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Bagnasco A, Alvaro R, Lancia L, Manara DF, Rasero L, Rocco G, Burgio A, Di Nitto M, Zanini M, Zega M, Cicolini G, Sasso L, Mazzoleni B. Working conditions, missed care and patient experience in home care nursing in Italy: An observational study. Public Health Nurs 2024. [PMID: 38708563 DOI: 10.1111/phn.13320] [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: 12/12/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described. OBJECTIVES To describe the characteristics of nurses and care recipients involved in home care. METHODS A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed. RESULTS A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10). CONCLUSIONS Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.
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Affiliation(s)
- Annamaria Bagnasco
- Scientific Committee CERSI-FNOPI, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Rosaria Alvaro
- Scientific Committee CERSI-FNOPI, Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Loreto Lancia
- Scientific Committee CERSI-FNOPI, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Laura Rasero
- Scientific Committee CERSI-FNOPI, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gennaro Rocco
- Scientific Committee CERSI-FNOPI, Centre of Excellence for Nursing Scholarship, c/o OPI Roma, Rome, Italy
| | - Alessandra Burgio
- Statistician, Italian National Statistics Institute - ISTAT, Rome, Italy
| | - Marco Di Nitto
- Scientific Committee CERSI-FNOPI, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Scientific Committee CERSI-FNOPI, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maurizio Zega
- FNOPI Board Member, University Policlinic A. Gemelli IRCCS, Rome, Italy
| | - Giancarlo Cicolini
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Loredana Sasso
- Scientific Committee CERSI-FNOPI, Department of Health Sciences, University of Genoa, Genoa, Italy
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Knop M, Mueller M, Kaiser S, Rester C. The impact of digital technology use on nurses' professional identity and relations of power: a literature review. J Adv Nurs 2024. [PMID: 38558440 DOI: 10.1111/jan.16178] [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: 09/27/2023] [Revised: 02/20/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
AIM This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. DESIGN Literature review. DATA SOURCES PubMed and CINAHL databases were searched in April 2023. METHODS We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. RESULTS Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. CONCLUSION Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. IMPLICATIONS FOR THE PROFESSION Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. IMPACT The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. REPORTING METHOD We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Michael Knop
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | | | | | - Christian Rester
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
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Tang L, Wang F, Tang T. Exploring the relationship between family care, organizational support, and resilience on the professional quality of life among emergency nurses: A cross-sectional study. Int Emerg Nurs 2024; 72:101399. [PMID: 38198948 DOI: 10.1016/j.ienj.2023.101399] [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: 08/04/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The professional quality of life (ProQOL), encompassing emotional, physical, and psychological well-being, is profoundly influenced by the unique nursing experiences of emergency nurses. Understanding and effectively enhancing their professional well-being are of paramount importance. This study aimed to explore the relationship between family care, organizational support, and resilience with the ProQOL among emergency nurses. METHODS This cross-sectional study, conducted between May 1 and June 1, 2023, involved 118 emergency nurses from Hunan Provincial Brain Hospital. Demographic and work-related information were collected. ProQOL, family care, organizational support and resilience were assessed using validated scales. Statistical analysis was conducted to examine the associations between these variables. RESULTS Significant differences were observed in the two dimensions of ProQOL (compassion satisfaction and burnout) among emergency nurses with different age, marital status, technical titles, work experience and night shift frequency (P < 0.05). Furthermore, both organizational support and resilience demonstrated a significant positive correlation with compassion satisfaction, while exhibiting a significant negative correlation with burnout (P < 0.05). Additionally, the third dimension of ProQOL (secondary trauma stress) was significantly negatively correlated with resilience (P < 0.05). CONCLUSION This study elucidates the pivotal role of organizational support and resilience in influencing the professional quality of life among emergency nurses, highlighting the specific needs of younger and less-experienced practitioners. Our findings lay the groundwork for targeted interventions aimed at enhancing the occupational well-being and job satisfaction of nursing staff.
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Affiliation(s)
- Ling Tang
- Department of Emergency Medicine, Hunan Provincial Brain Hospital (The Second People's Hospital of Hunan Province), Changsha 410007, China
| | - Feiyan Wang
- Department of Rehabilitation Medicine, Hunan Provincial Brain Hospital (The Second People's Hospital of Hunan Province), Changsha 410007, China
| | - Ting Tang
- Department of Emergency Medicine, Hunan Provincial Brain Hospital (The Second People's Hospital of Hunan Province), Changsha 410007, China.
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4
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Poghosyan L, Liu J, Spatz E, Flandrick K, Osakwe Z, Martsolf GR. Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease. J Gen Intern Med 2024; 39:61-68. [PMID: 37620724 PMCID: PMC10817858 DOI: 10.1007/s11606-023-08367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. OBJECTIVE To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. DESIGN In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. PARTICIPANTS A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. MAIN MEASURES All-cause and ambulatory care sensitive condition hospitalizations in 2018. KEY RESULTS There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries. CONCLUSIONS Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.
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Affiliation(s)
- Lusine Poghosyan
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA.
- Mailman School of Public Health, Columbia University, New York, USA.
| | - Jianfang Liu
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Erica Spatz
- School of Medicine, Yale University, New Haven, CT, USA
| | - Kathleen Flandrick
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Zainab Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Grant R Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Duhoux A, Rioux-Dubois A, Poitras ME, Lazarovici M, Gabet M, Dufour E. Clinical and Organizational Nursing Innovations in Primary Care: Findings From a Stakeholders' Symposium. J Nurs Adm 2023; 53:654-660. [PMID: 37983604 DOI: 10.1097/nna.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.
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Affiliation(s)
- Arnaud Duhoux
- Author Affiliations: Associate Professor (Dr Duhoux), Faculty of Nursing, University of Montreal, Montreal; Primary Health Care Nurse Practitioner (PHC-NP) and Professor (Dr Rioux-Dubois), Department of Nursing, University du Québec en Outaouais, Saint-Jérôme; Associate Professor (Dr Poitras), Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke; RN, Faculty of Nursing (Lazarovici), Université de Montréal, Montréal; and Postdoctoral Fellow (Dr Gabet), Department of Family Medicine, Université Laval, Ville de Québec, Quebec, Canada; and Postdoctoral Fellow (Dr Dufour), Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Forstner J, Mangold J, Litke N, Weis A, Szecsenyi J, Wensing M, Ullrich C. [Between New Responsibility and Daily Routines - The Role of the VERAH in GP Care: A Qualitative Secondary Data Case Study of the Introduction of Software-Based Case Management]. DAS GESUNDHEITSWESEN 2023; 85:1124-1130. [PMID: 37852278 PMCID: PMC10713334 DOI: 10.1055/a-2144-5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The concept of Care Assistant in General Practice (VERAH) was developed in order to integrate non-medical staff more strongly into primary care and thus to meet the increasing demand for care and the simultaneous shortage of medical staff. VERAHs are increasingly responsible for software-supported case management and are thus confronted with new tasks. The aim of this study was therefore to explore the role of the VERAH in primary care practices. METHODS The present study is a qualitative secondary data analysis; the data collection took place within the projects VESPEERA and TelePraCMan. Twenty individual interviews and two focus group meetings were conducted with a total of 30 physicians, VERAHs and medical assistants from primary care. The data were analysed qualitatively according to Emerson. Contextual and socio-demographic data were collected with an accompanying questionnaire. RESULTS The VERAHs of all primary care practices from which interview partners participated performed tasks within software-supported case management. Concerning the role of the VERAH, three themes were identified in the interviews: a) concrete tasks of the VERAH in software-supported case management within the practice team, b) relevance of software-supported case management within the activities of the VERAHS and c) relationship between VERAHs and patients. CONCLUSION Taking over tasks in software-supported case management can contribute to strengthening and expanding the role of the VERAH. In the future, more attention should be paid to a clear description of the new role, and the conditions of the VERAHs' task fulfilment should be considered.
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Affiliation(s)
- Johanna Forstner
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Jasmin Mangold
- Institut für Gesundheitswissenschaften, Abteilung
Pflegewissenschaft, Universitätsklinikum Tübingen,
Tübingen, Germany
- Zentrum für öffentliches Gesundheitswesen und
Versorgungsforschung (ZÖGV), Universitätsklinikum
Tübingen, Tübingen, Germany
| | - Nicola Litke
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Aline Weis
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Silverglow A, Wijk H, Lidén E, Johansson L. Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals. BMC Health Serv Res 2023; 23:998. [PMID: 37716938 PMCID: PMC10505324 DOI: 10.1186/s12913-023-10010-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people. METHODS This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture-norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience. RESULTS The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience. CONCLUSIONS This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.
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Affiliation(s)
- Anastasia Silverglow
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- The Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Johansson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
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Poghosyan L, Courtwright S, Flandrick KR, Pollifrone MM, Schlak A, O'Reilly-Jacob M, Brooks Carthon JM, Gigli KH, Porat-Dahlerbruch J, Alexander G, Brom H, Maier CB, Timmons E, Ferrara S, Martsolf GR. Advancement of research on nurse practitioners: Setting a research agenda. Nurs Outlook 2023; 71:102029. [PMID: 37619489 PMCID: PMC10810357 DOI: 10.1016/j.outlook.2023.102029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them. PURPOSE We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce. METHODS Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions. DISCUSSION The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives. CONCLUSION The agenda can advance evidence on the NP workforce to guide policy and practice.
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Affiliation(s)
| | | | | | | | - Amelia Schlak
- Office of Research and Development, Department of Veteran Affairs, Washington DC, WA
| | | | | | - Kristin Hittle Gigli
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Heather Brom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Edward Timmons
- John Chambers College of Business and Economics, West Virginia University, Morgantown, WV
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Osakwe ZT, Liu B, Ankuda CK, Ritchie CS, Leff B, Ornstein KA. The role of restrictive scope-of-practice regulations on the delivery of nurse practitioner-delivered home-based primary care. J Am Geriatr Soc 2023. [PMID: 36855242 PMCID: PMC10363209 DOI: 10.1111/jgs.18300] [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: 11/16/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Nurse practitioners (NPs) are the largest group of providers delivering home-based primary care (HBPC) in the U.S. We examined the association of scope-of-practice regulations and NP-HBPC rates. METHODS Using the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File for 2019, we conducted a state-level analysis to examine the impact of scope-of-practice regulations on the utilization of NP-HBPC. Healthcare Common Procedure Coding System codes were used to identify the HBPC visits in private residences (99341-99,345, 99,347-99,350) and domiciliary settings (99324-99,328, 99,334-99,337). We used linear regression to compare NP-HBPC utilization rates between states of either restricted or reduced scope-of-practice laws to states with full scope-of-practice, adjusting for a number of NP-HBPC providers, state ranking of total assisted living, the proportion of fee-for-service (FFS) Medicare beneficiaries and neighborhood-level socio-economic status and race and ethnicity. RESULTS Nearly half of NPs providing HBPC (46%; n = 7151) were in states with a restricted scope of practice regulations. Compared to states with full scope-of-practice, states with restricted or reduced scope-of-practice had higher adjusted rates of NP-HBPC per 1000 FFS Medicare beneficiaries. The average level of the utilization rate of NP-HBPC was 89.9, 63, and 49.1 visits, per 1000 FFS Medicare beneficiaries in states with restricted, reduced, and full- scope-of-practice laws, respectively. The rate of NP-HBPC visits was higher in states with restricted (Beta coefficient = 0.92; 95%CI 0.13-1.72; p = 0.023) and reduced scope-of-practice laws (Beta coefficient = 0.91; 95%CI 0.03-1.79; p = 0.043) compared to states with full scope-of-practice laws. CONCLUSION Restricted state NP scope-of-practice regulations were associated with higher rates of FFS Medicare NP-HBPC care delivery compared with full or reduced scope-of-practice. Understanding underlying mechanisms of how scope-of-practice affects NP-HBPC delivery could help to develop scope-of-practice regulations that improve access to HBPC for the underserved homebound population.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire K Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Li Y, Howell JR, Cimiotti JP. Nurse practitioner job preference: A discrete choice experiment. Int J Nurs Stud 2023; 138:104407. [PMID: 36481595 PMCID: PMC9671868 DOI: 10.1016/j.ijnurstu.2022.104407] [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: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN A two-stage design using a mixed method approach. SETTING(S) The state of Georgia in the United States. PARTICIPANTS 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (β = -1.50); administration that was not very responsive and supportive (β = -1.04); being supervised by a physician (β = -0.58); not having their own panel of patients (β = -0.42); and not billing under their own National Provider Identifier (β = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.
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Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA,Corresponding author at: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30324, USA
| | - John R. Howell
- Department of Marketing and Global Supply Chain, Brigham Young University, Provo, UT, USA
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Lizcano‐Álvarez A, Esteban‐Hernández J, Alameda‐Cuesta A, Cid‐Expósito G, Palacios‐Ceña D. Chronic cardiovascular nursing care in Spanish primary care: A qualitative study. Int J Nurs Pract 2022:e13117. [DOI: 10.1111/ijn.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Angel Lizcano‐Álvarez
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Jesús Esteban‐Hernández
- Department of Medical Specialties and Public Health, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | | | - Gema Cid‐Expósito
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Domingo Palacios‐Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS) Universidad Rey Juan Carlos Madrid Spain
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Poghosyan L, Stein JH, Liu J, Spetz J, Osakwe ZT, Martsolf G. State-level scope of practice regulations for nurse practitioners impact work environments: Six state investigation. Res Nurs Health 2022; 45:516-524. [PMID: 35852444 PMCID: PMC9534177 DOI: 10.1002/nur.22253] [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: 03/28/2022] [Revised: 06/02/2022] [Accepted: 06/18/2022] [Indexed: 11/12/2022]
Abstract
Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational-level work environment of NPs. Through a cross-sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018-2019. Arizona and Washington had full SOP-NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP-Administration Relations (NP-AR), NP-Physician Relations (NP-PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state-level SOP and practice-level NP work environment. NP-AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP-PR score. State-level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions.
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Affiliation(s)
| | - Jordan H. Stein
- School of Nursing, Columbia University, New York, New York, USA
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, New York, USA
| | - Joanne Spetz
- School of Nursing, University of California, San Francisco, California, USA
| | - Zainab T. Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Grant Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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A framework of the institutional policies and practice environments of nurse practitioner primary care models: A cross-case analysis. Health Care Manage Rev 2022; 47:369-379. [PMID: 35713574 DOI: 10.1097/hmr.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article was to compare the implementation of distinct models of nurse practitioner (NP) integration into primary care offices. DESIGN/METHODOLOGY A multiple case study design of three NP primary care practice models allowed for in-depth exploration of the management processes supporting the utilization of NPs. At each site, semistructured qualitative interviews, document review, and site tours/observations were conducted and subject to cross-case analysis guided by the NP Primary Care Organizational Framework (NP-PCOF)-developed for this study based on existing theory. RESULTS Our case study sites represent three distinct NP primary care models. In the restricted practice model, NPs care for same-day/walk-in acute patients. NPs in the independent practice model have an independent panel of patients and interact collegially as independent coworkers. NPs in the comanagement model function on a team (a physician and two NPs), have a team office space, collectively care for a shared panel of patients, and can earn financial bonuses contingent upon meeting team quality metrics. Our cross-case analysis confirmed differences in physical space design, the relational structure of a workplace, and the capacity for innovation via NP compensation and performance metrics across different NP primary care models. CONCLUSION Our findings suggest that NP primary care models are supported by complex management systems and the NP-PCOF is a tool to help understand this complexity. IMPLICATIONS The NP-PCOF is a framework to understand the management systems that facilitate the utilization of NPs within primary care organizations.
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Schlunegger MC, Aeschlimann S, Palm R, Zumstein-Shaha M. Competencies of nurse practitioners in family practices: A scoping review. J Clin Nurs 2022; 32:2521-2532. [PMID: 35642084 DOI: 10.1111/jocn.16382] [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: 03/10/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE To explore the existing literature related to nurse practitioner (NP) competencies in family practices and to examine the evidence and develop a list of competencies. BACKGROUND The integration of NPs into the healthcare system is at different stages of progress around the world. Therefore, an overview and clarification of competencies are important to ensure successful implementation of new roles in existing healthcare systems. However, detailed knowledge is lacking about the competencies of NPs in adult care in family practices. DESIGN AND METHODS We conducted a scoping review in accordance with the JBI methodology for scoping reviews and the PRISMA-ScR guidelines. We considered studies published in English, German or French from 1965 to the present. Databases searched included MEDLINE, CINAHL, Web of Science and PsycINFO. Sources of grey literature that were searched included ProQuest Dissertations and Theses, OpenGrey and websites of national NP organisations. Two reviewers retrieved full-text studies and extracted data independently. We described the competencies using Hamric's model of advanced practice nursing. RESULTS We included 23 publications. Competencies in direct clinical practice were described most often particularly pertaining to nursing or medical tasks. Indirect care activities were frequently mentioned. Less information was found regarding competencies in leadership, ethical decision-making and evidence-based practice. We found elementary and extended competencies required to perform the role in family practices. Depending on the country, the role was either emerging or already well-established. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE This review provides insight into current knowledge about competencies of NP in family practices. The identified competencies can be used to develop job descriptions or to conceptualise professional development programmes in countries where such roles are just recently emerging. A list of competencies will promote a common understanding of the NP role and to help clarify interprofessional collaboration in clinical practice.
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Affiliation(s)
- Margarithe Charlotte Schlunegger
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland.,School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Simona Aeschlimann
- Tilia Köniz, Tilia Foundation for Long-Term Care, Ostermundigen, Switzerland
| | - Rebecca Palm
- School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Maya Zumstein-Shaha
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland.,School of Nursing Science, Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
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Pulido-Fuentes M, González LA, Reneo IA, Cipriano-Crespo C, Flores-Martos JA, Santos AP. Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study. BMC Health Serv Res 2022; 22:665. [PMID: 35581581 PMCID: PMC9112637 DOI: 10.1186/s12913-022-07855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals' organisational and management strategies in primary care settings during the COVID-19 pandemic. DESIGN Qualitative, exploratory study based on the analysis of participants' accounts within a hermeneutic phenomenologicaly approach. METHODS Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years' experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: "liquid" healthcare and "the best healthcare system in the world". During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers' perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. CONCLUSION Primary care workers' professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. TRIAL REGISTRATION The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Toledo Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - Isaac Aranda Reneo
- Faculty of Social Sciences, University of Castilla -La Mancha, 45600 Talavera de la Reina, Toledo Spain
| | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Toledo Spain
| | | | - Ana Palmar Santos
- Faculty of Medicine, Autonomous University of Madrid, Calle Arzobispo Morcillo n° 4, 28029 Madrid, Spain
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Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, Navarta-Sánchez MV. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:64. [PMID: 35361146 PMCID: PMC8970064 DOI: 10.1186/s12875-022-01674-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Ana María Palmar-Santos
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | | | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Laura Alicia Rubio
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - MVictoria Navarta-Sánchez
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
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Barnett M, Balkissoon C, Sandhu J. The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review. J Am Assoc Nurse Pract 2022; 34:457-464. [PMID: 34678807 DOI: 10.1097/jxx.0000000000000660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is an increasing demand for high-quality primary care providers without adequate supply to meet the need. Nurse practitioners (NPs) are uniquely positioned to fill this demand but influence on regulatory practice authority from concerned groups regarding patient safety and quality of care has delayed this as an effective solution. OBJECTIVES The objective was to address concerns abovt NP-led care by examining evidence regarding patient safety, clinical outcomes, cost, and patient satisfaction that reflect on the ability of NPs to provide high-quality care within the primary care setting and to compare their ability with standard models of care led by physicians. DATA SOURCES A systematic review was completed using PubMed, CINHAL Complete, and Scopus. Using PRISMA guidelines to critique literature and the John's Hopkins Research Evidence Appraisal tool, articles were analyzed comparing the quality of care between NP and physician providers in the primary care setting. CONCLUSIONS A total of 11 articles met the criteria and reveal that NPs provide equal or better quality of care for all outcomes outcomes when compared with their physician colleagues. IMPLICATIONS FOR PRACTICE Quality patient care provided by NPs in the primary care setting is equal to, and in several cases superior to, that of physicians. Concerns for patient safety and quality care outcomes seem unsupported by data, and state legislatures should continue to grant full practice authority. as an effective source of providing high-quality primary health care.
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Affiliation(s)
- Michael Barnett
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
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Dropkin J, Roy A, Szeinuk J, Moline J, Baker R. A primary care team approach to secondary prevention of work-related musculoskeletal disorders: Physical therapy perspectives. Work 2021; 70:1195-1217. [PMID: 34842206 DOI: 10.3233/wor-205139] [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: 11/15/2022] Open
Abstract
BACKGROUND Among work-related conditions in the United States, musculoskeletal disorders (MSDs) account for about thirty-four percent of work absences. Primary care physicians (PCPs) play an essential role in the management of work-related MSDs. For conditions diagnosed as work-related, up to seventeen percent of cases are PCP managed; within these conditions, up to fifty-nine percent are diagnosed as musculoskeletal. Negative factors in treatment success confronting PCPs include time constraints and unfamiliarity with work-related MSDs. A multidimensional team approach to secondary prevention, where PCPs can leverage the expertise of allied health professionals, might provide a useful alternative to current PCP practices for the treatment of work-related MSDs. OBJECTIVE Provide the structure of and rationale for an "extended care team" within primary care for the management of work-related MSDs. METHODS A systematic literature search, combining medical subject headings and keywords, were used to examine eight peer-reviewed literature databases. Gray literature, such as government documents, were also used. RESULTS An extended care team would likely consist of at least nine stakeholders within primary care. Among these stakeholders, advanced practice orthopedic physical therapists can offer particularly focused guidance to PCPs on the evaluation and treatment of work-related MSDs. CONCLUSIONS A multidimensional approach has the potential to accelerate access and improve quality of work-related outcomes, while maintaining patient safety.
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Affiliation(s)
- Jonathan Dropkin
- Occupational Ergonomics, Workforce Safety, Northwell Health, Occupational Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Asha Roy
- Workforce Safety, Northwell Health, Lake Success, NY, USA
| | - Jaime Szeinuk
- Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Jacqueline Moline
- Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Robert Baker
- Rehabilitation Services, Outpatient Physical Therapy, Center for Orthopedics, North Bay Healthcare, Fairfield, CA, USA
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Hughes A, Keys Y, Peck J, Garcia T. Reducing Nurse Practitioner Turnover in Home Based Primary Care: A Department of Veterans Affairs Quality Improvement Project. Home Healthc Now 2021; 39:327-335. [PMID: 34738968 DOI: 10.1097/nhh.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Access to healthcare is challenging for both Veterans and the nation's general population. To keep up with national primary healthcare needs, the Department of Veteran Affairs (VA) implemented Home Based Primary Care (HBPC). After a structure remodel at a Texas VA medical center, 40% of nurse practitioners (NPs) left the HBPC department in one year. The Anticipated Turnover Scale and the Misener NP Job Satisfaction Scale were administered online (n = 7), and results were used to complete a program evaluation. Forty-three percent of participants indicated intent to leave, and 56% of answers indicated job dissatisfaction. Seven categories were identified to mitigate voluntary turnover: Recognition; Shared governance; Orientation; Full practice authority; Collaboration; Organizational workflow maps; and Mentoring. Implementation of recommendations resulting from this project may help retain NPs in both VA and non-VA organizations, reduce organizational costs, support optimal patient outcomes, and increase access to healthcare.
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Schlunegger MC, Aeschlimann S, Palm R, Zumstein-Shaha M. Competencies and scope of practice of nurse practitioners in primary health care: a scoping review protocol. JBI Evid Synth 2021; 19:899-905. [DOI: 10.11124/jbies-20-00554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pany MJ, Chen L, Sheridan B, Huckman RS. Provider Teams Outperform Solo Providers In Managing Chronic Diseases And Could Improve The Value Of Care. Health Aff (Millwood) 2021; 40:435-444. [DOI: 10.1377/hlthaff.2020.01580] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Maximilian J. Pany
- Maximilian J. Pany is an MD-PhD candidate in health policy at Harvard Medical School, in Boston, Massachusetts. Pany and Lucy Chen are co–first authors
| | - Lucy Chen
- Lucy Chen is an MD-PhD candidate in health policy at Harvard Medical School. Chen and Maximilian Pany are co–first authors
| | - Bethany Sheridan
- Bethany Sheridan is a senior manager of the Research and Insights team at athenahealth, Inc., in Watertown, Massachusetts
| | - Robert S. Huckman
- Robert S. Huckman is the Albert J. Weatherhead III Professor of Business Administration and the Unit Head for Technology and Operations Management at Harvard Business School, in Boston, Massachusetts
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Winter SG, Matsuda E, Stephan LM, Chapman SA. Enablers, Barriers, and Contributions of Pediatric Nurse Practitioners to Ambulatory Specialty Care. J Pediatr Health Care 2021; 35:226-230. [PMID: 33518443 DOI: 10.1016/j.pedhc.2020.10.007] [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: 02/20/2020] [Revised: 10/02/2020] [Accepted: 10/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective of this study was to explore the enablers of and barriers to the contribution of nurse practitioners (NPs) in pediatric specialty care. METHOD A total of 11 NPs in pediatric medical specialties were interviewed regarding teamwork, communication, documentation, satisfaction, overall role, and perception of the value they contribute to care. RESULTS Themes were identified related to structural and organizational enablers and barriers that facilitate or hinder the NPs' contribution to pediatric specialty care. DISCUSSION The findings of this study can provide a better understanding of the role of NPs caring for pediatric patients in the specialty setting and can also help guide organizational environments to maximize the potential of pediatric NPs to positively affect patient care.
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Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26. [PMID: 33485091 PMCID: PMC7836752 DOI: 10.1016/j.genhosppsych.2021.01.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. METHOD In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. RESULTS Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. CONCLUSION COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being.
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Affiliation(s)
- Allison A. Norful
- Columbia University School of Nursing, 630 W. 168th Street, Mail Code 6, New York, NY 10032, United States,Corresponding author
| | - Adam Rosenfeld
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, United States.
| | - Krista Schroeder
- Temple University College of Public Health, Jones Hall 526, 3307 N. Broad Street, Philadelphia, PA 19140, United States.
| | - Jasmine L. Travers
- New York University Rory Meyers College of Nursing, 433 1st Ave., New York, NY 10010, United States
| | - Sainfer Aliyu
- MedStar Washington Hospital Center, 110 Irving St., NW, Washington, DC 20010, United States.
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LaMothe J, Hendricks S, Halstead J, Taylor J, Lee E, Pike C, Ofner S. Developing interprofessional collaborative practice competencies in rural primary health care teams. Nurs Outlook 2020; 69:447-457. [PMID: 33386146 DOI: 10.1016/j.outlook.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. PURPOSE Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. METHODS The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. FINDINGS Significant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. DISCUSSION Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.
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Affiliation(s)
- Julie LaMothe
- Indiana University School of Nursing, Indianapolis, IN.
| | | | - Judith Halstead
- Indiana University School of Nursing, Indianapolis, IN; National League for Nursing Commission for Nursing Education Accreditation, Washington, DC
| | | | | | | | - Susan Ofner
- Indiana University Department of Biostatistics, Indianapolis, IN
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State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State. Nurs Outlook 2020; 69:74-83. [PMID: 33268102 DOI: 10.1016/j.outlook.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In January of 2015, New York (NY) implemented a new policy, Nurse Practitioners Modernization Act, which removed the required written practice agreement between physicians and experienced nurse practitioners (NPs). PURPOSE We examined NP work environment in NY before (2012) and after (2018) the implementation of the new policy. METHODS Cross-sectional survey data on work environments were collected from NPs in NY in 2012 and 2018. Work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire. In 2012, 278 and in 2018, 348 NPs completed the tool. Regression analyses were used to examine the relationship between the study year and work environment. FINDINGS Controlling for individual and organizational characteristics, NPs reported significantly better work environments in 2018. Positive changes were observed both for experienced and less experienced NPs. DISCUSSION Removing state-level policy restrictions on NPs may promote a better work environment within health care organizations.
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Luo Q, Dor A, Pittman P. Optimal staffing in community health centers to improve quality of care. Health Serv Res 2020; 56:112-122. [PMID: 33090467 DOI: 10.1111/1475-6773.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services. DATA SOURCES We linked the Uniform Data System from 2014 to 2016 with Internal Revenue Service nonprofit tax return data. The final database contained 3139 center-year observations from 1178 CHCs. STUDY DESIGN We estimated a system of two generalized linear production functions, with quality of care and volume of services as outputs, using the average percent of diabetic patients with controlled A1C level and hypertensive patients with controlled blood pressure as quality measures. To explore the substitutability and complementarity between staffing categories, we estimated a revenue function. FINDINGS Primary care physicians and advanced practice clinicians achieve similar quality outcomes (3.2 percent and 3.0 percent improvement in chronic condition management per full-time equivalent (FTE), respectively). Advanced practice clinicians generate less revenue per FTE but are generally less costly to employ. CONCLUSION As quality incentives are further integrated into payment systems, CHCs will need to optimize their workforce configuration to improve quality. Given the relative efficiency of advanced practice clinicians in producing quality, further hiring of these professionals is a cost-effective investment for CHCs.
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Affiliation(s)
- Qian Luo
- The Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA
| | - Avi Dor
- Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA.,National Bureau of Economic Research, Cambridge, Massachusetts, USA
| | - Patricia Pittman
- The Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA
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van der Gulden R, Haan NDSD, Greijn CM, Looman N, Tromp F, Dielissen PW. Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study. BMC MEDICAL EDUCATION 2020; 20:290. [PMID: 32883272 PMCID: PMC7469346 DOI: 10.1186/s12909-020-02206-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Effective interprofessional collaboration (IPC) is essential for the delivery of chronic care. Interprofessional education (IPE) can help support IPC skills. This makes IPE interesting for GP practices where chronic care is delivered by GPs together with practice nurses, especially for GP trainees who have to learn to collaborate with practice nurses during their training. The aim of this study is to gain insights in how IPE and IPC occur between GP trainees and practice nurses during the delivery of chronic care in GP training practices. METHODS We conducted a qualitative research using semi structured focus groups and interviews with GP trainees, practice nurses and GP supervisors. All respondents were primed to the subject of IPE as they had followed an interprofessional training on patient-centred communication. The verbatim transcripts of the focus groups and interviews were analysed using thematic analysis. RESULTS Despite the overall positive attitude displayed by respondents towards IPE and IPC, the occurrence of IPE and IPC in GP training practices was limited. Possible explanations for this are impeding factors such as limited knowledge, prejudice, lack of role models and a hierarchical organisational structure. Contributing to IPE and IPC use was the integration of IPE in daily practice, e.g. via recurring scheduled meetings. CONCLUSION We found a limited occurrence of IPE and IPC in GP training practices. Our results show a discrepancy between respondents enthusiasm for IPE and IPC and their actual behaviour. IPE activities have to be initiated in GP training practices, otherwise, despite good intentions, IPE and IPC will be ineffective.
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Affiliation(s)
- R van der Gulden
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - N D Scherpbier-de Haan
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - C M Greijn
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - N Looman
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - F Tromp
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - P W Dielissen
- Department of Primary and Community care, Radboud university medical centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Huang N, Raji M, Lin YL, Chou LN, Kuo YF. Nurse Practitioner Involvement in Medicare Accountable Care Organizations: Association With Quality of Care. Am J Med Qual 2020; 36:171-179. [PMID: 32715726 DOI: 10.1177/1062860620935199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective was to examine trend and care quality outcomes associated with nurse practitioner (NP) involvement in Accountable Care Organizations (ACOs) via a cross-sectional study of 521 Medicare Shared Savings Program ACOs during 2014 to 2016. Data include ACO provider/beneficiary files, Medicare claims, and ACO performance data with a focus on Medicare beneficiaries with diabetes, chronic obstructive pulmonary disease, or heart failure. ACO care quality measures were stratified by NP involvement and adjusted for patient, provider, and ACO factors. NP involvement was highest in larger ACOs, states that allow NPs full scope of practice, and rural areas. Greater involvement was associated with fewer readmissions and higher scores on measures of preventive care but not chronic disease and medication management. Greater NP involvement in ACOs was associated with improvement in some care quality measures. With NPs' increasing involvement in ACOs, more research is needed to understand the NP role in processes and outcomes of care.
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Affiliation(s)
- Nicole Huang
- University of Texas Medical Branch, Galveston, TX
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Torrens C, Campbell P, Hoskins G, Strachan H, Wells M, Cunningham M, Bottone H, Polson R, Maxwell M. Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. Int J Nurs Stud 2020; 104:103443. [DOI: 10.1016/j.ijnurstu.2019.103443] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
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Côté N, Freeman A, Jean E, Denis JL. New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning. BMC Health Serv Res 2019; 19:882. [PMID: 31752860 PMCID: PMC6873448 DOI: 10.1186/s12913-019-4731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada). METHODS We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017. RESULTS Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity). CONCLUSION Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.
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Affiliation(s)
- Nancy Côté
- Faculty of Social Sciences, Université Laval, Quebec City, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
| | - Andrew Freeman
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Emmanuelle Jean
- Department of Nursing Sciences, Université du Québec à Rimouski, Rimouski, Canada
| | - Jean-Louis Denis
- Département de gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, Canada
- Chaire de recherche du Canada sur la transformation, le design et l’amélioration des systèmes de santé, Montréal, Canada
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The Impact of Health Human Resources Policies in Primary Care Nursing: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193653. [PMID: 31569426 PMCID: PMC6801516 DOI: 10.3390/ijerph16193653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Organizational culture plays a key role regarding organizational outcomes and determining strategies, goals, and modes of operating which is associated with higher rates of worker morale, turnover and lower adverse events related to patient quality of care issues. AIM to describe the impact of the relocation of nurses from hospitals and other contexts to primary care from the perspective of primary care nurses. METHODS A qualitative, focused ethnographic study. Site: Cantabro Health Service, Cantabria, Spain. Purposeful sampling methods were used to include nurses who were working in primary care during the study, and who had previous experience of at least one year in primary care. Observation (385 hours, 7 months) and in-depth interviews (17) were used to collect data. A thematic analysis was applied. RESULTS Four themes emerged from the data: a) staff policies applied, b) beliefs regarding the newly incorporated nursing staff, c) reasons for relocation to primary care, and d) concern for the future. CONCLUSIONS In primary care, the relocation of non-qualified nursing professionals who are at the end of their career may have a negative impact on the organizational culture. It is necessary to research the most appropriate measures for guaranteeing a satisfactory work environment based on nurses who are qualified in primary health care settings.
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Guillaumie L, Therrien D, Bujold M, Pelletier J, Bujold L, Lauzier S. Perspectives of Quebec Primary Health Care Nurse Practitioners on Their Role and Challenges in Chronic Disease Management: A Qualitative Study. Can J Nurs Res 2019; 52:317-327. [PMID: 31530000 DOI: 10.1177/0844562119862735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face. PURPOSE The study aimed to describe PHCNPs' perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors. METHODS A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec. RESULTS PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs' practice, and a more flexible legislative framework. CONCLUSIONS The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.
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Affiliation(s)
| | - Dominique Therrien
- Department of Nursing, University of Quebec in Outaouais, Gatineau, Québec, Canada
| | - Mathieu Bujold
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Jérôme Pelletier
- Department of Nursing, University of Quebec at Rimouski, Rimouski, Québec, Canada
| | - Louise Bujold
- Faculty of Nursing, Laval University, Quebec City, Québec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
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Pettersson A, Modin S, Hasson H, Krakau I. Feasibility of referral to a therapist for assessment of psychiatric problems in primary care - an interview study. BMC FAMILY PRACTICE 2019; 20:117. [PMID: 31426751 PMCID: PMC6700983 DOI: 10.1186/s12875-019-1007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
Background Depression and anxiety disorders are common in primary care. Comorbidities are frequent, and the diagnoses can be difficult. The Mini-International Neuropsychiatric Interview (MINI) can be a support in the clinical examination of patients with complex problems. However, for family practitioners (FPs), time and perceptions about structured interviews can be barriers to the MINI. An inter-professional teamwork process where FPs refer a patient to a therapist for a MINI assessment represents one way in which to address the problem. The results are fed back to the FPs for diagnosis and treatment decisions. The purposes of this study were to explore if the process was feasible for FPs, patients and therapists in Swedish primary care, and to identify factors influencing the process, using the COM-B model. Methods FPs at two primary care centers (PHCC) in Stockholm were offered the opportunity to refer patients to in-house therapists. Semi-structured interviews or focus groups were conducted with 22 patients, 17 FPs and three therapists to capture their experiences and perceptions. Inductive content analysis for each group of participants was followed by triangulation across groups. Finally, the categories obtained were fitted to the components in the COM-B. Results Therapists at both PHCCs conducted the MINI. The intended process was adopted at one PHCC. At the second PHCC, the responsibilities for the diagnosis and treatment of patients referred were transferred to the therapist. The patients were satisfied, as they appreciated multi-professional examinations. The FPs’ competence in psychiatry, actual access to therapists, beliefs that the referrals saved the FPs time and effort, and established habits influenced whether patients were referred. Existing routines and professional expectations for work content influenced the degree of cooperation between the therapists and the FPs. Conclusions An inter-professional diagnostic process where FPs refer patients to a therapist for assessment and the results are fed back to the FPs can be feasible. Feasibility depends on access to a therapist, the perceptions of roles and competences among FPs and therapists, and strategies for supporting teamwork. Electronic supplementary material The online version of this article (10.1186/s12875-019-1007-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agneta Pettersson
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden. .,Swedish Agency for Health Technology Assessment and Social Assessment, SE-102 33, Stockholm, Sweden.
| | - Sonja Modin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23 D2, SE-141 83, Huddinge, Sweden
| | - Henna Hasson
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Ingvar Krakau
- Department of Medicine Solna, Karolinska Institutet, Clinical Epidemiology Unit T2, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
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Cimiotti JP, Li Y, Sloane DM, Barnes H, Brom HM, Aiken LH. Regulation of the Nurse Practitioner Workforce: Implications for Care Across Settings. JOURNAL OF NURSING REGULATION 2019; 10:31-37. [PMID: 33833902 DOI: 10.1016/s2155-8256(19)30113-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction The current shortage of physicians in the United States has potential to dramatically limit access to healthcare. Nurse practitioners (NPs) can provide a cost-effective solution to the shortage, yet few states allow NPs to practice independently. Purpose The purpose of this study was to provide an up-to-date description of the NP workforce and to identify the professional and organizational factors associated with NP care quality. Methods Cross-sectional survey data from a sample of NPs actively employed in four states with reduced or restricted practice (California, Florida, New Jersey, and Pennsylvania) was used. NPs were categorized into acute and primary care. Regression models were fit to estimate the odds of three measures of care quality: overall quality of patient care, NP confidence that patients and their caregivers can manage their care at home, and whether NPs would recommend their practice facility to family and friends. Results Receiving support from administrative staff and physicians was associated with an increase in the three measures of quality. The greatest effects were seen in primary care settings. Conclusion It is imperative that legislators and healthcare administrators implement policies that provide NPs with an environment that supports clinical practice and enhances care delivery.
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Affiliation(s)
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Nurse Practitioner Practice Environments in Primary Care and Quality of Care for Chronic Diseases. Med Care 2019; 56:791-797. [PMID: 30015724 DOI: 10.1097/mlr.0000000000000961] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The chronic disease burden in the United States represents a significant challenge for the primary care system. The nurse practitioner (NP) workforce can help meet the demand for care; however, organizational barriers such as poor practice environments prevent NPs from delivering high quality care. OBJECTIVES We investigated the relationship between NP practice environments and quality of care for chronic diseases. RESEARCH DESIGN We fit regression models to assess cross-sectional associations between claims-based quality measure performance and survey data on NP practice environments in Massachusetts. SUBJECTS We used survey data from 221 primary care NPs from 118 practices. We obtained quality of care data for patients with asthma, diabetes, and cardiovascular disease. MEASURES The Nurse Practitioner Primary Care Organizational Climate Questionnaire was used to measure practice environments with its following 4 subscales: NP-Physician Relations, Independent Practice and Support, Professional Visibility, and NP-Administration Relations. Three Healthcare Effectiveness Data and Information Set measures were used to evaluate the quality of care. RESULTS A 1-SD increase in the organizational-level NP-Administration Relations subscale score was associated with a near doubling of the odds of receiving medication management for asthma. A 1-SD increase in the organizational-level Independent Practice and Support subscale score was associated with a 60% increase in the odds of receiving recommended screening for cardiovascular disease. There was no impact on diabetes care measure. CONCLUSIONS NP practice environment affected the quality of care for 2 chronic conditions. Efforts should be implemented to improve NP practice environment to potentially improve care quality.
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Yakuwa MS, Neill S, Mello DFD. Nursing strategies for child health surveillance. Rev Lat Am Enfermagem 2018; 26:e3007. [PMID: 30020338 PMCID: PMC6053288 DOI: 10.1590/1518-8345.2434.3007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/12/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to appreciate the strategies promoted by nurses in the context of child health surveillance relevant to early childhood development. METHOD this is a qualitative study with an inductive thematic analysis of the data, based on the conceptual principles of child health surveillance, and developed through semi-structured interviews with Brazilian nurses working with families in primary health care. RESULTS the nurses' strategies in favor of child health surveillance focus on actions that anticipate harm with continuous follow-up and monitoring of health indicators. The process of child growth and development is the basis for responses and benefits to health, connection with the daily lives of families, active search, articulations between professionals and services, access to comprehensive care, and intrinsic actions between promotion, prevention and health follow-up. CONCLUSION child health surveillance actions developed by nurses with families involve knowledge sharing, favor the resolution of problems, increase child health indicators, and strengthen the relationship between health and children's rights, which support the promotion of development in early childhood.
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Affiliation(s)
- Marina Sayuri Yakuwa
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Scholarship holder at Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Sarah Neill
- PhD, Associate Professor, Faculty of Health and Society, University of Northampton, Northampton, England
| | - Débora Falleiros de Mello
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Norful AA, Dillon JC, Ye S, Poghosyan L. The perspectives of nurse practitioners and physicians on increasing the number of registered nurses in primary care. NURSING ECONOMIC$ 2018; 36:182-188. [PMID: 34083867 PMCID: PMC8172063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Primary care providers, including physicians and nurse practitioners, described the importance of increased RN staffing in primary care. Adequate RN staffing improves the quality and safety of patient care, alleviates provider workload, and increases care continuity in primary care practices.
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Affiliation(s)
- Allison A Norful
- Columbia University School of Nursing, Columbia University Medical Center Irving Institute for Clinical and Translational Research, 630 West 168 Street-Mail Code 6, New York, NY 10032
| | | | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Director, Cardiology Inpatient Consultation Service, Associate CMO, ColumbiaDoctors, Columbia University Medical Center
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Auerbach DI, Staiger DO, Buerhaus PI. Growing Ranks of Advanced Practice Clinicians - Implications for the Physician Workforce. N Engl J Med 2018; 378:2358-2360. [PMID: 29924944 DOI: 10.1056/nejmp1801869] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David I Auerbach
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
| | - Douglas O Staiger
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
| | - Peter I Buerhaus
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
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Organizational structures and outcomes of newly hired and experienced nurse practitioners in New York State. Nurs Outlook 2017; 65:607-614. [DOI: 10.1016/j.outlook.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/27/2017] [Accepted: 03/05/2017] [Indexed: 11/16/2022]
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