Community development through faculty practice in a rural nurse-managed clinic

Conceptual framework of the nursing centre for the integration of community health nursing practice, education, and research

AIM

To develop a conceptual framework that can be used for the integration of community health nursing (CHN) practice, education, and research within a Nursing Centre (NC) model.

BACKGROUND

New forms of training and support are needed to equip nurses to manage the complex and costly challenges facing health care systems. The NC model provides scope to address these challenges by integrating nursing practice, education, and research. However, there is little information about how these constructs are integrated or how education is constituted within the model.

METHODS

This study used an embedded single case study design across three Nursing Centres (NCs) in West Java Indonesia. Semi-structured interviews and a review of relevant documents were conducted. Interview participants were recruited purposively to select stakeholders with rich information, including clients, nurses, nursing students and lecturers who have been using the NC model, as well as the head of the co-located Community Health Centres. Data was analysed using thematic analysis, pattern matching and cross-unit synthesis.

FINDINGS

Four components relevant to integration in the NC were identified, namely (1) client-centred care as the shared common ground for integration in the NC; (2) nursing education using a service learning approach; (3) the NC as a model for reviving CHN services; and (4) service improvement through research and community service activities. The service learning approach was identified as appropriate because it links services with the learning process and this serves to address the interests of both practice and education institutions. The conceptual framework identified in this study can be used to improve the functionality of NCs in Indonesia and be considered for use internationally.

Analytical typology of multiprofessional primary care models

Background

There is only limited evidence to support care redefinition and role optimization processes needed for scaling up of a stronger primary care capacity.

Methods

Data collection was based on a keyword search in MEDLINE, EMBASE and CINAHL databases. Three thousand, two hundred and twenty-nine documents were identified, 1851 met our inclusion criteria, 71 were retained for full-text assessment and 52 included in the final selection. The analysis process was done in four steps. In the end, the elements that were identified as particularly central to the process of transforming primary care provision were used as the basis of two typologies.

Results

The first typology is based on two structural dimensions that characterize promising multiprofessional primary care teams. The first is the degree to which the division of tasks in the team was formalized. The second dimension is the centrality and autonomy of nurses in the care model. The second typology offers a refined definition of comprehensiveness of care and its relationship with the optimization of professional roles.

Conclusions

The literature we analyzed suggests there are several plausible avenues for coherently articulating the relationships between patients, professionals, and care pathways. The expertise, preferences, and numbers of available human resources will determine the plausibility that a model will be a coherent response that is appropriate to the needs and environmental constraints (funding models, insurance, etc.). The typologies developed can help assess existing care models analytically or evaluatively and to propose, prospectively, some optimal operational parameters for primary care provision.

Academic-service partnerships in nursing: an integrative review

This integrative review summarizes currently available evidence on academic-service partnerships in the profession of nursing. More than 300 articles, published primarily in refereed journals, were accessed. Articles (110) were included in this review as they presented detailed and substantive information about any aspect of a nursing academic-service partnership. The majority were anecdotal in nature. Topics clustered around the following categories: pre-requisites for successful partnerships, benefits of partnerships, types of partnerships, and workforce development with its themes of academic-practice progression and educational re-design. Many examples of partnerships between academic and service settings were thoroughly described and best practices suggested, most often, however, without formal evaluation of outcomes. Nursing leaders in both settings have a long tradition of partnering with very little replicable evidence to support their efforts. It is critical that future initiatives evaluate the effectiveness of these partnerships, not only to ensure quality of patient outcomes but also to maximize efforts at building capacity for tomorrow's workforce.

Nurse-led primary healthcare walk-in centres: an integrative literature review

AIMS

This paper is a report of an integrative review of the international literature examining established nurse-led primary healthcare walk-in centres and their outcomes to understand whether they are effective in improving access to primary health care.

BACKGROUND

Reviews of nurse-led primary care walk-in centres have included centres staffed by family physicians and general practitioners. There is a paucity of evidence about walk-in centres staffed solely by nurses.

DATA SOURCES

Studies were identified through an electronic search using the databases Medline, Cinahl and EBSCO from 1990 until July 2010. Papers were included if they examined walk-in centres providing nurse-led primary care for the general community. Only peer reviewed studies published in English were included.

REVIEW METHODS

An integrative approach utilizing Bowling's checklist facilitated a systematic appraisal of studies in regard to clarity of aims, objectives, methods and appropriate analysis of data.

RESULTS

Thirteen publications were categorized into five themes: 'users of walk-in centres', 'quality of care provided at walk-in centres', 'impact on other healthcare providers', 'perceptions of walk-in centres' and 'satisfaction with walk-in centres'.

CONCLUSION

The possibility that walk-in centres create demand highlights the need for clearer evidence of the drivers of demand for health care in walk-in centres. Innovations in healthcare provision need to be matched with adaptation to nursing education to ensure an adequately prepared nursing workforce. Improvement in access to primary healthcare needs to be measured in terms of equity and the capacity this access has to fill identified gaps in primary healthcare provision in the community.

The STTI Practice-Academe Innovative Collaboration Award: honoring innovation, partnership, and excellence

PURPOSE

To describe the benefits and barriers associated with practice-academe partnerships and introduce Sigma Theta Tau International's (STTI's) Practice-Academe Innovative Collaboration Award and the 2009 award recipients.

DESIGN AND METHODS

In 2008, STTI created the CNO-Dean Advisory Council and charged it with reviewing the state of practice-academe collaborations and developing strategies for optimizing how chief nursing officers (CNOs) and deans work together to advance the profession and discipline of nursing. The Council, in turn, developed the Practice-Academe Innovative Collaboration Award to encourage collaboration across sectors, recognize innovative collaborative efforts, and spotlight best practices. A call for award submissions resulted in 24 applications from around the globe.

FINDINGS

An award winner and seven initiatives receiving honorable mentions were selected. The winning initiatives reflect innovative academe-service partnerships that advance evidence-based practice, nursing education, nursing research, and patient care. The proposals were distinguished by their collaborators' shared vision and unity of purpose, ability to leverage strengths and resources, and willingness to recognize opportunities and take risks.

CONCLUSIONS

By partnering with one another, nurses in academe and in service settings can directly impact nursing education and practice, often effecting changes and achieving outcomes that are more extensive and powerful than could be achieved by working alone.

CLINICAL RELEVANCE

The award-winning initiatives represent best practices for bridging the practice-academe divide and can serve as guides for nurse leaders in both settings.

Perceptions of Effectiveness of Nurse-Managed Clinics: A Cross-Cultural Study

OBJECTIVE

To study perceptions of the effectiveness of two nurse-managed clinics (NMCs), one in the United States and the other in New Zealand.

DESIGN

Cross-cultural evaluation study utilizing qualitative methodology; two rounds of in-depth interviews were tape recorded, transcribed verbatim, and analyzed for themes.

SAMPLE

Data were initially collected from 21 participants. Sixteen of the original participants participated in a second interview.

INTERVENTION

The first round of interviews and provisional data analysis were conducted in the respective NMCs; joint data analysis to identify themes and develop a preliminary joint report of findings followed. Sixteen participants responded to the provisional report; additional data analysis resulted in the final report of findings.

RESULTS

Analysis of the data yielded three categories: the NMC milieu affects perceived effectiveness; perceptions are shaped by contrasting with past experiences; and the level of care affects personal health care decisions.

CONCLUSIONS

The milieu created in the NMC enhances perceptions of effectiveness and responsibility for personal health care. Further research related to effectiveness of NMC models of care and client outcomes is needed. Qualitative methodology is recommended for cross-cultural research.

Educating for rural nursing practice

BACKGROUND

Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided.

AIMS

The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care.

METHODS

We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network.

FINDINGS

The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily.

CONCLUSIONS

Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.

Nurse-Managed Primary Care: Outcomes of a Faculty Practice Network

PURPOSE

To describe selected outcomes of nurse-managed primary care in a large faculty practice network (FPN) and to use guidelines proposed by the National Organization of Nurse Practitioner Faculties (NONPF) to evaluate those outcomes.

DATA SOURCES

Mission and goals, nursing control, fiscal stability, health care outcomes, and faculty role integration were examined.

CONCLUSIONS

Outcomes show that the FPN directly supports the mission and goals of the East Tennessee State University College of Nursing and is managed by nurse faculty members. The FPN uses earned revenue, grants, and contracts to maintain fiscal stability. Patients are highly satisfied with services, and external and internal audits find the quality of care to be excellent. Students are educated in the centers. Faculty members publish and present research and other scholarly work derived from the FPN.

IMPLICATIONS FOR PRACTICE

This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.