scholarly journals Perception of the implementation of the nurse practitioner role in a Norwegian out-of-hours primary clinic: An email survey among healthcare professionals and patients

2020 ◽  
pp. 205715852096463
Author(s):  
Elisabeth Holm Hansen ◽  
Erika Boman ◽  
Lisbeth Fagerström
Keyword(s):  
Registered Nurses ◽  
General Practitioners ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Current Model ◽  
Waiting Times ◽  
Care Providers ◽  
Chi Square ◽  
Out Of Hours ◽  
Tract Infections

In Norway, more patients are visiting the out-of-hours primary clinic than before, and with a higher urgency level. As the first out-of-hours clinic in Norway, the leader at one medium/large clinic wanted to introduce the role of nurse practitioner (NP) for more effective and safer service for patients. The aim of this study was to explore challenges in the current model of care and whether NPs can perform new tasks in an out-of-hours clinic seen from both care providers’ and patients’ perspectives. All general practitioners and registered nurses who took part in out-of-hours shifts and patients classified as urgent priority during one week were invited to participate in a survey. Descriptive statistics and a chi-square test were used to identify statistically significant differences between groups. Long waiting times in the clinic and lack of patient information during waiting time were identified. General practitioners (GPs) were skeptical about task shifting, while the registered nurses and patients were more positive. All groups agreed that nurse practitioners could perform advanced assessment of patients until a GP took over. Possible new tasks were stitching wounds, referral to X-ray and treating lower urinary tract infections.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Potential scope and impact of a transboundary model of nurse practitioners in aged care

2009 ◽  
Vol 15 (3) ◽  
pp. 232 ◽  
Author(s):  
Kasia Bail ◽  
Paul Arbon ◽  
Marlene Eggert ◽  
Anne Gardner ◽  
Sonia Hogan ◽  
...  
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Service Delivery ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Providers ◽  
Care Nurse ◽  
Residential Aged Care Facilities

Aged care is a growing issue in Australia and other countries. There are significant barriers to meeting the health needs of this population. Current services have gaps between care and lack communication and integration between care providers. Research was conducted in the Australian Capital Territory to investigate the potential role of the aged care nurse practitioner in health service delivery in aged care settings. A multimethod case study design was utilised, with three student nurse practitioners (SNP) providing care to aged care clients across three sectors of health service delivery (residential aged care facilities, general medical practices and acute care). Data collection consisted of in-depth interviews and journal entries of the SNP, as well as focus groups and surveys of multidisciplinary staff and patients over the age of 65 years in the settings frequented by the SNP. The aged care SNP were found to cross professional and organisational boundaries, cross intra- as well as interorganisational boundaries and to contribute to more seamless patient care as members of a multidisciplinary aged care team. The aged care nurse practitioner role consequently has the potential to function in a networked rather than a hierarchical manner, and this could be a key element in addressing gaps in care across care locales and between disciplines.

scholarly journals Registered Nurses’ Decisions Around Referral of Residents With Urinary Tract Infections: A Retrospective Cohort Study

2020 ◽  
Vol 11 ◽  
pp. 215013272095744
Author(s):  
Ludmila Kosheleva ◽  
Irene Ngune
Keyword(s):  
Urinary Tract ◽  
Registered Nurses ◽  
Urinary Tract Infections ◽  
Nurse Practitioners ◽  
Retrospective Cohort ◽  
Vital Signs ◽  
Residential Aged Care ◽  
Limited Information ◽  
Tract Infections ◽  
Clinical Records

Background Referral of residents with urinary tract infections (UTIs) in residential aged care facilities (RACFs) to hospital are common. However, there is limited information on what influences Registered Nurses’ (RN) decision-making process. Aim To investigate resident factors that influence RN’s decisions to escalate care. Design A retrospective cohort approach audited electronic clinical records of residents with UTIs. Methods Data were extracted from the electronic database and analyzed using descriptive and regression analysis. Approval was obtained from both the RACFs and University Human Research Ethics Committee. Results There was a higher likelihood of being referred to hospital if residents were female, had had a past fall, had related comorbidity, or had abnormal vital signs. However, being older and having a urinary catheter were protective factors for referral by the RN. Conclusion Referral of residents with UTIs by RNs to hospital is common in RACFs. Resident characteristics such as abnormal vital signs, past falls, and presence of comorbidity influence referrals by RNs. Nurse Practitioners dedicated to the RACFs could complement the role of a general practitioner. UTI-specific escalation protocols can assist RNs to make decisions about referrals. RNs’ related risk factors also need to be examined to understand other influencing factors.

Commentary on Potential Crisis in Nurse Practitioner Preparation in the United States

2019 ◽  
Vol 20 (4) ◽  
pp. 186-187 ◽  
Author(s):  
Bobby Bellflower ◽  
Wendy Likes
Keyword(s):  
United States ◽  
Health Care ◽  
Registered Nurses ◽  
Health Care Providers ◽  
Nurse Practitioner ◽  
Master's Degree ◽  
Clinical Skill ◽  
The United States ◽  
Care Providers ◽  
Master’S Degree

Nurse practitioner preparation and education, while evolving, still remains at a crossroads. In a recent article by Mundinger and Carter, a timeline and analysis of the number of Doctor of Nursing Practice (DNP) programs in the United States clearly demonstrated that since inception of the DNP degree, 85% of DNP programs are nonclinical. Many of the nonclinical programs in leadership and administration do not require additional clinical preparation beyond the bachelor’s or master’s degree in nursing. Thus, registered nurses and advanced practice registered nurses (APRNs) may obtain a DNP degree without additional clinical skill preparation beyond a baccalaureate or master’s degree, respectively. Several aspects of the nonclinical DNP are concerning. Among the most challenging issues that nonclinical DNPs present is confusion on the part of other health care providers and the public. The relatively low number of clinically focused DNP programs is also problematic. If we do not prepare APRNs at the clinical doctoral level, then other providers such as physician assistants will meet the health care needs of the community. The future of APRNs could be threatened, especially in primary care.

Knowledge and attitudes of permanent chemotherapy-induced alopecia among health care providers.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 142-142
Author(s):  
Jenna Rose Stoehr ◽  
Cory Kosche ◽  
Jennifer N. Choi
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Care Providers ◽  
Chi Square ◽  
Hospital System ◽  
Medical Specialties ◽  
General Internal ◽  
Correct Definition ◽  
Significant Difference

142 Background: Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties. Methods: An electronic survey was distributed to HCPs (resident physicians, attending physicians, and nurse practitioners) in the departments of dermatology, oncology, and general internal medicine (GIM) within one Midwestern hospital system. Results: Of the 62 participants (response rate: 13%), there were 19 from dermatology, 20 from oncology, and 23 from GIM. Responses were analyzed with descriptive statistics, and chi-square and ANOVA tests. There was a significant difference in the number of subjects that had heard of PCIA prior to starting the survey (Derm: 79%, Onc: 30%, GIM: 22%, p<0.05). A larger percentage of dermatology and oncology HCPs knew the correct definition of the condition (alopecia persisting >6 months) than GIM (42% and 45% vs. 17%) and significantly more had encountered patients with the condition (47% and 45% vs. 17%). More providers in dermatology and GIM knew how to diagnose PCIA compared to oncology (84% and 83% vs. 70%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA. Most providers across the three specialties believed that patients would accept PCIA treatment that was topical, oral, injectable, and required frequent administration or monitoring, but not treatment that was expensive or high risk. A majority of HCPs surveyed (94%) agreed that the diagnosis of PCIA is important. However, there was a significant difference in the confidence of HCPs in diagnosing and managing PCIA. A minority of dermatology providers (2/19) specified that they would refer to an alopecia or oncodermatology specialist, while the majority of oncology and GIM providers would refer to dermatology. Conclusions: The results of this survey identify knowledge gaps about PCIA amongst health care providers. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA as part of survivorship care.

The role of the psychiatric nurse practitioner in disaster response

2009 ◽  
Vol 7 (4) ◽  
pp. 39
Author(s):  
Brenda Marshall, EdD, MSN, PMHNP-BC
Keyword(s):  
Life Cycle ◽  
Registered Nurses ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Disaster Response ◽  
Healthcare Providers ◽  
Psychiatric Nurse ◽  
Florence Nightingale

Nurses have responded to, and prepared for disasters from the time of Florence Nightingale and Harriet Werley. Nurses are the largest group of professional healthcare providers in America with more than 2.4 million registered nurses, a quarter of a million of whom are Nurse Practitioners capable of diagnosing, prescribing, and treating patients. Psychiatric Nurse Practitioners are in a position to understand the unique cultural nuances and needs of a community in all phases of the disaster life cycle.

scholarly journals Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

2021 ◽  
Vol 8 ◽  
Author(s):  
Annelies Colliers ◽  
Katrien Bombeke ◽  
Hilde Philips ◽  
Roy Remmen ◽  
Samuel Coenen ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Communication Skills ◽  
Respiratory Tract Infections ◽  
Patient Expectations ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Doctor Patient Communication ◽  
Tract Infections

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

scholarly journals GP decisions to participate in emergencies: a randomised vignette study

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101153
Author(s):  
Magnus Hjortdahl ◽  
Dorte Gyrd-Hansen ◽  
Peder A. Halvorsen
Keyword(s):  
Confidence Interval ◽  
General Practitioners ◽  
Odds Ratio ◽  
Online Survey ◽  
Adjusted Odds Ratio ◽  
Team Training ◽  
Shortness Of Breath ◽  
Chi Square ◽  
Out Of Hours ◽  
Vignette Study

Background Little is known about how General Practitioners (GPs) decide whether to participate in emergencies. Aim To test whether GPs participation is associated with cause of symptoms, distance to the patient, other patients waiting and out of hours (OOH) clinic characteristics. Design and Setting Online survey to all Norwegian GPs (n = 4701). Method GPs were randomised to vignettes describing a patient with acute shortness of breath and asked if they would participate in a call-out. The vignettes varied with respect to cause of symptoms (trauma versus illness), distance to the patient (15 versus 45 minutes) and other patients waiting at the OOH clinic (crowding versus no crowding). The survey included questions about OOH clinic characteristics. Results Of the 1013 GPs (22%) that responded, 76% reported that they would participate. The proportion was higher in trauma (83% versus 69%, chi square 24.8, p < 0.001), short distances (80% versus 71%, chi square 9.5, p = 0.002) and no crowding (81% versus 70% chi square 14.6, p < 0.001). Participation was associated with availability of a manned response vehicle (adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] 1.25-3.41), and team training at the OOH clinic once a year (OR 1.78, 95% CI 1.12-2.82) or more than once a year (OR 3.78, 95% CI 1.64-8.68). Conclusion GPs were less likely to participate when the incident was not due to trauma, was far away and when other patients were waiting. A manned response vehicle and regular team training were associated with increased participation.

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