Small talk as work talk: Enacting the patient-centered approach in nurse-practitioner-patient visits

2018 ◽  
Vol 14 (2) ◽  
pp. 97-107 ◽  
Author(s):  
Staci Defibaugh
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Visit ◽  
Patient Centered ◽  
Small Talk ◽  
Medical Visits ◽  
Relational Work ◽  
The Us ◽  
The Individual ◽  
Patient Relationships

Small talk in medical visits has received ample attention; however, small talk that occurs at the close of a medical visit has not been explored. Small talk, with its focus on relational work, is an important aspect of medical care, particularly so considering the current focus in the US on the patient-centered approach and the desire to construct positive provider– patient relationships, which have been shown to contribute to higher patient satisfaction and better health outcomes. Therefore, even small talk that is unrelated to the transactional aspect of the medical visit in fact serves an important function. In this article, I analyze small talk exchanges between nurse practitioners (NPs) and their patients which occur after the transactional work of the visit is completed. I focus on two exchanges which highlight different interactional goals. I argue that these examples illustrate a willingness on the part of all participants to extend the visit solely for the purpose of constructing positive provider–patient relationships. Furthermore, because exchanges occur after the ‘work’ of the visit has been completed, they have the potential to construct positive relationships that extend beyond the individual visit.

Holistic Nursing Values in Nurse Practitioner Education

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Elizabeth Kinchen
Keyword(s):  
Nursing Education ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
High Reliability ◽  
Reliability And Validity ◽  
Advanced Practice Nursing ◽  
Patient Centered ◽  
Holistic Nursing ◽  
Nursing Values ◽  
Practitioner Education

AbstractMuch has been written about the inclusion of holistic nursing values and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education has not been fully explored. Nurse practitioners (NPs) are nurses, so it is assumed that the nursing perspective provides a framework for NP education and practice, and that NP education represents the blending of a holistic nursing approach with medical diagnosis and treatment. Nurse practitioners are taking increasing responsibility for filling the gap in primary healthcare availability in the U.S., and in the current political and economic healthcare climate, NPs are in a position to promote primary care models that honor comprehensive, patient-centered, and relationship-based care. As a result, it becomes essential to quantify the inclusion of these values in NP educational programs and coursework, as instilling core values for practice begins in educational environments. This quantitative, descriptive study explored the inclusion of holistic nursing values by NP faculty, using the Nurse Practitioner Holistic Caring Instrument (NPHCI). The NPHCI exhibited quite high reliability and validity in the sample, including confirmation of its three subscales. Survey results suggest that NP faculty actively incorporate holistic nursing values in educational coursework, and that age, length of time teaching in NP programs, highest educational degree, and academics as the primary area of practice were important indicators of the inclusion of holistic nursing values in NP program curricula. Findings add to knowledge of NP education, but further study is warranted.

scholarly journals Group Medical Visit Training in Family Medicine Residency:

2019 ◽  
Vol 51 (4) ◽  
pp. 319-325 ◽  
Author(s):  
Carmen Strickland ◽  
Joanne C. Sandberg ◽  
Stephen W. Davis ◽  
Sally P. Weaver
Keyword(s):  
Family Medicine ◽  
Program Directors ◽  
Resident Training ◽  
Training Methods ◽  
Medical Visit ◽  
Patient Centered ◽  
Family Medicine Residency ◽  
Group Medical Visits ◽  
Medical Visits ◽  
The Status

Background and Objectives: Group medical visits (GMV) have been shown to improve clinical outcomes and patient satisfaction and are included as a new tool in the patient-centered medical home (PCMH). The capacity for and interest in developing GMV skills in family medicine residency have not been assessed. This study aims to describe the extent of existing training in GMV as well as attitudes toward and barriers to this training. Methods: The Council of Academic Family Medicine Educational Research Alliance (CERA) sent a survey in the fall of 2015 to all US family medicine residency program directors (PDs) containing questions about the status of GMV training for their residents. Results: The survey response rate was 53%. Fifty-nine percent of program director respondents report access to GMV and 61% note some form of training in this model of care. Seventy-nine percent of respondents indicate that GMV training is important for residents. Multiple barriers exist to optimizing GMV as part of current family medicine training. Conclusions: A majority of family medicine PD respondents report both access to and curriculum for GMV. While program directors endorse this practice model as an important element in resident training, they acknowledge challenges that may limit its availability. Opportunities to better understand and overcome barriers may increase programs’ capacity to deliver GMV skills.

The effectiveness of the shared medical visit among patients with a gynecologic malignancy undergoing chemotherapy along the Texas-Mexico border.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 63-63
Author(s):  
Kayla E. Castañeda ◽  
Loretta L. Hernandez ◽  
Zuber Mulla ◽  
Harvey Greenberg ◽  
J. Salvador Saldivar
Keyword(s):  
Patient Satisfaction ◽  
Perceived Stress ◽  
Medical Visit ◽  
Gynecologic Malignancy ◽  
Patient Centered ◽  
Individual Group ◽  
Average Change ◽  
Centered Care ◽  
Mexico Border ◽  
The Individual

63 Background: The goal of this program was developed in response to The Institute of Medicine’s (IOM) “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001) to provide patient-centered care that would result in improved patient satisfaction and decreased stress through the use of a shared medical visit (SMV) for patients with a gynecologic malignancy undergoing chemotherapy in place of an individual visit. Methods: The study design was a prospective cohort at a university health sciences center located on the Texas-Mexico border. A total of 20 patients will be enrolled in the SMV and 20 in the individualized visit. Participants attended group sessions with the provider that combined assessment, education, and social support. Patient-centered care was achieved by assisting them to obtain their own vital signs and by using a facilitative learning approach during the educational and social support component. Patients in the comparison group were patients who continued in the individual visits. The average differences between the pre- and post-session scores for perceived stress and patient satisfaction were calculated for both groups. Differences between both patient groups were tested for statistical significance using the Student’s independent two sample t-test. Results: The first twelve patients completed pre- and post-session questionnaires on perceived stress and patient satisfaction. For perceived stress, a lower score indicated lower stress. The average change in score for the individual group (n=6) was 0.67, and the average change in score for the SMV group (n=6) was -2.83 (p=0.28). For patient satisfaction, a higher score indicated higher satisfaction. The average change in score for the individual group (n=6) was -5.5; the average change in score for the SMV group (n=6) was -7.5 (p=0.80). Conclusions: Overall, patients felt they benefited from the shared medical visit. While the results of our interim analyses were not statistically significant, it appears that patient stress with the shared medical visit model may decrease over time. Based on our preliminary results we will continue to enroll patients and evaluate this unique program.

scholarly journals State-Granted Practice Authority: Do Nurse Practitioners Vote with Their Feet?

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
John J. Perry
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
State Level ◽  
Large Change ◽  
National Sample ◽  
Sample Survey ◽  
Regulatory Changes ◽  
The Us ◽  
Using Data ◽  
The Impact

Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice authority on the probability of a nurse practitioner moving from a state. The empirical results indicate that nurse practitioners in states that grant expanded practice are less likely to move from the state than nurse practitioners in states that have not granted expanded practice authority. The estimated effect is robust and is statistically and economically meaningful. This finding is in concert with and strengthens the wider literature which finds states that grant expanded practice authority to nurse practitioners tend to have larger nurse practitioner populations.

Care Work on the Front Lines

2020 ◽  
Vol 119 (820) ◽  
pp. 326-328
Author(s):  
Mary F. E. Ebeling
Keyword(s):  
Nurse Practitioners ◽  
Outpatient Care ◽  
Care Facility ◽  
Safety Net ◽  
Ethnographic Study ◽  
Care Work ◽  
Medical Professionals ◽  
Essential Work ◽  
Social Safety Net ◽  
The Us

An ethnographic study of the work of nurse practitioners at an outpatient care facility shows how these medical professionals must endlessly multitask to fill gaps in the US social safety net. In the context of the COVID-19 pandemic, a new focus on the essential work of nurses and the lack of resources with which they often contend is especially timely.

A University Education

2017 ◽  
Author(s):  
David Willetts
Keyword(s):  
Higher Education ◽  
Modern Society ◽  
University Education ◽  
Modern World ◽  
Controversial Issues ◽  
The Us ◽  
The Individual ◽  
The University ◽  
First Time ◽  
The Relationship

Universities have a crucial role in the modern world. In England, entrance to universities is by nation-wide competition which means English universities have an exceptional influence on schools--a striking theme of the book. This important book first investigates the university as an institution and then tracks the individual on their journey to and through university. In A University Education, David Willetts presents a compelling case for the ongoing importance of the university, both as one of the great institutions of modern society and as a transformational experience for the individual. The book also makes illuminating comparisons with higher education in other countries, especially the US and Germany. Drawing on his experience as UK Minister for Universities and Science from 2010 to 2014, the author offers a powerful account of the value of higher education and the case for more expansion. He covers controversial issues in which he was involved from access for disadvantaged students to the introduction of L9,000 fees. The final section addresses some of the big questions for the future, such as the the relationship between universities and business, especially in promoting innovation.. He argues that the two great contemporary trends of globalisation and technological innovation will both change the university significantly. This is an authoritative account of English universities setting them for the first time in their new legal and regulatory framework.

Punk as Folk: Continuities and Tensions in the UK and Beyond

2020 ◽  
Author(s):  
Pete Dale
Keyword(s):  
Folk Music ◽  
Music Making ◽  
Collective Creativity ◽  
Living Tradition ◽  
Wide Range ◽  
The Us ◽  
The Common ◽  
The Individual ◽  
The Uk

Numerous claims have been made by a wide range of commentators that punk is somehow “a folk music” of some kind. Doubtless there are several continuities. Indeed, both tend to encourage amateur music-making, both often have affiliations with the Left, and both emerge at least partly from a collective/anti-competitive approach to music-making. However, there are also significant tensions between punk and folk as ideas/ideals and as applied in practice. Most obviously, punk makes claims to a “year zero” creativity (despite inevitably offering re-presentation of at least some existing elements in every instance), whereas folk music is supposed to carry forward a tradition (which, thankfully, is more recognized in recent decades as a subject-to-change “living tradition” than was the case in folk’s more purist periods). Politically, meanwhile, postwar folk has tended more toward a socialist and/or Marxist orientation, both in the US and UK, whereas punk has at least rhetorically claimed to be in favor of “anarchy” (in the UK, in particular). Collective creativity and competitive tendencies also differ between the two (perceived) genre areas. Although the folk scene’s “floor singer” tradition offers a dispersal of expressive opportunity comparable in some ways to the “anyone can do it” idea that gets associated with punk, the creative expectation of the individual within the group differs between the two. Punk has some similarities to folk, then, but there are tensions, too, and these are well worth examining if one is serious about testing out the common claim, in both folk and punk, that “anyone can do it.”

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.

scholarly journals AB0801 TIME FOR REFERRAL AND DEFINITIVE DIAGNOSIS IN PATIENTS WITH HAND ARTHRALGIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1425.1-1425
Author(s):  
P. Herrera-Sandate ◽  
G. Figueroa-Parra ◽  
D. Vega-Morales ◽  
J. A. Esquivel Valerio ◽  
B. R. Vázquez Fuentes ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Time Delay ◽  
Family Medicine ◽  
Tertiary Care ◽  
Definitive Diagnosis ◽  
Official Journal ◽  
Medical Visit ◽  
Medicine Clinic ◽  
Medical Visits ◽  
Medical Quality

Background:Early referral of patients with suspicion of progression to rheumatoid arthritis (RA) is of paramount importance in disease prognosis. We had previously described a time delay of 28 months between symptom onset and evaluation by a rheumatologist, and a mean wait time of 9.5 weeks for referral to a secondary-level public hospital (1). The availability of specialized interdisciplinary evaluation of patients in a third-level of care raises the possibility of shortening this time gap, as well as describing patient and physician decisions amidst the referral to a Rheumatology center.Objectives:Describe the diagnosis profile of patients with hand arthralgia and time of referral to Rheumatology in a Family Medicine clinic.Methods:A cohort study was conducted in 110 patients from October 2018 to December 2020 in a Family Medicine clinic within the tertiary-care University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. Patients with hand arthralgia as their chief complaint were recruited. An observational, descriptive compilation of patient history was retrieved prospectively through medical records. Variables included time of inclusion, number of medical visits until referral and definitive diagnosis. Descriptive statistics, Kaplan-Meier curves and log-rank tests were used to test the association between time of diagnosis and clinical variables of interest.Results:Assessed variables are shown in Table 1. Out of 110 patients with hand arthralgia, a quarter received a final diagnosis within 3 medical visits. Less than half of patients were referred, and only a third attended the referral indication. It takes 39.3 days from the first medical visit to be referred, and 69 days and 2.89 consultations to receive a definitive diagnosis. Around half of patients will have a definitive diagnosis, osteoarthritis being the most common. The log-rank test for categoric variables including a positive squeeze test or ≥4 criteria of clinically suspect arthralgia did not show a significant association for time of referral and definitive diagnosis (data not shown).Table 1.Diagnostic and referral characteristics of patients with hand arthralgia attending a Family medicine clinicPatients recruited in a Family Medicine clinicn = 110Female, n (%)90 (81.8)Age in years, mean ± SD49.69 ± 14.90RF, ACPA, or hand radiography request, n (%)100 (90.9)Diagnosis in Family MedicineDiagnosed patients after 1 medical visit, cumulative n (%)5 (4.6)Diagnosed patients after 2 medical visits, cumulative n (%)22 (20.0)Diagnosed patients after 3 medical visits, cumulative n (%)26 (23.6)Referral to Rheumatology for diagnostic doubt or clinical follow-upPatients referred to a Rheumatology clinic, n (%)49 (44.5)Patients attending Rheumatology referral, n (%)34 (30.9)Time for referral, days ± SD39.37 ± 38.64Global definitive diagnosisPatients with a definitive diagnosis, n (%)51 (46.4)Osteoarthritis diagnosis, n (%)23 (20.9)Rheumatoid arthritis diagnosis, n (%)13 (11.8)Overlap syndrome diagnosis, n (%)5 (4.5)Time for definitive diagnosis, days ± SD68.96 ± 106.57Number of consultations for definitive diagnosis, mean ± SD2.86 ± 1.05RF, rheumatoid factor; ACPA, anticitrullinated protein antibodies; SD, standard deviation.Conclusion:Patients with hand arthralgia evaluated in a tertiary-care Rheumatology center receive a timely referral in one month and a definitive diagnosis after 3 medical visits in around two months.References:[1]Vega-Morales, D., Covarrubias-Castañeda, Y., Arana-Guajardo, A. C., & Esquivel-Valerio, J. A. (2016). Time Delay to Rheumatology Consultation: Rheumatoid Arthritis Diagnostic Concordance Between Primary Care Physician and Rheumatologist. American journal of medical quality: the official journal of the American College of Medical Quality, 31(6), 603.Graphs:Disclosure of Interests:None declared

Nurse Practitioner Students’ Perceptions on Delivering Culturally Congruent Care to Vulnerable Mexican Immigrants: A Qualitative Study

2021 ◽  
pp. 154041532110204
Author(s):  
Linda S. Eanes ◽  
Carolina Huerta ◽  
Lilia Azeneth Fuentes ◽  
Beatriz Bautista
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Race And Ethnicity ◽  
Mexican Immigrants ◽  
Group Discussion ◽  
Cultural Beliefs ◽  
Cultural Influences ◽  
Therapeutic Communication ◽  
Culturally Congruent ◽  
Nurse Practitioner Students

Increasingly, nurse practitioners serve as vanguards in providing primary health care to vulnerable Mexican immigrants. The aims of this study were to explore the lived experiences of nurse practitioner students in caring for Mexican immigrant patients and to capture their meaning of cultural influences deemed essential to the delivery of culturally congruent care. An exploratory descriptive design was employed. Purposive sampling was used to select 17 nurse practitioner students who volunteered to complete a semistructured face-to-face audio-taped interview and follow-up focus group discussion. Constant comparison was utilized to analyze data. From this process, four distinct themes emerged: Culturally congruent care extends beyond race and ethnicity, understands the importance of therapeutic communication, accepts complementary and alternative medical modalities, and recognizes the importance of eating patterns, food choices, and perceptions of ideal weight and health. These findings build on our understanding of key evidence–based cultural beliefs and practices that are important in delivering culturally congruent care to this subgroup.

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