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.

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.

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 The culture of UK employee-owned worker cooperatives

2020 ◽  
Vol 42 (3) ◽  
pp. 761-776
Author(s):  
David Wren
Keyword(s):  
Qualitative Data ◽  
Participant Observation ◽  
Employee Ownership ◽  
Self Control ◽  
Structured Interviews ◽  
Additional Time ◽  
Content Type ◽  
Worker Cooperatives ◽  
The Uk ◽  
Ownership Types

PurposeThis paper presents exploratory, empirical data from a three-year study of organizational culture in for-profit, employee-owned businesses within the UK, comparing ownership types (direct, trust, and cooperative). It outlines the study and then focuses on worker cooperatives. Culture is illuminated through the lens of performance and reward management.Design/methodology/approachQualitative data was gathered from three worker cooperatives based in the North of England, using semi-structured interviews, participant observation, and document review and was compared to qualitative data collected from other types of employee-owned businesses.FindingsThe findings suggest a distinct culture within worker cooperatives encompassing five key values: a whole life perspective, consistently shared values, self-ownership, self-control, and secure employment.Research limitations/implicationsAdditional time with each cooperative and a greater spread of cooperatives would be beneficial. The research was carried out during a period of organizational growth for the case organizations, which may influence attitudes to reward and retention management.Practical implicationsThe results inform recruitment and retention policy and practice within worker cooperatives and highlight concerns regarding the stresses of being a self-owner. These are important considerations for potential worker co-operatives alongside policy recommendations to advance employee ownership.Originality/valueA comparative analysis of culture, performance, and rewards across different employee ownership types has not been undertaken before. This addresses an under-researched area of employee ownership regarding HR practices. Within the UK, recent research on the culture(s) of worker cooperatives is limited.

scholarly journals Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

2020 ◽  
Vol 70 (691) ◽  
pp. e102-e110 ◽  
Author(s):  
Verity Wainwright ◽  
Lis Cordingley ◽  
Carolyn A Chew-Graham ◽  
Nav Kapur ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Support Needs ◽  
Structured Interviews ◽  
Perceived Needs ◽  
The North ◽  
Suicide Bereavement ◽  
Additional Support ◽  
The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

scholarly journals Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
K. Bristow ◽  
S. Edwards ◽  
E. Funnel ◽  
L. Fisher ◽  
L. Gask ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Help Seeking ◽  
Mental Health Problems ◽  
Health Problems ◽  
Structured Interviews ◽  
Care Givers ◽  
Common Mental Health Problems ◽  
Access To Primary Care ◽  
The Uk

Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from “hard-to-reach” groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from “hard-to-reach” groups including the need to offer a flexible, non-biomedical response to distress.

scholarly journals Integrating nurse practitioners into primary care: policy considerations from a Canadian province

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stacey Black ◽  
Raad Fadaak ◽  
Myles Leslie
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care System ◽  
Structured Interviews ◽  
Primary Care Delivery ◽  
Key Stakeholders ◽  
The Status ◽  
Practice Opportunities ◽  
Care System

Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

scholarly journals The payment for performance model and its influence on British general practitioners' principles and practice

2014 ◽  
Vol 30 (1) ◽  
pp. 55-67 ◽  
Author(s):  
Armando Henrique Norman ◽  
Andrew J. Russell ◽  
Jane Macnaughton
Keyword(s):  
General Practitioners ◽  
Nurse Practitioners ◽  
Financial Incentive ◽  
Healthcare Services ◽  
Performance Model ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Middle Income ◽  
The Uk

This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Providers of Home Visits: An Exploratory Study of Two Cases

2020 ◽  
Vol 33 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Stefan Gysin ◽  
Iren Bischofberger ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Home Visits ◽  
Patient Characteristics ◽  
Pilot Projects ◽  
Family Practices ◽  
Multimorbid Patients ◽  
High Degree ◽  
Swiss Primary Care

In Swiss primary care, general practitioner (GP) home visits have decreased due to impending GP shortages particularly in rural areas. Nurse practitioners (NP) are newly introduced in family practices and could potentially offer home visits to the increasing number of multimorbid elderly. We analysed consultation data from two pilot projects (Practice A and Practice B) with the goal to measure the frequency and patient characteristics of NP consultations both in the practice and on home visits, and to determine the NPs’ autonomy based on the required GP supervision. In Practice A, 17% of all NP consultations were home visits, in Practice B 51%. In both practices, the NPs saw older patients and reported higher autonomy on home visits compared to consultations in the practice. In Practice A, the NP encountered a higher share of multimorbid patients on home visits than in the practice, and the NP’s proportion of autonomously conducted consultations increased from 0% in the first month to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of consultations after 2 years on the job. These first cases provide some evidence that NPs could reach a relatively high degree of autonomy and might pose a potential solution for the decreasing numbers of GP home visits to multimorbid elderly in Swiss primary care.

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