scholarly journals National Competencies for Registered Nurses in Primary Care: A Delphi Study

2020 ◽  
Vol 42 (12) ◽  
pp. 1078-1087
Author(s):  
Julia Lukewich ◽  
Michelle Allard ◽  
Lisa Ashley ◽  
Kris Aubrey-Bassler ◽  
Denise Bryant-Lukosius ◽  
...  
Keyword(s):  
Primary Care ◽  
Registered Nurses ◽  
Delphi Study ◽  
Delphi Consensus ◽  
Care Experience ◽  
Role Integration ◽  
Partnership Quality ◽  
Research Leadership ◽  
Team Functioning ◽  
Final Round

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.

scholarly journals The development of a faecal incontinence core outcome set: an international Delphi study protocol

2021 ◽  
Vol 36 (3) ◽  
pp. 617-622
Author(s):  
Sadé Assmann ◽  
Daniel Keszthelyi ◽  
Jos Kleijnen ◽  
Merel Kimman ◽  
Foteini Anastasiou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Protocol ◽  
Faecal Incontinence ◽  
Delphi Study ◽  
Evidence Synthesis ◽  
Core Outcome Set ◽  
Core Outcome ◽  
Delphi Consensus ◽  
Link Type ◽  
Outcome Set

Abstract Purpose Faecal incontinence (FI) is estimated to affect around 7.7% of people. There is a lack of uniformity in outcome definitions, measurement and reporting in FI studies. Until now, there is no general consensus on which outcomes should be assessed and reported in FI research. This complicates comparison between studies and evidence synthesis, potentially leading to recommendations not evidence-based enough to guide physicians in selecting an FI therapy. A solution for this lack of uniformity in reporting of outcomes is the development of a Core Outcome Set (COS) for FI. This paper describes the protocol for the development of a European COS for FI. Methods Patient interviews and a systematic review of the literature will be performed to identify patient-, physician- and researcher-oriented outcomes. The outcomes will be categorised using the COMET taxonomy and put forward to a group of patients, physicians (i.e. colorectal surgeons, gastroenterologists and general practitioners) and researchers in a Delphi consensus exercise. This exercise will consist of up to three web-based rounds in which participants will prioritise and condense the list of outcomes, which is expected to result in consensus. A consensus meeting with participants from all stakeholder groups will take place to reach a final agreement on the COS. Discussion This study protocol describes the development of a European COS to improve reliability and consistency of outcome reporting in FI studies, thereby improving evidence synthesis and patient care. Trial registration This project has been registered in the COMET database on the 1st of April 2020, available at http://www.comet-initiative.org/Studies/Details/1554. The systematic review has been registered on the PROSPERO database on the 31st of August 2020, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=202020&VersionID=1381336.

scholarly journals Hospital – primary care articulation in care transition: both sides of the process

2021 ◽  
Vol 55 ◽  
Author(s):  
Adriéli Donati Mauro ◽  
Danielle Fabiana Cucolo ◽  
Marcia Galan Perroca
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Discharge Planning ◽  
Patient Discharge ◽  
Team Work ◽  
Discharge Process ◽  
Care Experience ◽  
Integration Of Services ◽  
Communication And Coordination

ABSTRACT Objective: To analyze how the articulation between hospital and primary health care related to patient discharge and continuity of care after hospitalization takes place. Method: Qualitative study, using the focus group technique to explore the experience of 21 nurses in hospitals (n = 10) and at primary care (n = 11) in a municipality in the northwest area of the State of São Paulo. Data collection took place between December 2019 and April 2020. Four focus groups were carried out (two in the hospital and two in the health units) and the findings underwent thematic analysis. Results: The categories identified were: Patient inclusion flow in the responsible discharge planning, Patient/family member/caregiver participation, Care planning, Communication between services, and Challenges in the discharge process. According to reports, the discharge process is centered on bureaucratic aspects with gaps in communication and coordination of care. Conclusion: This research allowed understanding how nurses from different points of health care experience the discharge and (dis)articulation of the team work. The findings can equip managers in the (re)agreement of practices and integration of services to promote continuity of care.

scholarly journals Development of a screening tool for pelvic floor dysfunction in female athletes: protocol of a Delphi consensus

2022 ◽  
Author(s):  
Silvia Giagio ◽  
Andrea Turolla ◽  
Tiziano Innocenti ◽  
Stefano Salvioli ◽  
Giulia Gava ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Pelvic Floor ◽  
Delphi Study ◽  
Sports Medicine ◽  
Screening Tool ◽  
Female Athletes ◽  
Pelvic Floor Dysfunction ◽  
Negative Influence ◽  
Delphi Consensus

Background/aim: Several epidemiological studies have found a high prevalence of Pelvic Floor Dysfunction (PFD) among female athletes. However, according to several authors, these data could even be underestimated, both in research and clinical practice. Screening for potential PFD is often delayed and risk factors are not often evaluated. As a consequence, withdrawal from sport, negative influence on performance, worsening symptoms and unrecognized diagnosis may occur. The aim of our research is to develop a screening tool for pelvic floor dysfunction in female athletes useful for clinicians (musculoskeletal/sport physiotherapists, sports medicine physicians, team physicians) to guide referral to a PFD expert (e.g. pelvic floor/women's health physiotherapist, gynecologist, uro-gynecologist, urologist). Methods: A 2-round modified Delphi study will be conducted to ascertain expert opinion on which combination of variables and risk factors should be included in the screening tool. Conclusion: The implementation of the present screening tool into clinical practice may facilitate the referral to a PFD expert for further assessment of the pelvic floor and therefore, to identify potential dysfunction and, eventually, the related treatment pathway.

scholarly journals Advanced practice nurses in primary care in Switzerland: an analysis of interprofessional collaboration

2019 ◽  
Author(s):  
Renata Josi ◽  
Monica Bianchi ◽  
Sophie Brandt
Keyword(s):  
Primary Care ◽  
Medical Practice ◽  
Health Professionals ◽  
Interprofessional Collaboration ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Practice Nurses ◽  
Care Models ◽  
Team Functioning ◽  
Swiss Primary Care

Abstract Background: The increase in the number of chronically ill patients due to ageing is calling existing models of primary care into question. New care models have recently been implemented in Swiss primary care and involve interprofessional teams. This paper aimed to analyze the practice of interprofessional collaboration between advanced practice nurses, registered nurses, and medical practice assistants within new models of primary care in Switzerland using the National Interprofessional Competency Framework (NICF). Methods: An ethnographic design comprising semi-structured interviews and non-participant observations was conducted. Sixteen interviews were conducted with care providers at their primary care practice. Interviewees included four advanced practice nurses, two registered nurses, six medical practice assistants, and four general practitioners. Nine other health professionals were subsequently observed in their practice. Interviews and observations were conducted by the first author from February to April 2019. Results: Our analysis confirmed that role clarification, team functioning, collaborative leadership, interprofessional conflict resolution, patient-centered care, and interprofessional communication have a significant influence on the interprofessional collaboration among health professionals in Swiss primary care. Among these domains, role clarification and team functioning were the most frequently raised issues. Both were found to have the potential to negatively influence and, therefore, hinder efficient interprofessional collaboration within primary care. The observation of APNs and MPAs working in practice confirmed these results. Conclusion: From the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss primary care context. Our study results may inform international health policymakers and practitioners about six important domains of interprofessional care when implementing new care models. Practical experience with new models of care involving advanced practice nurses and medical practice assistants may also influence the regulation of the scope of practice of these health professionals in Switzerland.

Multifaceted competence requirements in care homes: Ethical and interactional competence emphasized

2017 ◽  
Vol 38 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Outi Kiljunen ◽  
Tarja Välimäki ◽  
Pirjo Partanen ◽  
Päivi Kankkunen
Keyword(s):  
Older People ◽  
Registered Nurses ◽  
Delphi Study ◽  
Care Home ◽  
Care Homes ◽  
Interactional Competence ◽  
Licensed Practical Nurses ◽  
Modified Delphi ◽  
Practical Nurses ◽  
Care For Older People

Nurses need versatile competence to care for older people in care home settings. A modified Delphi study was conducted to identify competencies registered nurses and licensed practical nurses need to care for older people in care homes. A total of 38 panelists consisting of experienced professionals in clinical and managerial roles were recruited to identify types of competencies these nurses require. In total, 80 competencies for licensed practical nurses and 81 competencies for registered nurses were identified as necessary. This study has shown that licensed practical nurses are required to have similar competencies to registered nurses in care homes. Nurse managers, nurse educators, and policy makers should pay more attention, to nurses’ work requirements, especially for licensed practical nurses, and support nurses to meet the needs of older people living in care homes.

Assessment of Staffing Needs for Registered Nurses and Licensed Practical Nurses at Primary Care Units in Brazil Using the Workload Indicators of Staffing Need (WISN) Method

2021 ◽  
Author(s):  
Daiana Bonfim ◽  
Ana Carolina Cintra Nunes Mafra ◽  
Danielle da Costa Palacio ◽  
Talita Rewa
Keyword(s):  
Primary Care ◽  
Registered Nurses ◽  
Supply And Demand ◽  
Licensed Practical Nurses ◽  
Primary Health ◽  
Practical Nurses ◽  
High Workload ◽  
Planning Methods ◽  
Staffing Needs ◽  
The City

Abstract Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

scholarly journals Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

2020 ◽  
Vol 29 (155) ◽  
pp. 190147 ◽  
Author(s):  
Franck F. Rahaghi ◽  
Nadera J. Sweiss ◽  
Lesley Ann Saketkoo ◽  
Mary Beth Scholand ◽  
Joseph B. Barney ◽  
...  
Keyword(s):  
Adverse Events ◽  
Delphi Study ◽  
Severe Disease ◽  
Pulmonary Sarcoidosis ◽  
Event Management ◽  
Delphi Consensus ◽  
Consensus Recommendations ◽  
Modified Delphi ◽  
Immunosuppressive Medications ◽  
Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

scholarly journals Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study

2015 ◽  
Vol 24 (01) ◽  
pp. 22-29 ◽  
Author(s):  
H. Liyanage ◽  
S-T. Correa ◽  
C. Kuziemsky ◽  
A. L. Terry ◽  
S. de Lusignan
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Care Delivery ◽  
Quality Care ◽  
Care Providers ◽  
Coordinated Care ◽  
International Panel ◽  
Other Information ◽  
Core Concepts

Summary Background: Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care. Objective: To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care.Method: The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes. Results:The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation. Conclusions: The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.

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