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Reis KGL, Serranegra NVDF, Varela ALV, Almeida PAD, Carrer MO, Barreto CP, Cordeiro JKR, Martiniano CS, Miranda Neto MVD, Bonfim D. Child health nursing consultation and competencies for Advanced Practice Nurses. Rev Esc Enferm USP 2024; 58:e20230269. [PMID: 38808705 PMCID: PMC11145758 DOI: 10.1590/1980-220x-reeusp-2023-0269en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/16/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To analyze nurses' practice in child health nursing consultations and the presence of care management competencies proposed for Advanced Practice Nurses (APN). METHOD Multicenter, exploratory sequential mixed methods research, carried out in 17 Basic Health Units in four Brazilian cities. Collection was carried out from May to July 2022 through filming of consultation and analysis of medical records. Consultations with compliance with the Nursing Process ≥50% were analyzed to identify the competencies proposed for APN. RESULTS 24 child consultations carried out by 12 nurses were filmed. In the quantitative analysis, 11 nursing consultations, carried out by seven nurses, achieved ≥50% Nursing Process compliance. In the qualitative analysis of these consultations, some APN competencies in care management were identified, but incomplete. CONCLUSION child health nursing consultations present weaknesses in carrying out the Nursing Process, and nurses demonstrated a partial and superficial application of the care management competencies proposed for APN.
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Affiliation(s)
- Keila Gisele Lima Reis
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Patricia Aline de Almeida
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Marilia Orlandelli Carrer
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Carla Pereira Barreto
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | - Daiana Bonfim
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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Cook KL, Mayahara M, Tivis L. Evaluation of the Nurse Practitioner Offsite Model. J Gerontol Nurs 2023; 49:25-30. [PMID: 37379050 DOI: 10.3928/00989134-20230615-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Rural older adults residing in assisted living (AL) (herein referred to as residents) have limited access to health care for urgent and chronic management of diseases. The current project aimed to assess rural residents, families, and staff satisfaction with the Nurse Practitioner (NP) Offsite Visit Program. Residents and their families were asked to complete the NP Satisfaction Survey. The survey comprised three subscales (satisfaction, communication, and accessibility) and measured residents' and families' satisfaction. AL staff attended a 1-hour focus interview. Mean survey scores were 81.5 for satisfaction, 26.4 for communication, and 16.9 for accessibility subscales. Focus interview themes included Care Coordination, Prevention of Acute Care Utilization, and Access to Care. Findings suggest that residents, families, and site staff believe the NP Offsite Visit Program was beneficial and improved care coordination between residents and the provider team. The next step is to evaluate the program's impact on residents' health outcomes and further evaluate the Offsite team membership. [Journal of Gerontological Nursing, 49(7), 25-30.].
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Strachan H, Hoskins G, Wells M, Maxwell M. A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland. J Adv Nurs 2022; 78:2916-2932. [PMID: 35436359 PMCID: PMC9541711 DOI: 10.1111/jan.15252] [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: 09/20/2021] [Revised: 02/11/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
Aim To evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context. Design A realist evaluation using multiple case studies. Methods Two phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups. Results Sixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience. Conclusions At the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits. Impact ANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration.
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Affiliation(s)
- Heather Strachan
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - Gaylor Hoskins
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - Mary Wells
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
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Andrade B, Pedebos LA, Silva ACSD, Amante LN, Paes LG, Paese F. Diagnóstico e tratamento de infecções sexualmente transmissíveis realizados por enfermeiros na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: No final da década de 1990, iniciou-se as atividades de prevenção das infecções sexualmente transmissíveis para a atenção primária à saúde. Nas duas últimas décadas, vem ocorrendo uma ampliação da assistência de enfermeiros no tratamento dessas infecções. A Lei do Exercício Profissional da Enfermagem nº 7.498./86, garante aos enfermeiros na consulta de enfermagem o direito de realizar a prescrição de medicamentos aprovados por protocolos institucionais. Objetivo: Verificar se os enfermeiros que atuam na Atenção Primária à Saúde de Florianópolis se sentem aptos para a execução do diagnóstico e do tratamento medicamentoso das infecções sexualmente transmissíveis (IST) com base nos Protocolos de Enfermagem do município. Métodos: Pesquisa exploratório-descritiva de abordagem qualitativa realizada por meio de entrevista semiestruturada com perguntas disparadoras. Foram entrevistados dez enfermeiros assistenciais da Atenção Primária à Saúde do município. Os dados foram analisados segundo a técnica de Bardin. Resultados: Identificaram-se duas categorias analíticas: “O enfermeiro e a (re)construção de sua prática profissional” e “O enfermeiro e a sua contribuição na qualidade de serviço na Atenção Primária à Saúde”. Conclusões: Os enfermeiros da rede assistencial da Atenção Primária à Saúde de Florianópolis mostram-se altamente qualificados e sentem-se capazes de responder adequadamente às necessidades de sua prática profissional.
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Barratt J. RE: Valuing the paradigm of nursing: Can nurse practitioners resist medicalisation to transform healthcare? J Adv Nurs 2022; 78:e41-e42. [PMID: 35037296 DOI: 10.1111/jan.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Julian Barratt
- Faculty for Advancing Practice (Midlands), Health Education England, Birmingham, UK.,Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
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O'Reilly D, Brady AM, Bryant-Lukosius D, Varley J, Daly L, Cotter P, Elliot N, Lehane E, Fleming S, Savage E, Hegarty J, Drennan J. Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey. J Adv Nurs 2021; 77:4279-4289. [PMID: 34449917 DOI: 10.1111/jan.15026] [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: 10/20/2020] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
AIM The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice. DESIGN Cross-sectional survey; validity and reliability analysis. METHODS The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations. RESULTS A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement. CONCLUSION The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP. IMPACT Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.
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Affiliation(s)
- David O'Reilly
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Jarlath Varley
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Daly
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Cotter
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Naomi Elliot
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Sandra Fleming
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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Community nurse-paramedics' sphere of practice in primary care; an ethnographic study. BMC Health Serv Res 2021; 21:710. [PMID: 34275436 PMCID: PMC8286441 DOI: 10.1186/s12913-021-06691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice. Methods A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis. Results Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models. Conclusions Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.
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9
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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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10
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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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11
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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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12
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Chan CHY, Lau BHP, Chan THY, Leung HT, So GYK, Chan CLW. Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong. Front Psychol 2020; 11:1081. [PMID: 32655430 PMCID: PMC7325961 DOI: 10.3389/fpsyg.2020.01081] [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: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Little research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM). Methods The participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data. Results We found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety-driven treatment seeking as measured by annual clinic visits. Conclusion These findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).
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Affiliation(s)
- Celia H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Bobo H P Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Timothy H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - H T Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Georgina Y K So
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Evans C, Pearce R, Greaves S, Blake H. Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124500. [PMID: 32585866 PMCID: PMC7344450 DOI: 10.3390/ijerph17124500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 01/02/2023]
Abstract
Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- Correspondence:
| | - Ruth Pearce
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Sarah Greaves
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2HA, UK
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Nurse practitioner consultations in primary health care: patient, carer, and nurse practitioner qualitative interpretations of communication processes. Prim Health Care Res Dev 2018; 20:e42. [PMID: 30376908 PMCID: PMC6536759 DOI: 10.1017/s1463423618000798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim To advance understanding of the discrete nature of the communication processes and social interactions occurring in nurse practitioner consultations. Background Preceding qualitative investigations of nurse practitioner consultations have, when conducting interviews with participants, often exclusively sampled either nurse practitioners or patients. Furthermore, previous qualitative studies of the nature of nurse practitioner consultations have not typically also sampled carers attending with patients for nurse practitioner consultations. Accordingly this study was developed, in part, to address this exclusivity of sampling in qualitative research of nurse practitioner consultations by developing an inclusive sample of patient, carer and nurse practitioner participants of nurse practitioner consultations, so as to conjointly develop an understanding of the multiple perceptions of those participants of communication processes occurring in nurse practitioner consultations. Methods Qualitative component of a larger mixed methods case study of communication processes and social interactions in nurse practitioner consultations, utilising individual semi-structured interviews with the patient (n = 9), carer (n = 2) and nurse practitioner (n = 3) participants of video-recorded consultations derived from a nurse practitioner-led general practice clinic. Interview transcripts were initially analysed via an emergent thematic analysis, followed up by computer-assisted qualitative data analysis with NVivo 9. Findings The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes: Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style; Nurse practitioner role ambiguity; Creating the impression of time and Expectations for safety netting. The findings identify a need for policy makers to address a perceived ambiguity of the nature of the nurse practitioner role amongst patients and carers. The benefits of nurse practitioners using personable, everyday lifeworld styles of communication for optimising interactions, sharing clinical reasoning and conveying a sense of having time for patients and carers in consultations are also identified.
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