Nursing in primary care

2020 ◽  
pp. 35-66
Keyword(s):  
Primary Care ◽  
Leadership Development ◽  
Clinical Supervision ◽  
Nurse Practitioners ◽  
Community Care ◽  
Continuing Professional Development ◽  
Project Planning ◽  
School Nursing ◽  
Practice Research ◽  
Nursing Health

This chapter begins by outlining the different roles that nurses can occupy in primary and community care. It provides information on learning to work in primary and community care, the focus and responsibilities of general practice nursing (including advanced nurse practitioners), school nursing, health visiting, and district nursing. It covers clinical supervision and appraisal, continuing professional development, and facilitating nursing in practice. Research ethics and research governance in primary care and community nursing is discussed, alongside teamwork and leadership development, and innovation and project planning. Finally, it considers information for changing and informing practice.

scholarly journals In-hours acute home visits by advanced nurse practitioners in primary care: a qualitative study

2021 ◽  
Vol 30 (13) ◽  
pp. 788-792
Author(s):  
Alison Wells ◽  
Edward Tolhurst
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Nurse Practitioners ◽  
Role Ambiguity ◽  
Qualitative Data ◽  
Home Visits ◽  
Holistic Care ◽  
Structured Interviews ◽  
Home Setting ◽  
The Uk

Background: The extension of roles within the primary care team is one approach recommended to address the shortage of GPs in the UK. A key aspect of care that advanced nurse practitioners (ANPs) can undertake is acute home visits. Aim: To evaluate the perspectives of ANPs performing acute in-hours home visits in primary care. Methods: Qualitative data were gathered in eight semi-structured interviews across a primary care locality, then analysed via a process of thematic analysis. Findings: Three key themes were identified: providing holistic care; engaging with the home setting; and negotiating role ambiguity. Conclusion: Practices wishing to involve ANPs in acute home visits should ensure clear definition and good understanding of the ANP role. Effective interprofessional relationships should be fostered with appropriate mentorship and clinical supervision to support ANPs in optimising their contribution to acute home visits.

scholarly journals Nurse practitioners in Swiss family practices as potentially autonomous providers of home visits: an exploratory study

2019 ◽  
Author(s):  
Stefan Gysin ◽  
Iren Bischofberger ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Work Experience ◽  
Home Visits ◽  
Postgraduate Education ◽  
Coding System ◽  
Family Practices ◽  
Swiss Primary Care

Abstract Background Swiss primary care is challenged by impending shortages of general practitioners (GPs) in rural areas and decreasing number of GP home visits. In Anglo-Saxon and many other countries, nurse practitioners (NPs) have been implemented and provide high quality, patient-centred home visits autonomously. In Switzerland, the NP role is new and there are currently only a handful of ongoing pilot projects in family practices. Hence, studies are lacking and data collection is challenging as NPs are not yet registered providers who could be identified in billing or health insurance data. Our aims were to gain insights in the frequency of home visits by NPs in Swiss family practices, and to determine their autonomy based on the required level of GP supervision during consultations.Methods We used consultation data from two pilot practices in rural Switzerland. In “Practice A”, the NP was in postgraduate education and data was gathered electronically between August 2017 and 2018. In “Practice B”, the NP had completed her education, and had two years of work experience as a NP when data was collected manually between April and June 2018. We used a coding system based on five levels of GP supervision to identify NP consultations and home visits, and to determine the NPs’ autonomy in each consultation.Results We analysed data from 1375 consultations. The share of home visits in all NP consultations was 17% in Practice A and 51% in Practice B. Both NPs had a higher share of autonomously conducted consultations during home visits than in the office. In Practice A, the proportion of consultations in which the NP was autonomous increased from 0% in the first month of her employment to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of her consultations.Conclusions After completing postgraduate education with clinical supervision by GPs, and few years of practical experience in their role, NPs can reach a relatively high degree of autonomy and might pose a potential solution to the decreasing numbers of GP home visits in Swiss primary care.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Benefits and Characteristics of Mentoring Students and Young Professionals

2008 ◽  
Vol 18 (2) ◽  
pp. 67-73 ◽  
Author(s):  
Kristal Mills
Keyword(s):  
Leadership Development ◽  
Clinical Supervision ◽  
Effective Means ◽  
Academic Research ◽  
Mentoring Programs ◽  
Teaching Skills ◽  
Online Mentoring ◽  
Young Professionals ◽  
Research And Teaching ◽  
Workplace Retention

Abstract Mentoring has long been believed to be an effective means of developing students' clinical, research, and teaching skills to become competent professionals. The American Speech-Language-Hearing Association (ASHA) has developed two online mentoring programs, Student to Empowered Professional (S.T.E.P. 1:1) and Mentoring Academic Research Careers (MARC), to aid in the development of students. This paper provides a review of the literature on mentoring and compares and contrasts mentoring/mentors with clinical supervision/preceptors. Characteristics of effective mentors and mentees are offered. Additionally, the benefits of clinical mentoring such as, teambuilding in the workplace, retention of new staff, leadership development, and improved job satisfaction are discussed.

Preliminary results from the COPE study using primary-care electronic health records and environmental modelling to examine COPD exacerbations

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696749 ◽  
Author(s):  
Maimoona Hashmi ◽  
Mark Wright ◽  
Kirin Sultana ◽  
Benjamin Barratt ◽  
Lia Chatzidiakou ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Health Management ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Preliminary Results ◽  
Copd Exacerbations ◽  
Electronic Health

BackgroundChronic Obstructive Airway Disease (COPD) is marked by often severely debilitating exacerbations. Efficient patient-centric research approaches are needed to better inform health management primary-care.AimThe ‘COPE study’ aims to develop a method of predicting COPD exacerbations utilising personal air quality sensors, environmental exposure modelling and electronic health records through the recruitment of patients from consenting GPs contributing to the Clinical Practice Research Datalink (CPRD).MethodThe study made use of Electronic Healthcare Records (EHR) from CPRD, an anonymised GP records database to screen and locate patients within GP practices in Central London. Personal air monitors were used to capture data on individual activities and environmental exposures. Output from the monitors were then linked with the EHR data to obtain information on COPD management, severity, comorbidities and exacerbations. Symptom changes not equating to full exacerbations were captured on diary cards. Linear regression was used to investigate the relationship between subject peak flow, symptoms, exacerbation events and exposure data.ResultsPreliminary results on the first 80 patients who have completed the study indicate variable susceptibility to environmental stressors in COPD patients. Some individuals appear highly susceptible to environmental stress and others appear to have unrelated triggers.ConclusionRecruiting patients through EHR for a study is feasible and allows easy collection of data for long term follow up. Portable environmental sensors could now be used to develop personalised models to predict risk of COPD exacerbations in susceptible individuals. Identification of direct links between participant health and activities would allow improved health management thus cost savings.

scholarly journals Primary Care Practice Environment and Burnout Among Nurse Practitioners

2021 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Allison A. Norful ◽  
Affan Ghaffari ◽  
Jianfang Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Practice ◽  
Care Practice ◽  
Practice Environment

scholarly journals Evaluation of an unscheduled care model delivered by advanced nurse practitioners in a primary-care setting

2019 ◽  
Vol 24 (8) ◽  
pp. 696-709
Author(s):  
Calum F Leask ◽  
Heather Tennant
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Home Visits ◽  
Rejection Rate ◽  
Service Level ◽  
Average Score ◽  
Unscheduled Care ◽  
Viable Solution

Background Considering new models of delivery may help reduce increasing pressures on primary care. One potentially viable solution is utilising Advanced Practitioners to deliver unscheduled afternoon visits otherwise undertaken by a General Practitioner (GP). Aims Evaluate the feasibility of utilising an Advanced Nurse Practitioner (ANP) to deliver unscheduled home visits on behalf of GPs in a primary care setting. Methods Following a telephone request from patients, ANPs conducted unscheduled home visits on behalf of GPs over a six-month period. Service-level data collected included patient-facing time and outcome of visits. Practice staff and ANPs participated in mind-mapping sessions to explore perceptions of the service. Results There were 239 accepted referrals (total visiting time 106.55 hours). The most common outcomes for visits were ‘medication and worsening statement given’ (107 cases) and ‘self-care advice’ (47 cases). GPs were very satisfied with the service (average score 90%), reporting reductions in stress and capacity improvements. Given the low referral rejection rate, ANPs discussed the potential to increase the number of practices able to access this model, in addition to the possibility of utilising other practitioners (such as paramedics or physiotherapists) to deliver the same service. Conclusions It appears delivering unscheduled care provision using an ANP is feasible and acceptable to GPs.

scholarly journals Inter-professional education and primary care: EFPC position paper

2019 ◽  
Vol 20 ◽  
Author(s):  
Robin Miller ◽  
Nynke Scherpbier ◽  
Loes van Amsterdam ◽  
Virgínia Guedes ◽  
Peter Pype
Keyword(s):  
Primary Care ◽  
Professional Education ◽  
Good Practice ◽  
Continuing Professional Development ◽  
Position Paper ◽  
Successful Implementation ◽  
Ability To Work ◽  
Design And Implementation ◽  
European Forum ◽  
Evidence Review

Abstract Inter-professional education (IPE) can support professionals in developing their ability to work collaboratively. This position paper from the European Forum for Primary Care considers the design and implementation of IPE within primary care. This paper is based on workshops and is an evidence review of good practice. Enablers of IPE programmes are involving patients in the design and delivery, providing a holistic focus, focussing on practical actions, deploying multi-modal learning formats and activities, including more than two professions, evaluating formative and summative aspects, and encouraging team-based working. Guidance for the successful implementation of IPE is set out with examples from qualifying and continuing professional development programmes.

A Meta-Analysis of Nurse Practitioners and Nurse Midwives in Primary Care

1995 ◽  
Vol 44 (6) ◽  
pp. 332???339 ◽  
Author(s):  
SHARON A. BROWN ◽  
DEANNA E. GRIMES
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Meta Analysis ◽  
Nurse Midwives
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