctures. These interventions feature nurses in advanced practice developing care plans in partnership with patients, to simplify and improve the quality of care both in the long and short-term. IMPACT This is the first mixed-methods review which includes all types of nurse-led interventions for multimorbidity and does not focus on specific comorbidities or elderly/frail populations. Using adapted consensus-developed frameworks for interventions and outcomes, we have identified the common features of interventions and their overall typology. We suggest these interventions are of value to patients and healthcare systems but require localization and granular evaluation of their components to maximize potential benefits.
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Affiliation(s)
- Chris McParland
- School of MedicineDentistry and NursingUniversity of GlasgowGlasgowScotland,NHS Greater Glasgow and ClydeGlasgowScotland
| | - Bridget Johnston
- School of MedicineDentistry and NursingUniversity of GlasgowGlasgowScotland,NHS Greater Glasgow and ClydeGlasgowScotland
| | - Mark Cooper
- School of MedicineDentistry and NursingUniversity of GlasgowGlasgowScotland,NHS Greater Glasgow and ClydeGlasgowScotland
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Pol-Castañeda S, Rodriguez-Calero MA, Villafáfila-Gomila CJ, Blanco-Mavillard I, Zaforteza-Lallemand C, Ferrer-Cruz F, De Pedro-Gómez JE. Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study. BMC Nurs 2022; 21:331. [PMID: 36447167 PMCID: PMC9706842 DOI: 10.1186/s12912-022-01110-x] [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: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Incorporating the best available evidence into clinical practice is a determining challenge for healthcare professionals and organisations. The role of advanced practice nurses is viewed as a facilitator to adapt guideline recommendations to suit specific contexts and to overcome barriers to implementation. In this study, we evaluate the impact of advanced practice nurses on clinical indicators of hospitalised patients and on adherence to recommendations derived from two clinical practice guidelines (pressure ulcer prevention and treatment and vascular access device management). METHODS Quasi-experimental study in five intervention (IU) and five control (CU) hospital units at three hospitals in Spain (period 2018-19). Five advanced practice nurses were incorporated into IU, with the intention that would produce attitudinal changes and enhance the skills and knowledge of the nursing team regarding 18 clinical practice recommendations. In this study, 41 indicators were evaluated through direct observation of all patients admitted, at monthly intervals for 1 year. Outcomes were assessed by means of a descriptive, multi-line regression and association analysis. RESULTS The study population was composed of 3742 inpatients admitted for pressure ulcer assessment and 2631 fitted with vascular access devices. By the end of the study period, all variables had improved in the IU, where average compliance with recommendations was statistically significantly higher (pressure ulcer guidance 7.9 ± 1.9 vs 6.0 ± 1.7. OR 1.86, 95% CI 1.67-2.05; vascular access devices guidance 5.4 ± 1.4 vs 4.4 ± 1,6. OR 1.06, 95% CI 0.95-1.17). The prevalence of pressure lesions and catheter-related adverse events decreased statistically significantly in the IU compared to the CU. The prevalence of pressure ulcers decreases (5.7% in IU vs 8.7% in CU p < 0.005) as well as the prevalence of adverse events related to the catheter (14% In IU vs 21.6% in CU p < 0.005). The unnecessary catheters decressed in IU 10.9% VS CU 15.8% (p < 0.005). CONCLUSIONS The incorporation of an advanced practice nurse statistically significantly improves clinical indicators related to the prevention and treatment of pressure ulcers and to the management of vascular access devices. TRIAL REGISTRATION ISRCTN18259923 retrospectively registered on 11/02/2022.
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Affiliation(s)
- Sandra Pol-Castañeda
- grid.413457.0Hospital Son Llàtzer, 07198 Palma, Balearic Islands Spain ,grid.507085.fCare, Chronicity and Health Evidences (CuRES) Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Balearic Islands Spain
| | - Miguel Angel Rodriguez-Calero
- grid.507085.fCare, Chronicity and Health Evidences (CuRES) Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Balearic Islands Spain ,Balearic Islands Health Services, 07003 Palma, Balearic Islands Spain
| | | | - Ian Blanco-Mavillard
- grid.507085.fCare, Chronicity and Health Evidences (CuRES) Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Balearic Islands Spain ,Hospital Manacor, 07500 Manacor, Balearic Islands Spain
| | - Concepción Zaforteza-Lallemand
- grid.507085.fCare, Chronicity and Health Evidences (CuRES) Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Balearic Islands Spain ,Hospital Comarcal d’Inca, 07300 Inca, Balearic Islands Spain
| | | | - Joan Ernest De Pedro-Gómez
- grid.507085.fCare, Chronicity and Health Evidences (CuRES) Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Balearic Islands Spain ,grid.9563.90000 0001 1940 4767Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Balearic Islands Spain
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Gutiérrez-Rodríguez L, García-Mayor S, León-Campos Á, Gómez-González AJ, Pérez-Ardanaz B, Rodríguez-Gómez S, Fajardo-Samper M, Morilla-Herrera JC, Morales-Asencio JM. Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148415. [PMID: 35886267 PMCID: PMC9323129 DOI: 10.3390/ijerph19148415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.
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Affiliation(s)
- Laura Gutiérrez-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-879
| | - Alberto José Gómez-González
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Bibiana Pérez-Ardanaz
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | | | | | - Juan Carlos Morilla-Herrera
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
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Peters MD, Marnie C. Nurse practitioner models of care in aged care: a scoping review protocol. JBI Evid Synth 2022; 20:2064-2070. [DOI: 10.11124/jbies-21-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Almukhaini S, Weeks LE, Macdonald M, Martin-Misener R, Ismaili ZA, Macdonald D, Al-Fahdi N, Rasbi SA, Nasaif H, Rothfus MA. Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review. JBI Evid Synth 2022; 20:1209-1242. [PMID: 35066558 DOI: 10.11124/jbies-21-00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The objectives of this review were to map and summarize evidence regarding advanced practice nursing roles in Arab countries located in the Eastern Mediterranean region. INTRODUCTION Many countries have reported an increase in the number and types of advanced practice nursing roles as research demonstrating their positive impact on patient and health system outcomes continues to accumulate. There is international evidence that the achievement of these outcomes depends on the effective implementation of advanced practice nursing roles at the organizational and country levels. A comprehensive review of the status of advanced practice nursing role implementation in Arab countries in the Eastern Mediterranean region has not been conducted. INCLUSION CRITERIA Eligible studies included advanced practice nursing roles (including, but not limited to, nurse practitioners and clinical nurse specialists) in Arab countries in the Eastern Mediterranean region. Studies were considered if they focused on role development, titles, entry-level education, regulation and scope of practice, and facilitators and barriers to role implementation. METHODS A comprehensive systematic search was completed for both published and non-published literature. The databases searched included CINAHL, PubMed, PsycINFO, Embase, Nursing and Allied Health Database, and Scopus. Gray literature was searched using websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses, World Health Organization regional office for the Eastern Mediterranean region, and websites of nursing associations and Ministries of Health in Arab countries. The search included literature published in Arabic and English from the inception of the databases to August 2020. RESULTS A total of 35 articles were included, the majority (n = 24) of which were published from 2010 onward. Ten of the included studies were empirical research papers that used qualitative and quantitative research designs. Advanced practice nursing role development is still in its infancy in most of the Arab countries in the Eastern Mediterranean region and can be described as slowly and steadily evolving. The main driving forces for the implementation of the roles in this region included a shortage of physicians both in number and specialties, the emergence of chronic diseases due to lifestyle changes, the desire to have more cost-effective primary care, and to advance nursing as a profession. Clinical nurse specialists and nurse practitioners are the most common titles for the advanced nursing roles practiced in the region. Some advanced practice nursing roles stipulated a master's degree as a minimum requirement, while others required a 12-month in-house training program. Oman is the only Arab country that authorizes nurse practitioners to prescribe pre-set medications. The common barriers to advanced practice nursing role implementation included a lack of recognition of roles at national levels, role ambiguity, lack of clear scope of practice, resistance from male physicians, low involvement of nurses in policy-making, and low status of nursing as a profession. CONCLUSION The successful implementation and sustainment of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region requires foundational work, including development of definitions, educational standards, regulations, and a clear scope of practice. SCOPING REVIEW REGISTRATION NUMBER Open Science Framework: https://osf.io/wyj8a.
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Affiliation(s)
- Salma Almukhaini
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Sultan Qaboos University, Muscat, Oman
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | | | - Danielle Macdonald
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | | | | | - Husain Nasaif
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
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Rodríguez Rodríguez P, Gonzalo Jiménez E. [COVID-19 in nursing homes: structural factors and experiences that endorse a change of model in Spain]. GACETA SANITARIA 2022; 36:270-273. [PMID: 34772547 PMCID: PMC8520854 DOI: 10.1016/j.gaceta.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
The effects of COVID-19 pandemic on older people living in care homes have been devastating. In Spain approximately 3% of the cases and 40% of the deaths have occurred in this group. In addition, due to measures taken to control the crisis, the incidence of geriatric syndromes has increased, and residents' fundamental rights have been violated. In this article we describe structural factors of care homes and their relationship with public health services that have influenced the impact of the pandemic. We suggest different types of group homes, and models of provision/coordination with public health services that have given excellent results protecting nursing homes residents from COVID-19, as alternative models to conventional residences and to the regular provision of health care services. We recommend that these successful experiences are taken into account in the transformation of the social-health model (to one integrated and focused on people) that has begun to be implemented in some Autonomous Communities of Spain.
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Affiliation(s)
| | - Elena Gonzalo Jiménez
- Escuela Andaluza de Salud Pública, Granada, España,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España,Autor para correspondencia
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Popejoy LL, Vogelsmeier AA, Canada KE, Kist S, Miller SJ, Galambos C, Alexander GL, Crecelius C, Rantz M. A Call to Address RN, Social Work, and Advanced Practice Registered Nurses in Nursing Homes: Solutions From the Missouri Quality Initiative. J Nurs Care Qual 2022; 37:21-27. [PMID: 34751164 PMCID: PMC8608010 DOI: 10.1097/ncq.0000000000000604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. PROBLEM For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. APPROACH It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. CONCLUSIONS Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.
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Affiliation(s)
- Lori L. Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Amy A. Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Kelli E. Canada
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Shari Kist
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Steven J. Miller
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Colleen Galambos
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Gregory L. Alexander
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Charles Crecelius
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
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Li Y, Chen M, Lin R, Li H. Perceptions and Expectations of Advanced Geriatric Nursing Role Development in Primary Health Care: A Qualitative Study Exploring Staff's Perspectives. J Multidiscip Healthc 2021; 14:3607-3619. [PMID: 35002250 PMCID: PMC8722692 DOI: 10.2147/jmdh.s343622] [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] [Received: 10/09/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This qualitative study aimed to explore multidisciplinary members' perceptions and expectations of advanced geriatric nursing role development in primary health care. PATIENTS AND METHODS A multi-center, cross-sectional study based on semi-structured individual interviews was conducted with registered nurses, general physicians, and managers involved in the care of older people in primary health care between September 2020 and January 2021. Recruitment was purposive and the framework method was used to inductively analyze the data. The Consolidated Criteria for Reporting Qualitative research (COREQ) served to structure our manuscript. RESULTS In total, 29 registered nurses, 6 general physicians, and 10 managers from 8 health centers were interviewed. The relevant themes interpreted from the interview data were as follows: (1) the current roles of registered nurses in the care of older people; (2) the factors affect the advanced geriatric nursing role development; (3) expectations of the advanced geriatric nursing roles. CONCLUSION There is a need for appropriate educational programs, well-established laws, and regulations to support the sustainable development of advanced geriatric nursing roles. To build the expected role model, the nursing education program in the future should integrate gerontological nursing, public health nursing, and nursing management to maximize the role of gerontological nurse practitioners in primary health care.
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Affiliation(s)
- Yulian Li
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
| | - Meirong Chen
- Department of Nursing, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
| | - Rong Lin
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
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Brimblecombe N, Nolan F. A qualitative study of perceptions of senior health service staff as to factors influencing the development of Advanced Clinical Practice roles in mental health services. J Psychiatr Ment Health Nurs 2021; 28:829-837. [PMID: 34363270 DOI: 10.1111/jpm.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Advanced clinical practitioners (ACPs) are, typically, non-medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities. Most ACPs are nurses and new ACP roles are increasingly being established around the world. The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainability Research on mental health nursing ACP roles is sparse. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs. Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established. Some mental health nurses may require long-term developmental pathways to help prepare them to take on a master's level course and then the ACP role. ABSTRACT: Introduction Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method Focus group and semi-structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long-term developmental pathways for staff. Implications for practice Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes.
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Abstract
BACKGROUND Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law. OBJECTIVE To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice. METHODS A 16-month learning survey of nurses based on a validated questionnaire developed for this project. RESULTS The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge. CONCLUSIONS The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.
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Sutton EL, Kearney RS. What works? Interventions to reduce readmission after hip fracture: A rapid review of systematic reviews. Injury 2021; 52:1851-1860. [PMID: 33985752 DOI: 10.1016/j.injury.2021.04.049] [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] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture is a common serious injury in older people and reducing readmission after hip fracture is a priority in many healthcare systems. Interventions which significantly reduce readmission after hip fracture have been identified and the aim of this review is to collate and summarise the efficacy of these interventions in one place. METHODS In a rapid review of systematic reviews one reviewer (ELS) searched the Ovid SP version of Medline and the Cochrane Database of Systematic Reviews. Titles and abstracts of 915 articles were reviewed. Nineteen systematic reviews were included. (ELS) used a data extraction sheet to capture data on interventions and their effect on readmission. A second reviewer (RK) verified data extraction in a random sample of four systematic reviews. Results were not meta-analysed. Odds and risk ratios are presented where available. RESULTS Three interventions significantly reduce readmission in elderly populations after hip fracture: personalised discharge planning, self-care and regional anaesthesia. Three interventions are not conclusively supported by evidence: Oral Nutritional Supplementation, integration of care, and case management. Two interventions do not affect readmission after hip fracture: Enhanced Recovery pathways and comprehensive geriatric assessment. CONCLUSIONS Three interventions are most effective at reducing readmissions in older people: discharge planning, self-care, and regional anaesthesia. Further work is needed to optimise interventions and ensure the most at-risk populations benefit from them, and complete development work on interventions (e.g. interventions to reduce loneliness) and intervention components (e.g. adapting self-care interventions for dementia patients) which have not been fully tested yet.
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Affiliation(s)
- E L Sutton
- Coventry University, School of Nursing, Midwifery and Health, Richard Crossman Building, CV1 5FB Coventry, England.
| | - R S Kearney
- University of Warwick, Clinical Trials Unit, CV4 7AL Coventry, England
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22
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Duffield C, Gardner G, Doubrovsky A, Adams M. Does education level influence the practice profile of advanced practice nursing? Collegian 2021. [DOI: 10.1016/j.colegn.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schneider F, Kempfer SS, Backes VMS. Training of advanced practice nurses in oncology for the best care: a systematic review. Rev Esc Enferm USP 2021; 55:e03700. [PMID: 33978139 DOI: 10.1590/s1980-220x2019043403700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To search for evidence on the training of advanced practice nurses, through clinical practice and nursing care with cancer patients. METHOD Systematic review, searching the databases: MEDLINE-PubMed, LILACS, Web of Science, Scopus, CINAHL and Cochrane CENTRAL. A manual search of the reference list and Google Scholar was also carried out. To assess the methodological quality of the studies, the following tools were used: Cochrane Collaboration Risk of Bias Tool (RoB 1) for randomized controlled trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for quasi-experimental studies. RESULTS A total of 12 experimental studies were identified. The main intervention identified in the studies was educational guidance. The studies showed improvement in pain control or other symptoms related to disease and/or treatment, satisfaction and improvement in the quality of life of cancer patients. CONCLUSION It is observed that there are studies that demonstrate the value of advanced practice nursing in oncology, through differentiated clinical training and advanced professional performance. Registration number of the systematic review: CRD42018098906.
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Affiliation(s)
- Franciane Schneider
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
| | - Silvana Silveira Kempfer
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
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Ahmed A, van den Muijsenbergh METC, Mewes JC, Wodchis WP, Vrijhoef HJM. Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review. BMJ Open 2021; 11:e043280. [PMID: 33895713 PMCID: PMC8074568 DOI: 10.1136/bmjopen-2020-043280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory. DESIGN Rapid realist review. INCLUSION CRITERIA Reviews and meta-analyses (January 2013-January 2019) and non-peer-reviewed literature (January 2013-December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years). ANALYSIS Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS). RESULTS 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are 'creating an enabling environment', followed by 'strengthening governance and accountability'. CONCLUSION Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient).
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Affiliation(s)
- Anam Ahmed
- Panaxea, Amsterdam, Netherlands
- Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
| | | | | | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Hubertus J M Vrijhoef
- Panaxea, Amsterdam, Netherlands
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, Netherlands
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Loussouarn C, Franc C, Videau Y, Mousquès J. Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities. HEALTH ECONOMICS 2021; 30:680-698. [PMID: 33377283 DOI: 10.1002/hec.4214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 05/13/2023]
Abstract
The integration of primary care organizations and interprofessional cooperation is encouraged in many countries to both improve the productive and allocative efficiency of care provision and address the unequal geographical distribution of general practitioners (GPs). In France, a pilot experiment promoted the vertical integration of and teamwork between GPs and nurses. This pilot experiment relied on the staffing and training of nurses; skill mixing, including the authorization to shift tasks from GPs to nurses; and new remuneration schemes. This article evaluates the overall impact of this pilot experiment over the period 2010-2017 on GP activities based on the following indicators: number of working days, patients seen at least once, patients registered, and visits delivered. We control for endogeneity and reduce selection bias by using a case-control design combining coarsened exact matching and difference-in-differences estimates on panel data. We find a small positive impact on the number of GP working days (+1.2%) following enrollment and a more pronounced effect on the number of patients seen (+7.55%) or registered (+6.87%). However, we find no effect on the number of office and home visits. In this context, cooperation and teamwork between GPs and nurses seem to improve access to care for patients.
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Affiliation(s)
- Christophe Loussouarn
- ERUDITE (EA 437), FR TEPP CNRS 3435, University Paris-Est Créteil (UPEC), Créteil, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
| | - Carine Franc
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
| | - Yann Videau
- ERUDITE (EA 437), FR TEPP CNRS 3435, University Paris-Est Créteil (UPEC), Créteil, France
| | - Julien Mousquès
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 DOI: 10.1186/s12960-021-00562-711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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27
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 PMCID: PMC7890991 DOI: 10.1186/s12960-021-00562-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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Wood E, King R, Robertson S, Allmark P, Senek M, Tod A, Ryan T. Advanced practice nurses' experiences and well-being: Baseline demographics from a cohort study. J Nurs Manag 2021; 28:959-967. [PMID: 32501626 DOI: 10.1111/jonm.13030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
AIMS To create a cohort of advanced practice nurses from across the UK and to report the initial questionnaire including demographics, work experiences and well-being. BACKGROUND In the UK, advanced nursing practice is not regulated. This has led to the concern that advanced nurses are working in very different ways with different levels of autonomy and support. METHODS Participants were recruited via university and Royal College of Nursing mailing lists, and social media adverts. They completed the initial questionnaire about their background and workplace, work experiences, credentialing and well-being. RESULTS A total of 143 nurses were recruited to the cohort and 86 completed the survey. Over 40 job titles were reported, across five pay bands. Job title was not correlated with pay band (p = .988). Participant well-being was not significantly different from the UK general population, but they reported high rates of work-related stress (44.2%) compared with the National Health Service national average (37.9%). CONCLUSION There is a wide disparity in pay, which is not reflected in title or setting. The high levels of work-related stress require further exploration. IMPLICATIONS FOR NURSING MANAGEMENT The range of experiences reported here should encourage managers to evaluate whether title, pay and support mechanisms for Advanced Practice Nurses in their organisations align with suggested national standards set by Royal Colleges and government departments.
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Affiliation(s)
- Emily Wood
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Rachel King
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Steve Robertson
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK.,Leeds Beckett University, Leeds, UK.,Waterford Institute of Technology, Waterford City, Ireland
| | - Peter Allmark
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Michaela Senek
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Angela Tod
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
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Wood E, King R, Robertson S, Senek M, Tod A, Ryan T. Sources of satisfaction, dissatisfaction and well-being for UK advanced practice nurses: A qualitative study. J Nurs Manag 2021; 29:1073-1080. [PMID: 33404130 DOI: 10.1111/jonm.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
AIMS To examine and explore organisational and role conditions that promote or inhibit job satisfaction and workplace well-being for advanced practice nurses. BACKGROUND The advanced practice role is common across the world. Research shows it is well regarded by patients and improves patient outcomes, but there is little evidence about what the role is like for nurses. METHODS A subsample of an existing cohort of advanced practice nurses were invited for interview. Twenty-two nurses were interviewed over the phone. Interviews transcripts were analysed using thematic analysis. RESULTS Four themes were derived from the data; 'the advanced nurse role and professional identity', 'feeling exposed', 'support for the advancement of the role' and 'demonstrating impact'. CONCLUSION Nurses report considerable dissatisfaction with role identity and concerns relating to isolation on a daily basis, and these negatively affect well-being. However, they also identified significant satisfaction with the role, particularly when well supported and able to recognize the unique contribution that they made to the lives of patients and to their organisations. IMPLICATIONS FOR NURSING MANAGEMENT Clear role definitions, provision of high-quality clinical supervision and addressing issues of isolation are likely to improve the job satisfaction of advanced practice nurses.
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Affiliation(s)
- Emily Wood
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Rachel King
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Steve Robertson
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK.,Leeds Beckett University, Leeds, UK.,Waterford Institute of Technology, Waterford City, Ireland
| | - Michaela Senek
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
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Rantz M, Petroski GF, Popejoy LL, Vogelsmeier AA, Canada KE, Galambos C, Alexander GL, Crecelius C. Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative. J Nutr Health Aging 2021; 25:1124-1130. [PMID: 34725672 PMCID: PMC8485110 DOI: 10.1007/s12603-021-1684-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. DESIGN A four group comparative analysis of longitudinal data from September 2013 thru December 2019. SETTING NHs in the interventions of both Phases 1 (2012-2016) and 2 (2016-2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). PARTICIPANTS NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. MEASUREMENTS Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. RESULTS The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) out-performed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. CONCLUSION These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.
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Affiliation(s)
- M Rantz
- Marilyn Rantz, University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
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Michalowsky B, Henning E, Rädke A, Dreier-Wolfgramm A, Altiner A, Wollny A, Drewelow E, Kohlmann T, Biedenweg B, Buchholz M, Oppermann RF, Zorn D, Hoffmann W. Attitudes towards advanced nursing roles in primary dementia care - Results of an observational study in Germany. J Adv Nurs 2020; 77:1800-1812. [PMID: 33305488 DOI: 10.1111/jan.14705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/05/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS To demonstrate the attitudes of general practitioners (GPs), nurses, persons with dementia, and caregiver towards suitable tasks and qualification needs for and the acceptance and impact of advanced nursing roles in German dementia primary care. DESIGN Observational study using a questionnaire survey with 225 GPs, 232 nurses, 211 persons with dementia, and 197 caregivers, conducted between December 2017-August 2018. METHODS A questionnaire was generated that includes specific assessment, prescription, and monitoring tasks of advanced nursing roles in dementia primary care as well as qualification requirements for and the acceptance and the impact of advanced nursing roles. Data were analysed using descriptive statistics. Group differences were assessed using the Fisher's exact test. RESULTS Advanced nursing roles were highly appreciated across all groups. Assessment and monitoring tasks were rated as highly suitable, and prescription authorities as moderately suitable. Nurses felt less confident in assessment and monitoring, but more confident in prescribing as practitioners expected. Patients and caregivers would appreciate a takeover of tasks by nurses; nurses and practitioners preferred a delegation. A dementia-specific qualification was rated as best suitable for advanced nursing roles, followed by 'no specific qualification' if medical tasks that only can be carried out by practitioners were delegated and an academic degree if tasks were substituted. Advanced nursing roles were rated as beneficial, strengthening the confidence in nursing care and improving the cooperation between professionals and the treatment. Practitioners assumed that advanced nursing roles would improve job satisfaction of nurses, which was not confirmed by nurses. CONCLUSION There is an extended consensus towards the enlargement of advanced nursing roles, represented by high endorsement, acceptance, and willingness to reorganize tasks. IMPACT Results debunk the common notion that German practitioners would be reluctant towards advanced nursing roles and a takeover of current practitioner tasks, supporting the implementation of advanced nursing roles in Germany.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) e.V. Site Rostock/Greifswald, Translational Health Care Research, Greifswald, Germany
| | - Esther Henning
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE) e.V. Site Rostock/Greifswald, Translational Health Care Research, Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Department of Nursing and Management, Faculty of Business & Social Science, University of Applied Science Hamburg (HAW), Hamburg, Germany
| | - Attila Altiner
- Institute for General Practice, University Medical Center Rostock, Rostock, Germany
| | - Anja Wollny
- Institute for General Practice, University Medical Center Rostock, Rostock, Germany
| | - Eva Drewelow
- Institute for General Practice, University Medical Center Rostock, Rostock, Germany
| | - Thomas Kohlmann
- Section Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Bianca Biedenweg
- Section Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Maresa Buchholz
- Section Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Roman F Oppermann
- Department of Health, Nursing and Management, University of Applied Science Neubrandenburg, Neubrandenburg, Germany
| | - Daniela Zorn
- Department of Health, Nursing and Management, University of Applied Science Neubrandenburg, Neubrandenburg, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) e.V. Site Rostock/Greifswald, Translational Health Care Research, Greifswald, Germany.,Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Price A. Improving outcomes for older people undergoing emergency surgery: Opportunities for advanced practice. J Adv Nurs 2020; 77:504-505. [PMID: 33249642 DOI: 10.1111/jan.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Angeline Price
- Salford Royal Hospital Ringgold Standard Institution - Ageing and Complex Medicine, Salford, UK
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Kelly D, Lankshear A, Wiseman T, Jahn P, Mall-Roosmäe H, Rannus K, Oldenmenger W, Sharp L. The experiences of cancer nurses working in four European countries: A qualitative study. Eur J Oncol Nurs 2020; 49:101844. [PMID: 33166924 PMCID: PMC7556264 DOI: 10.1016/j.ejon.2020.101844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
Purpose Cancer nurses across Europe are being tasked with delivery of an increasing number of complex treatments and supportive care interventions as a result of ongoing advances in cancer research, and a rise in cancer incidence due to demographic changes. However, all health systems delivering cancer treatment innovations require access to an educated and motivated nursing workforce to meet demand. This study by the European Oncology Nursing Society examines comparative features of cancer nursing in Estonia, Germany, the Netherlands (NL) and the United Kingdom (UK). Methods Descriptive qualitative study using focus groups and individual interviews drawing on the views of cancer nurses, managers and stakeholders from four European countries (n = 97). Data collection was designed around national cancer nursing conferences held in Berlin (Germany), Ede (NL), Harrogate (UK) and Tallinn and Tartu (Estonia) between May 2017 and April 2018. Participants included a mix of nursing grades and specialisms. Findings According to the participants education and career structure for cancer nursing was most well-developed in the Netherlands and the United Kingdom. In Germany and Estonia developments were taking place at Masters level. None of the countries had recordable qualifications in cancer nursing. Variations existed in terms of advanced practice roles and salary. Workload pressures were common, and were rising, and wellbeing initiatives were not identified. Nurses reported gaining positive feedback from caring for patients. Discussion As demand for cancer treatment continues to grow there is a need to ensure an adequate supply of cancer nurses with the appropriate education and career structure to support patients. This study provides insights from four countries and suggests the need for better recognition as well as working conditions, education and career structures that advance the potential of the cancer nursing role in Europe. Increasingly high nursing workloads are evident in Europe alongside workforce shortages. Major changes taking place in the treatment of cancer require more individualised and targeted treatment approaches. In some countries, cancer nurses adopt advanced roles that include prescribing, treatment co-ordination and clinical procedures. Comparative qualitative insights are provided concerning cancer nursing in Estonia, Germany, the Netherlands and the United Kingdom. Despite common European Union Directives disparities exist in the availability of cancer nursing education and working across EU countries.
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Affiliation(s)
- Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK.
| | - Annette Lankshear
- School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK.
| | - Theresa Wiseman
- The Royal Marsden NHS Foundation Trust, Fulham Road. London, SW3 6JJ, UK.
| | - Patrick Jahn
- Health Services Research Working Group, Department of Internal Medicine, University Hospital Halle (Saale), Germany.
| | | | - Kristi Rannus
- North Estonia Medical Centre, Oncology and Haematology Clinic, 19 J.Sütiste Str, 13419, Tallinn, Estonia; Tallinn Health Care College, 67 Kannu Str, 13418, Tallinn, Estonia.
| | - Wendy Oldenmenger
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Lena Sharp
- Division of Innovative Care Research, Department of Learning Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden.
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Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Caro-Bautista J, Villa-Estrada F, Gómez-González A, Lupiáñez-Pérez I, Morilla-Herrera JC, Kaknani-Uttumchandani S, García-Mayor S, Morales-Asencio JM. Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol. J Adv Nurs 2020; 77:427-438. [PMID: 33009844 DOI: 10.1111/jan.14580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
AIM To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour. DESIGN Cluster randomized controlled clinical trial. METHODS This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014. DISCUSSION The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population. IMPACT The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.
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Affiliation(s)
- Jorge Caro-Bautista
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Francisca Villa-Estrada
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alberto Gómez-González
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Inmaculada Lupiáñez-Pérez
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
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Greenbank K, Hemingway S, Thiyagesh S, Stephenson J. Service user and carer experiences of the advanced nurse practitioner role in a memory assessment team. ACTA ACUST UNITED AC 2020; 29:960-967. [PMID: 32901537 DOI: 10.12968/bjon.2020.29.16.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advanced nurse practitioners (ANPs) within memory services can support prompt diagnoses of dementia. Further understanding of the role is necessary as evidence on its effectiveness is limited. AIM To assess service user and carer satisfaction with the ANP role within Kirklees memory assessment team. METHODS A cross-sectional survey was undertaken to evaluate carer and patient perceptions of the ANP role in a local memory assessment team. The survey was developed using the Royal College of Nursing's four pillars as a structure: clinical/direct care practice, leadership and collaborative practice, improving quality and developing practice, and developing self and others. RESULTS One hundred and fifteen surveys were sent out, and 85 were completed, a response rate of 73.9%. Patients expressed significant satisfaction with the ANP, in particular in the areas of direct clinical practice (84%) and quality of care received (87%). CONCLUSION Patients and families are highly satisfied with the service provided by the ANP. High-quality research is needed on the cost effectiveness and outcomes of ANP interventions.
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Affiliation(s)
- Karen Greenbank
- Advanced Nurse Practitioner, Kirklees Memory Assessment Team, South West Yorkshire Partnership NHS Foundation Trust
| | - Steve Hemingway
- Senior Lecturer in Mental Health, University of Huddersfield
| | - Subha Thiyagesh
- Consultant in Psychiatry for Older People, Medical Director, South West Yorkshire Partnership NHS Foundation Trust
| | - John Stephenson
- Senior Lecturer in Biomedical Statistics, University of Huddersfield
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Structure evaluation of the implementation of geriatric models in primary care: a multiple-case study of models involving advanced geriatric nurses in five municipalities in Norway. BMC Health Serv Res 2020; 20:749. [PMID: 32795370 PMCID: PMC7427927 DOI: 10.1186/s12913-020-05566-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background The Advanced Geriatric Nurse role recently has been introduced into Norway’s primary healthcare system, and our study’s purpose was to examine the implementation of models of care developed for Advanced Geriatric Nurse in primary care. With a structure evaluation, we tried to identify conditions that affect the implementation of different models of care and understand how these conditions affected the realisation of each model’s intentions and goals. Methods An embedded multiple-case study was used that included five Norwegian municipalities and seven AGNs. The study included data from August 2014 through September 2018. We used data from 25 semi-structured face-to-face interviews with AGNs and stakeholders, documents and statistical information. We used a cross-case procedure with an emphasis on case findings for the analysis of the multiple case study. Results We analysed the structure-related conditions on two levels: the meso-level and the micro-level. On the meso-level, we found that the conditions that affected the implementation of the different models of care were related to each municipality’s structure characteristics, stakeholders’ involvement in the design of the models of care, the clarity of the models and their goals, the evaluation of the models and their adaptation. At the micro-level, we found that the conditions that affected the models’ implementation were related to the collaboration within the implemented models of care, the role clarity of Advanced Geriatric Nurses themselves and adjustments within the models. Conclusions The implementation of the AGN role in Norway seems to have been implemented in ways that can impact patients and municipalities positively. Potential improvements include extensive stakeholder involvement, improved roles, goal clarity and better documentation of structures and outcomes. The models’ dynamic nature seemed to be a beneficial characteristic, but adaptation should be systematic and a necessary time should be considered for a new model of care to be integrated and produce results.
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Gysin S, Meier R, van Vught A, Merlo C, Gemperli A, Essig S. Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study. BMC FAMILY PRACTICE 2020; 21:164. [PMID: 32791993 PMCID: PMC7425147 DOI: 10.1186/s12875-020-01240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in Swiss primary care. Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results Data from 5210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70–4.36), multimorbid (OR 1.37; 95%-CI 1.24–1.51; p < 0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15–1.42; p < 0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72–3.42; p < 0.001) and anthropometric data (OR 1.33; 95%-CI 1.09–1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04–1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30–0.41; p < 0.001) were prescribed or changed less frequently in NP consultations. Conclusions Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care.
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Affiliation(s)
- Stefan Gysin
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
| | - Rahel Meier
- Institute of Primary Care Zurich, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| | - Anneke van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
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Dawson S, Kunonga P, Beyer F, Spiers G, Booker M, McDonald R, Cameron A, Craig D, Hanratty B, Salisbury C, Huntley A. Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews. F1000Res 2020; 9:857. [PMID: 34621521 PMCID: PMC8482050 DOI: 10.12688/f1000research.25277.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being. Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013-March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others. Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews. Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes. Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patience Kunonga
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Dawn Craig
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Tchouaket É, Kilpatrick K, Jabbour M. Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis. Nurs Outlook 2020; 68:611-625. [PMID: 32713732 DOI: 10.1016/j.outlook.2020.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Internationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Québec Canada where roles are new. PURPOSE To evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Québec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs). METHODS A cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated. FINDINGS The median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4. DISCUSSION This is the first study to present the financial consequence of adverse events sensitive to nurse practitioner care in long-term care. Important cost savings were generated from the reduction of adverse events after the implementation of nurse practitioner roles in long-term care. Government should consider these results for prevention and improvements in quality and safety in long-term care.
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Affiliation(s)
- Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada.
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal-Hôpital, Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
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Craswell A, Wallis M, Coates K, Marsden E, Taylor A, Broadbent M, Nguyen KH, Johnston-Devin C, Glenwright A, Crilly J. Enhanced primary care provided by a nurse practitioner candidate to aged care facility residents: A mixed methods study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Munk T, Svendsen JA, Knudsen AW, Østergaard TB, Beck AM. Effect of nutritional interventions on discharged older patients: study protocol for a randomized controlled trial. Trials 2020; 21:365. [PMID: 32345358 PMCID: PMC7189460 DOI: 10.1186/s13063-020-04301-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/01/2020] [Indexed: 01/04/2023] Open
Abstract
Background During hospitalization, many older patients are at nutritional risk or malnourished, and their nutritional condition is often further impaired during hospitalization. After discharge, a “nutrition gap” often occurs in which the patient does not receive enough nutrition to ensure an optimal recovery. Methods The study is a randomized controlled study ongoing over 112 days. At discharge, the intervention group receives guidance from a clinical dietitian, and an individualized nutrition plan is made. The dietitian will perform telephone follow-up after 4 and 30 days. It will also be possible for the participant, the participant’s relatives, or the participant’s municipality to contact the dietitian if nutritional questions arise. At the time of discharge, the intervention group will receive a package containing foods and drinks that will cover their nutritional needs on the first day after discharge. They will also receive a goodie bag containing samples of protein-rich, milk-based drinks. Data are collected on quality of life, appetite, physical function, dietary intake, weight, height, energy and protein needs, and experience of discharge and cooperation with the municipality. Information about nutrition status will be sent to the municipality so that the municipality can take over nutritional treatment. The control group receives a standard treatment. Discussion This study is the first to combine previously successful single nutritional interventions into a multimodal intervention whose aim is to obtain an effect on patient-related outcomes. We hope that the results will prove beneficial and help to ensure the cross-sector quality of nutritional support to older patients. Trial registration ClinicalTrials.gov, NCT03488329. April 5, 2018.
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Affiliation(s)
- Tina Munk
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Jonas Anias Svendsen
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Tanja Bak Østergaard
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark. .,University College Copenhagen, Faculty of Health, Institute of Nursing and Nutrition, Copenhagen, Denmark.
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Lucena ADF, Argenta C, Luzia MDF, Almeida MDA, Barreto LNM, Swanson E. Multidimensional model of successful aging and nursing terminologies: similarities for use in the clinical practice. ACTA ACUST UNITED AC 2020; 41:e20190148. [PMID: 32294686 DOI: 10.1590/1983-1447.2020.20190148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022]
Abstract
AIM To compare the domains of the Multidimensional Model of Successful Aging (MMSA) with the nursing terminologies, such as, NANDA International (NANDA-I), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC), in order to find similarities among them. METHOD Cross-mapping between MMSA and nursing terminologies in two stages: individual analysis and comparison between the MMSA and the nursing terminologies, based on the mapping process rules; consensus among researchers to validate the results. RESULTS All NOC and NIC domains were mapped with similarity in the MMSA domains, and 12 of the 13 NANDA-I domains showed similarity to the MMSA domains. In addition, similarity was identified between MMSA and most classes of the three classifications. CONCLUSIONS The similarity between MMSA, NANDA-I, NIC and NOC supported the idea that the MMSA framework can be used in the nursing process to qualify the nursing practice in the elderly care.
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Affiliation(s)
- Amália de Fátima Lucena
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de enfermagem, Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | - Carla Argenta
- Universidade do Estado de Santa Catarina (UDESC). Chapecó, Santa Catarina, Brasil
| | | | - Miriam de Abreu Almeida
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de enfermagem, Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Elizabeth Swanson
- University of Iowa, College of Nursing. Iowa City, Iowa, United States of America
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Kobleder A, Mayer H, Senn B. Die Advanced Practice Nurse (APN) in der gynäkologischen Onkologie. Pflege 2020; 33:13-23. [DOI: 10.1024/1012-5302/a000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Die Advanced Practice Nurse (APN) kann für Frauen mit einer gynäkologischen Krebserkrankung eine bedeutsame Unterstützung im Behandlungsprozess darstellen. In Österreich und der Schweiz steht die APN-Entwicklung allerdings erst am Anfang und es fehlt an systematisch entwickelten Konzepten. Fragestellung: Welche Merkmale sollte ein auf wissenschaftlichen Erkenntnissen basierendes APN-Konzept in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz beinhalten? Methode: Die Entwicklung des Konzepts erfolgte mit Hilfe einer Matrix, die basierend auf dem PEPPA plus-Framework entstand, Inhalte des Nursing Role Effectiveness Models (NREM) enthielt und Daten aus vier vorangegangenen Einzelstudien zusammenführte. Dreizehn Expertinnen und Experten aus Pflege und Medizin waren an der Vernehmlassung des Konzepts beteiligt. Ergebnisse: Unterteilt in Struktur-, Prozess- und Outcome-Kriterien beschreibt das Konzept zentrale Inhalte der APN-Rolle in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz. Zusätzlich werden die Beziehungen zwischen Struktur-Prozess, Struktur-Outcome und Prozess-Outcome dargestellt. Schlussfolgerungen: Das in dieser Studie entwickelte Konzept bietet eine Grundlage zur (1) weiteren Ausgestaltung einer APN-Rollenbeschreibung in der gynäkologischen Onkologie auf institutioneller Ebene sowie (2) curricularen Entwicklung entsprechender Studiengänge. Durch die gemeinsame Basis kann eine Harmonisierung der APN-Rolle im Versorgungskontext Österreich und Schweiz gefördert werden.
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Affiliation(s)
- Andrea Kobleder
- Institut für Angewandte Pflegewissenschaft, FHS St. Gallen, Hochschule für Angewandte Wissenschaften, St. Gallen
- Institut für Pflegewissenschaft, Universität Wien
| | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien
| | - Beate Senn
- Institut für Angewandte Pflegewissenschaft, FHS St. Gallen, Hochschule für Angewandte Wissenschaften, St. Gallen
- Sydney Nursing School, Universität Sydney, Australien
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Minotti B, Blättler-Remund T, Sieber R, Tabakovic S. Nurse practitioners in emergency medicine: the Swiss experience. Eur J Emerg Med 2020; 27:7-8. [PMID: 31855886 DOI: 10.1097/mej.0000000000000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruno Minotti
- Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen
| | | | - Robert Sieber
- Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen
| | - Senad Tabakovic
- Emergency Department, Hospital Limmattal, Schlieren, Switzerland
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Kilpatrick K, Tchouaket É, Jabbour M, Hains S. A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities. BMC Nurs 2020; 19:6. [PMID: 32015689 PMCID: PMC6990528 DOI: 10.1186/s12912-019-0395-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. METHODS Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. RESULTS Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. CONCLUSIONS The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
| | - Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada
| | | | - Sylvie Hains
- Retired, Ministère de la Santé et des services sociaux du Québec, Québec, Canada
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Hyde R, MacVicar S, Humphrey T. Advanced practice for children and young people: A systematic review with narrative summary. J Adv Nurs 2019; 76:135-146. [DOI: 10.1111/jan.14243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Robin Hyde
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
| | - Sonya MacVicar
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
| | - Tracy Humphrey
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
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Yousefi H, Ziaee ES, Golshiri P. The Role of Nursing Consultant in Iran: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:387-393. [PMID: 31516526 PMCID: PMC6714120 DOI: 10.4103/ijnmr.ijnmr_53_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Nursing consultation is one of the important roles of nurses and is very effective in improving care results. But this role is unknown in Iran and there are no respective organizational positions. The purpose of this study is to examine the factors affecting the position of this role. Materials and Methods: This study, as a qualitative research was conducted from April to December 2017 using content analysis approach. We performed semi-structured in-depth interviews with 23 participants who were selected using purposeful sampling and were asked to describe the factors affecting the organizational position of nurse consultant. Results: The mean (standard deviation) age of the participants was 44.5 years (10.68). 279 meaning units, 39 codes, 6 subcategories and two categories were obtained in this essay. The two main categories include necessity for nursing consultation role with two subcategories (nursing consultation role as one of the main roles in nursing, and the need for nursing consultation in healthcare system in Iran), and the obstacles of nursing consultation role with four subcategories (healthcare system problems, problems associated with physicians, problems associated with nurses and problems associated with patients' culture). Conclusions: Considering the importance of nursing consultation role in improving the health of the patients, the policymakers should take into account the consultant role of nurses and they should understand the importance of and the need for this role. As such, we hope that managers and policymakers create a role position by removing the obstacles and considering the necessity of this role.
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Affiliation(s)
- Hojatollah Yousefi
- Department of Adult Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh-Sadat Ziaee
- Department of Community Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parastoo Golshiri
- Department of Community Medicine and Family Physician, School of Health, Isfahan University of Medical Science, Isfahan, Iran
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A nurse practitioner-led medication reconciliation process to reduce hospital readmissions from a skilled nursing facility. J Am Assoc Nurse Pract 2019; 32:160-167. [PMID: 31397737 DOI: 10.1097/jxx.0000000000000264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Skilled nursing facilities (SNFs) are penalized for hospital readmissions within 30 days. Medication errors often precipitate hospital returns. The Centers for Medicare and Medicaid Services mandates that health care providers must determine whether medications pose significant risks and implement corrective actions. Federal restrictions exist regarding nurse practitioners (NPs) in long-term care; however, NPs are efficient in the health care of patients requiring a SNF, including completing thorough medication reconciliation and correcting deficiencies. LOCAL PROBLEM A needs assessment of a 90-bed SNF revealed inadequate medical coverage and no formalized program to reduce hospital readmissions, including a mandated medication reconciliation process. The problem contributed to an average 30-day readmission rate of 24.15%. METHODS The investigators sought to determine whether an NP-led medication reconciliation on admission would reduce hospital readmissions from a SNF. A pre- and postimplementation design was used to compare 30-day hospital readmission rates over a 30-day project period. INTERVENTIONS An evidence-based workflow process for systematic medication reconciliation was designed. A full-time NP used the workflow process to complete stabilization visits with medication reconciliation on each facility admission. RESULTS Results revealed a hospital readmission rate of 19.2% preimplementation and 13.5% postimplementation, reflecting a 29.7% decrease in the rate of hospital readmissions within a 30-day period. CONCLUSION A chi-square analysis conveyed no statistical significance; yet, the positive benefits of NP intervention included reduced hospitalizations, increased revenue, improved quality measures and survey results, and preparation for the Centers for Medicare and Medicaid Services mandates. IMPLICATIONS FOR PRACTICE Nurse practitioners have the necessary education and skills to provide quality care as well as achieving CMS mandates and improving quality measures in SNF settings.
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Zúñiga F, De Geest S, Guerbaai RA, Basinska K, Nicca D, Kressig RW, Zeller A, Wellens NIH, De Pietro C, Vlaeyen E, Desmedt M, Serdaly C, Simon M. Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol. J Am Geriatr Soc 2019; 67:2145-2150. [PMID: 31317544 DOI: 10.1111/jgs.16074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/15/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in-house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse-led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. DESIGN An effectiveness-implementation hybrid type 2 design to assess clinical outcomes of a nurse-led care model and a mixed-method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). SETTING NHs in the German-speaking region of Switzerland. PARTICIPANTS Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse-led care model. INTERVENTION The multilevel complex context-adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence-based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. MEASUREMENTS The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. CONCLUSION The INTERCARE study will provide evidence about the effectiveness of a nurse-led care model in the real-world setting and accompanying implementation strategies. J Am Geriatr Soc 67:2145-2150, 2019.
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Affiliation(s)
- Franziska Zúñiga
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Raphaëlle Ashley Guerbaai
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Kornelia Basinska
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dunja Nicca
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Nursing and Allied Health Professions, University Hospital Basel, Basel, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland
| | - Carlo De Pietro
- Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Ellen Vlaeyen
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Mario Desmedt
- Foundation Asile des Aveugles, Lausanne, Switzerland
| | | | - Michael Simon
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing & Midwifery Research Unit, Bern, Switzerland
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