scholarly journals Seeing patients first: creating an opportunity for practice nurse care?

2010 ◽  
Vol 2 (2) ◽  
pp. 136 ◽  
Author(s):  
Tim Kenealy ◽  
Barbara Docherty ◽  
Nicolette Sheridan ◽  
Ryan Gao
Keyword(s):  
New Zealand ◽  
General Practitioner ◽  
Postal Survey ◽  
Working Environment ◽  
Work Organisation ◽  
Practice Nurses ◽  
Telephone Interviews ◽  
General Practices ◽  
Nursing Roles ◽  
Activity Method

INTRODUCTION: Practice nurses see patients in both a planned (i.e. scheduled appointment) and an unplanned (i.e. opportunistic) manner. This study aimed to investigate how often and why New Zealand practice nurses see patients prior to the general practitioner and whether they organise their care to support unplanned, opportunistic activity. METHOD: National postal survey from a random sample of 500 general practices, requesting a response from one nurse per practice. Semi-structured telephone interviews with a purposeful sample of respondents. FINDINGS: Responses came from 225 nurses (51% of practices confirmed to be eligible). Nearly all (92%) said their work role was the same as that of others in their practice. Only 13% of nurses routinely saw patients prior to the doctor, while 24% would choose to do so it they could, and 65% thought it important. Positive and negative aspects of seeing patients first are presented. Constraints included time, their role assisting practice workflow and perceptions of patient expectations. Few organised their work to create opportunities for lifestyle interventions. CONCLUSION: The current working environment of practice nurses in New Zealand does not readily support them routinely seeing patients before the general practitioner. We suggest this is a lost opportunity for patient-centred preventive care. KEYWORDS: Practice nursing roles; opportunistic interventions; work organisation; primary health care; chronic conditions

Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England

1998 ◽  
Vol 3 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Susan Kerrison ◽  
Roslyn Corney
Keyword(s):  
General Practitioner ◽  
Postal Survey ◽  
Medical Specialist ◽  
Private Provision ◽  
Private Practitioners ◽  
General Practices ◽  
Outreach Clinic ◽  
Set Up ◽  
Second Wave ◽  
Relative Quality

Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.

scholarly journals The Nursing Presence in General Practice: Revealing Dimensions of Day-to-day Experience of Practice Nurses in New Zealand

2021 ◽  
Author(s):  
◽  
Katrina Fyers
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Models Of Care ◽  
Complex Nature ◽  
Practice Nurses ◽  
Nursing Leaders ◽  
Primary Health ◽  
General Practices

<p>This study makes visible and gives value to the day-to-day experience of practice nurses who work in New Zealand general practices. Nursing leaders internationally and locally have highlighted the importance of the Primary Health Care nurse to improving health outcomes, addressing inequalities and implementing new models of care. As one of the largest groups of Primary Health Care nurses, practice nurses have a significant part to play. There is however, no consensus and limited research related to the day-to-day experience of practice nurses. Therefore, the nature, extent, and contribution of nursing in general practice may be overlooked or misunderstood. Furthermore as an autonomous self-regulating profession, nursing has a responsibility to the public to provide understanding of nursing in the present and in the future, particularly when this relates to the care of families and the structure of health systems. Located within the qualitative research paradigm and utilising a narrative inquiry methodology, this study applies a 'supportive voice' to highlight the experience of five practice nurses, and in the process makes visible the dimensions of nursing work in New Zealand general practices. The five constructed narratives particularly draw attention to the complex nature of nursing work that practice nurses engage in daily, the importance of nurse-patient relationships and continuity of care and the significance of autonomous and specialty aspects of nursing practice. Ultimately, the value of the practice nurse in the day-to-day operation of general practice is brought to the fore.</p>

scholarly journals The Nursing Presence in General Practice: Revealing Dimensions of Day-to-day Experience of Practice Nurses in New Zealand

2021 ◽  
Author(s):  
◽  
Katrina Fyers
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Models Of Care ◽  
Complex Nature ◽  
Practice Nurses ◽  
Nursing Leaders ◽  
Primary Health ◽  
General Practices

<p>This study makes visible and gives value to the day-to-day experience of practice nurses who work in New Zealand general practices. Nursing leaders internationally and locally have highlighted the importance of the Primary Health Care nurse to improving health outcomes, addressing inequalities and implementing new models of care. As one of the largest groups of Primary Health Care nurses, practice nurses have a significant part to play. There is however, no consensus and limited research related to the day-to-day experience of practice nurses. Therefore, the nature, extent, and contribution of nursing in general practice may be overlooked or misunderstood. Furthermore as an autonomous self-regulating profession, nursing has a responsibility to the public to provide understanding of nursing in the present and in the future, particularly when this relates to the care of families and the structure of health systems. Located within the qualitative research paradigm and utilising a narrative inquiry methodology, this study applies a 'supportive voice' to highlight the experience of five practice nurses, and in the process makes visible the dimensions of nursing work in New Zealand general practices. The five constructed narratives particularly draw attention to the complex nature of nursing work that practice nurses engage in daily, the importance of nurse-patient relationships and continuity of care and the significance of autonomous and specialty aspects of nursing practice. Ultimately, the value of the practice nurse in the day-to-day operation of general practice is brought to the fore.</p>

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals Negotiating Gender and Police Culture: Exploring the Barriers to Retention and Progression of Female Police Officers in New Zealand

2021 ◽  
Author(s):  
◽  
Shannon M. Chan
Keyword(s):  
New Zealand ◽  
Predominantly White ◽  
Police Officers ◽  
Working Environment ◽  
Police Culture ◽  
Women Officers ◽  
Face To Face ◽  
New Rhetoric ◽  
Women's Narratives ◽  
Female Police Officers

<p>Women officers represent a minority within the New Zealand Police (Police) particularly within the senior ranks. In recent years, Police have made concerted efforts to increase women’s representation as well as improve the working environment. However, recent reviews of the 2007 Commission of Inquiry into Police Conduct have reported that women continue to face barriers to full integration and furthermore, that the changes to the police culture have reached a plateau. New Zealand and international research have established that police culture continues to pose a barrier to women’s full acceptance within policing. This culture is characterised by predominantly white, heterosexual males, who form what has been described as a “cult of masculinity”. Therefore, women find they must adopt the culture in order to “fit in” and be accepted as “one of the boys”.  Adopting a qualitative framework, this research involved semi-structured face-to-face interviews with sworn female police officers. Exploring female police officers’ experiences identified five pertinent barriers to women’s retention and progression. These were the emphasis on physical skills and excitement, the police camaraderie and the cult of masculinity, sexual harassment within the workplace, women’s minority status, and balancing motherhood with policing. It was found that the persistence of these barriers came back to core features of police culture. Due to the strong allegiance to the positive aspects of the police culture, such as the camaraderie, negative features such as sexual banter and harassment were subsumed within the wider culture. Negative features were tolerated and accepted as part and parcel of working in the Police. Women’s narratives demonstrated that they adhered to core police culture features and thus contributed to the sustenance of the culture. Furthermore, how women articulated their experiences and perceptions of barriers was complex and nuanced. Many held the belief that there were no longer any barriers for women in the Police, yet such positive views were in contradiction with their own experiences. The tension between “perceptions” and “reality” creates a situation where the Police currently sit at a crossroads between the “old” culture and the new rhetoric of “change”.</p>

scholarly journals Potentials and current shortcomings in the cooperation between German centers for rare diseases and primary care physicians: results from the project TRANSLATE-NAMSE

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
D. Druschke ◽  
F. Krause ◽  
G. Müller ◽  
J. Scharfe ◽  
G. F. Hoffmann ◽  
...  
Keyword(s):  
Primary Care ◽  
Rare Disease ◽  
Rare Diseases ◽  
Primary Care Physicians ◽  
Postal Survey ◽  
National Plan ◽  
Major Step ◽  
Interface Management ◽  
Telephone Interviews ◽  
Center For Rare Diseases

Abstract Background The TRANSLATE-NAMSE project with the strengthening of the centers for rare diseases with their affiliation to the European Reference Networks was a major step towards the implementation of the German National Plan of Action for People with Rare Diseases establishing better care structures. As primary care physicians, general practitioners and pediatricians play a central role in the diagnosis of patients with rare disease, as it is usually them referring to specialists and rare disease centers. Therefore, the interface management between primary care physicians and the centers for rare diseases is of particular importance. Methods In a mixed-method-approach an anonymous postal survey of 1,500 randomly selected primary care physicians in Germany was conducted with focus on (1) knowledge about a center for rare diseases and how it works, (2) in case of cooperation, satisfaction with the services provided by centers, and (3) expectations and needs they have with regard to the centers. In addition, in-depth telephone interviews were conducted with physicians who had already referred patients to a center. Results In total, 248 physicians responded to the survey, and 15 primary care physicians were interviewed. We observed a wide lack of knowledge about the existence of (45.6% confirmed to know at least one center) about how to access rare disease centers (50.4% of those who know a center confirmed knowledge) and what the center specializes in. In case of cooperation the evaluation was mostly positive. Conclusion To improve medical care, the interplay between primary care physicians and rare disease centers needs to be strengthened. (1) To improve the communication, the objectives and functioning of the rare disease centers should become more visible. (2) Other projects dealing with the analysis and improvement of interface management between centers and primary care physicians, as described in the National Plan of Action for People with Rare Diseases, need to be implemented immediately. (3) If the project is evaluated positively, the structures of TRANSLATE-NAMSE should be introduced nationwide into the German health care system to ensure comprehensive, quality-assured care for people with rare diseases with special consideration of the key role of primary care physicians—also taking into account the financial expenditures of this new care model.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

2013 ◽  
Vol 19 (2) ◽  
pp. 150 ◽  
Author(s):  
Diann S. Eley ◽  
Elizabeth Patterson ◽  
Jacqui Young ◽  
Paul P. Fahey ◽  
Chris B. Del Mar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Models Of Care ◽  
Practice Nurses ◽  
Australian General Practice ◽  
General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

scholarly journals A taboo topic? How General Practitioners talk about overweight and obesity in New Zealand

2018 ◽  
Vol 10 (2) ◽  
pp. 150 ◽  
Author(s):  
Lesley Gray ◽  
Maria Stubbe ◽  
Lindsay Macdonald ◽  
Rachel Tester ◽  
Jo Hilder ◽  
...  
Keyword(s):  
New Zealand ◽  
Weight Management ◽  
General Practitioners ◽  
Health Professionals ◽  
Secondary Analysis ◽  
Overweight And Obesity ◽  
Full Potential ◽  
Naturally Occurring ◽  
Interactional Analysis ◽  
General Practices

ABSTRACT INTRODUCTION Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients. However, research shows consistently low rates of weight management discussion, suggesting that health professionals may not be realising their full potential to address obesity. AIM To identify communication strategies used by General Practitioners (GPs) to open the topic of weight and weight management in routine consultations. METHODS A secondary analysis was conducted of 36 video-recorded consultations in general practices, selected for relevance from a database of 205 consultations. Content and interactional analysis was conducted in the context of the entire consultation. RESULTS The topic of weight was initiated more often by GPs than patients and was raised mostly once or twice in a consultation and occasionally as many as six times. GPs employed opportunistic strategies twice as often as they used structured strategies. DISCUSSION This study of naturally occurring consultations confirmed GPs do engage in opportunistic discussions about weight. However, such discussions are challenging and interactionally delicate. Highlighting the clinical relevance of weight appears to be effective. The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight. Further research is required to identify suitable training and brief intervention tools for use in routine consultations that may be beneficial for both GPs and patients.

scholarly journals Educational needs of practice nurses in mental health

2011 ◽  
Vol 3 (2) ◽  
pp. 142 ◽  
Author(s):  
Anne Prince ◽  
Katherine Nelson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Assessment ◽  
Behavioural Therapy ◽  
Postal Survey ◽  
Health Concern ◽  
Health Concerns ◽  
Practice Nurses ◽  
Mental Health Concern ◽  
Mental Health Concerns

INTRODUCTION: Large numbers of patients see practice nurses (PNs) daily for their health care. Many of these patients will have a mental health need. International research suggests that practice nurses are undertaking mental health assessment and interventions without the requisite skills and knowledge. AIM: To describe the needs of PNs in mental health education and to explore any involvement with patients with mental health concerns. METHODS: Postal survey of PNs in Hawkes Bay and Tairawhiti regions. Analysis was by descriptive, correlation and inferential statistics and content analysis for open questions. RESULTS: Fifty-two respondents completed the survey (response rate 36%) and the results demonstrate that these PNs are caring for patients with an extensive range of mental health concerns daily. Most common are people with depression and anxiety. The nurses perform a variety of mental health interventions such as counselling and advice on medication and have minimal confidence in their skill level. Their expressed learning needs included education on many mental health conditions including suicidal ideation, all types of depression and bipolar disorder, and of therapies such as cognitive behavioural therapy and family therapy. DISCUSSION: PNs require education and support specifically designed to meet their identified needs in mental health to help improve care to patients. This will require collaboration between secondary mental health services, primary mental health nurses and tertiary institutions. With targeted education these nurses should become more confident and competent in their dealings with people who present to their practice with a mental health concern. KEYWORDS: Education; mental health; practice nurse; survey; primary health care

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