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Braithwaite S, Tranmer J, Wilson R, Almost J, Tregunno D. Measuring Scope of Practice Enactment Among Primary Care Registered Nurses. Can J Nurs Res 2021; 54:508-517. [PMID: 34806439 PMCID: PMC9597129 DOI: 10.1177/08445621211058328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Scope of practice enactment is poorly understood in the primary care
setting. Purpose The following research objectives were addressed: (1) to revise and adapt the
Actual Scope of Practice (ASCOP) questionnaire for use in the primary care
setting, and (2) to determine internal consistency, construct validity, and
sensitivity of the modified instrument. Methods To address the first objective, a narrative literature review and synthesis
and an expert panel review was conducted. To address the second objective, a
cross-sectional survey of 178 registered nurses who worked in primary care
was conducted. Results The ASCOP, with few modifications, addressed key attributes of nursing scope
of practice in the primary care setting. The modified instrument yielded
acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of
4.8 (SD = .67) suggests that registered nurses within interprofessional
primary care teams almost always engage in activities reflected in the
modified instrument. Conclusions The modified instrument is the first instrument validated to measure nursing
scope of practice enactment in the primary care setting. Findings from this
study support the use of the modified ASCOP questionnaire as a reliable and
valid measure of scope of practice enactment among primary care registered
nurses.
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Affiliation(s)
- Suzanne Braithwaite
- School of Nursing, 4257Queen's University.,School of Health Human and Justice Studies, 49998Loyalist College
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Braithwaite S, Lukewich J, Macdonald D, Tranmer J. Influence of organisational attributes on registered nurse contributions to well-child care: a scoping review protocol. BMJ Open 2021; 11:e052634. [PMID: 34548364 PMCID: PMC8458309 DOI: 10.1136/bmjopen-2021-052634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Universal access to preventative healthcare is essential to children's health. Registered nurses (RN) are well positioned to deliver well-child care within primary care settings; however, RN role implementation varies widely in this sector and the scope of literature that examines the influence of organisational attributes on nursing contributions to well-child care is not well understood. The aim of this scoping review is to identify the scope and characteristics of the literature related to organisational attributes that act as barriers to, or facilitators for RN delivery of well-child care within the context of primary care in high-income countries. METHODS AND ANALYSIS The Joanna Briggs Institute scoping review methodology will be used to conduct this review. Databases that will be accessed include Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and Embase. Inclusion criteria includes articles with a focus on RNs who deliver well-child care in primary care settings. Literature that meets this inclusion criteria will be included in the study. Covidence software platform will be used to review citations and full-text articles. Titles, abstracts and full-text articles will be reviewed independently by two reviewers. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. Data will be extracted and organised according to the dimensions outlined in the nursing care organisation conceptual framework (NCOF). Principles of the 'best fit' framework synthesis will guide the data analysis approach and the NCOF will act as the framework for data coding and analysis. ETHICS AND DISSEMINATION This scoping review will undertake a secondary analysis of data already published and does not require ethical approval. Findings will be disseminated via peer-reviewed publications and conference presentations targeting stakeholders involved in nursing practice and the delivery of well-child care. TRIAL REGISTRATION DETAILS Braithwaite, S., Tranmer, J., Lukewich, J., & Macdonald, D. (2021, March 31). Protocol for a Scoping Review of the Influence of Organisational Attributes on Registered Nurse Contributions to Well-child Care. https://doi.org/10.17605/OSF.IO/UZYX5.
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Affiliation(s)
- Suzanne Braithwaite
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health, Human, and Justice Studies, Loyalist College, Belleville, Ontario, Canada
| | - Julia Lukewich
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Nursing, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada
| | | | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Lukewich J, Allard M, Ashley L, Aubrey-Bassler K, Bryant-Lukosius D, Klassen T, Magee T, Martin-Misener R, Mathews M, Poitras ME, Roussel J, Ryan D, Schofield R, Tranmer J, Valaitis R, Wong ST. National Competencies for Registered Nurses in Primary Care: A Delphi Study. West J Nurs Res 2020; 42:1078-1087. [PMID: 32615873 PMCID: PMC7594255 DOI: 10.1177/0193945920935590] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A Delphi (consensus) process was used to obtain national agreement on
competencies for registered nurses (RNs) in primary care. A draft of
competencies was developed by key informants. Following this, nurses with
primary care experience/expertise completed a Delphi survey to rate the
importance of competency statements on a six-point Likert scale. Statements not
reaching consensus (agreement ≥80%) were modified and included in a second
(final) round. The first survey was completed by 63% (n =
86/137) of participants and 84% (n = 72/86) of these
participants completed the second survey. Most statements (n =
45) achieved agreement after the first survey; one statement was dropped and two
were combined following the second round. The final list of competencies
consists of 47 statements across six domains (professionalism; clinical
practice; communication; collaboration and partnership; quality assurance,
evaluation, and research; leadership). National competencies will help
strengthen the RN workforce within primary care, improve team functioning, and
support role integration/optimization.
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Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
| | - Michelle Allard
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Ashley
- Lisa Ashley Consulting, Inc., Ottawa, ON, Canada
| | | | | | | | - Tanya Magee
- Registered Nurse Professional Development Centre, Halifax, NS, Canada
| | | | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Marie-Eve Poitras
- Family Medicine Department/School of Nursing, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Dana Ryan
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
| | - Ruth Schofield
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Lukewich JA, Tranmer JE, Kirkland MC, Walsh AJ. Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review. Nurs Open 2019; 6:685-697. [PMID: 31367390 PMCID: PMC6650680 DOI: 10.1002/nop2.281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023] Open
Abstract
AIMS To inform a discussion for the applicability of using the Nursing Role Effectiveness Model (NREM) in the primary health care setting through a synthesis of the literature that has used the model in all health care sectors. DESIGN Scoping Review. METHODS Articles were considered for inclusion if they discussed any aspect of the NREM in health care research that presented information related to any nursing regulatory designation, such as nurse practitioner (NP), registered nurse (RN), licensed/registered practical nurse (LPN/RPN) and considered both quantitative and qualitative study designs, including expert opinions and reports. RESULTS A total of 22 articles that cited and/or used the NREM were identified in this review. Only two studies were focused in the primary health care setting. There is precedence for the use of the NREM to guide research in primary health care. The NREM should be modified to incorporate the unique characteristics of the primary health care setting.
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Affiliation(s)
- Julia A. Lukewich
- Faculty of NursingMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
| | - Joan E. Tranmer
- School of Nursing and Department of Public Health Sciences, Faculty of Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Megan C. Kirkland
- Faculty of MedicineMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
| | - Anna J. Walsh
- Department of PsychologyMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
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Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey. Prim Health Care Res Dev 2018; 19:622-628. [PMID: 29655397 DOI: 10.1017/s1463423618000257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. METHODS We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.
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Wissow LS, Brown JD, Hilt RJ, Sarvet BD. Evaluating Integrated Mental Health Care Programs for Children and Youth. Child Adolesc Psychiatr Clin N Am 2017; 26:795-814. [PMID: 28916015 DOI: 10.1016/j.chc.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evaluations of integrated care programs share many characteristics of evaluations of other complex health system interventions. However, evaluating integrated care for child and adolescent mental health poses special challenges that stem from the broad range of social, emotional, and developmental problems that need to be addressed; the need to integrate care for other family members; and the lack of evidence-based interventions already adapted for primary care settings. Integrated care programs for children's mental health need to adapt and learn on the fly, so that evaluations may best be viewed through the lens of continuous quality improvement rather than evaluations of fixed programs.
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Affiliation(s)
- Lawrence S Wissow
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, 550 North Broadway, Room 949, Baltimore, MD 21205, USA.
| | - Jonathan D Brown
- Mathematica Policy Research, 1100 1st Street, NE 12th Floor, Washington, DC 20024-2512, USA
| | - Robert J Hilt
- Department of Psychiatry and Behavioral Sciences, University of Washington, M/S CPH, PO Box 5371, Seattle, WA 98105, USA
| | - Barry D Sarvet
- Department of Psychiatry, University of Massachusetts, Medical School at Baystate, 759 Chestnut Street, WG703, Springfield, MA 01199, USA
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Cunningham FC, Ferguson-Hill S, Matthews V, Bailie R. Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study. BMC Health Serv Res 2016; 16:583. [PMID: 27756295 PMCID: PMC5070177 DOI: 10.1186/s12913-016-1810-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/30/2016] [Indexed: 11/28/2022] Open
Abstract
Background Assessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes. The Systems Assessment Tool (SAT) was designed to support Indigenous PHC services in assessing and improving their health care systems. It was based on the Assessment of Chronic Illness Care scale, and on practical experience with applying systems assessments in quality improvement in Indigenous primary health care. We describe the development and application of the SAT, report on a survey to assess the utility of the SAT and review the use of the SAT in other CQI research programs. Methods The mixed methods approach involved a review of documents and internal reports relating to experience with use of the SAT since its development in 2002 and a survey of key informants on their experience with using the SAT. Results The paper drew from documents and internal reports to describe the SAT development and application in primary health care services from 2002 to 2014. Survey feedback highlighted the benefit to the whole primary health care team from participating in the SAT, bringing to light issues that might not emerge with separate individual tool completion. A majority of respondents reported changes in their health centres as a result of using the SAT. Good organisational and management support assisted with ensuring allocation of time and resources for SAT conduct. Respondents identified the importance of having a skilled, external facilitator. Conclusions Originally designed as a measurement tool, the SAT rapidly evolved to become an important development tool, assisting teams in learning about primary health care system functioning, applying best practice and contributing to team strengthening. It is valued by primary health care centres as a lever in implementing improvements to strengthen centre delivery systems, and has potential for further adaptation and wider application in Australia and internationally. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1810-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frances C Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia.
| | - Sue Ferguson-Hill
- National Centre for Quality Improvement in Indigenous Primary Health Care, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia
| | - Veronica Matthews
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Sydney, Australia
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