Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education.

Purpose: Nurses constitute the largest non-medical primary care workforce in Canada and play an integral role in promoting health equity and improving access, continuity of care, patient satisfaction, and clinical outcomes. In 2019, the Canadian Family Practice Nurses Association (CFPNA) published Canadian competencies unique to registered nurses (RNs) in primary care. However, primary care–focused content has not been well integrated into Canadian nursing curriculum, and additional education is required to enable nurses to enact these competencies in practice. To address this gap, the purpose of this paper was to identify post-licensure education programs available to nurses in primary care across Canada and explore their alignment with the CFPNA Competencies for RNs in Primary Care and the College of Family Physicians of Canada Patient’s Medical Home (PMH) model. Method: An environmental scan was conducted, consisting of a literature review and expert consultations. The literature review involved a search of electronic databases (CINAHL Plus, MEDLINE via EBSCOhost) using relevant keywords/search strings and grey literature collected from websites of academic institutions, government/professional organizations, and nursing regulatory bodies. Studies considered for inclusion reported on programs available to RNs and nurse practitioners involving high-level primary care education, with properties related to the CFPNA competencies and/or PMH model. Data were extracted and grouped according to the type of program, content, targeted skills/knowledge, CFPNA competency domains and/or PMH model pillars, and delivery methods. Expert consultations involved data verification by key informants and an electronic questionnaire. Key informants, who had expertise in primary care, nursing, and/or continuing education, were contacted via email and asked to verify data retrieved from the literature review. An electronic questionnaire (via Qualtrics) was sent to primary care nurses/administrators to gather additional data on education programs and identify factors that support or hinder nurse involvement. Responses were categorized narratively based on overarching themes. Results: Ten unique programs were identified across 12 sources. All identified programs offered high-level primary care content that was generally tailored to specific practice areas (e.g., chronic disease management). Programs addressed some of the CFPNA competency domains (i.e., clinical practice; leadership) and the PMH model pillars (i.e., patient- and family-centred care; training, education, and continuing professional development; measurement, continuous improvement, and research). Courses contained theory and/or clinical components and most were limited to provincial-level delivery. A total of 63 respondents completed the electronic questionnaire across multiple provinces and reported that education programs differed within provinces and that there was no required education to practise in primary care beyond entry-to-practice preparation. Key factors that supported or hindered their ability to participate in education were identified, and consensus was expressed that a national, standardized program tailored to the nursing role in primary care is needed. Conclusion: These findings highlight notable gaps in primary care nursing education and emphasize the need for an education program that aligns with established primary care frameworks to guide clinical practice, nurses’ scope of practice, and their unique contributions to primary care. A standardized education program has the potential to improve quality of patient care, increase nurse satisfaction, and enhance overall collaborative practice within team-based care.

The core of many countries' primary care strategies has been increasing community engagement in primary care, greater efforts in preventive illnesses and promoting health, and greater harmony and synergy of current services in accordance with the community's needs. Primary care nurses have a lot of opportunity to provide strategies for health promotion and prevention, and prior research has revealed the multitude of functions that nurses can play, such as managing complex medical problems. Nurses employed in general practices have been observed to be effective in providing a number of preventative initiatives, including smoking cessation. It has been seen that though nurses who work in this environment are eager to counsel patients about physical exercise but have major deficiencies in their understanding of existing recommendations, suggesting a dearth of training preparation for such tasks. Very often, primary health care nurses' ability to undertake health promotion is restricted by the general practice environment, their skillset, and general practitioners' perspectives toward nurses' participation in health promotion activities. Primary care nurses may be able to bridge the gap between societal expectations of this field and how patients view prevention in the context of general practice. Primary care nurses have a lot of room to grow in their ability to collaborate with other healthcare providers and work outside the confines of general practice settings. In primary care settings, nursing appears to be underused despite its potential to be working more successfully in HPP. The effectiveness of present primary health care changes depends on identifying and addressing the enablers and hurdles to health promotion and prevention among primary care nurses.

Nursing: the answer to the primary health care dilemma

Nurse Practitioners, Practice Nurses and Nurse Specialists: what's in a name?

A training program for primary health care nurses on timely diagnosis and management of dementia in general practice: An evaluation study

Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up. Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

Background: Given the worldwide evolution to deinstitutionalize care for people with a disability (PD), the importance of having care services, for instance as offered by primary care nurses (PCN), to deliver necessary care to PD can only be emphasized. European data (from 2014) show a relatively high percentage of PD in Belgium (16.2%) using home care services provided by primary health care providers (PCN, general practitioners…). Moreover, satisfaction levels regarding these services are among the highest in Europe. The objective of this research was to gain insight into the needs of PD regarding nursing care, based on PCN’s experiences.Methods: Between September and December 2015, a questionnaire – drawn up by a multidisciplinary team (4 general practitioners and 20 PCN) – was distributed electronically to 1547 PCN working in primary care in the Belgian region Limburg. Open-ended questions of this questionnaire were analyzed using techniques developed for qualitative data analysis. PCN were asked to report about (1) mental and behavioural problems, (2) medication policy, (3) swallowing problems, (4) monitoring of nutritional status and (5) any other needs arising in the care for PD.Results: Comments of 588 PCN were generated (response rate of 38%). Besides the (routine) tasks of PCN, the impact of PD’s and informal caregivers’ behaviour on PCN’s working environment were mentioned, particularly regarding medication policy, swallowing problems and nutrional status monitoring. PCN’s collaboration with PD and their informal caregivers is often reported about in relation to respectively PD’s limited ability to communicate or to understand PCN and informal caregivers behaving in a counteracting way, not following through PCN’s advice. Additionally, PCN report about consulting and activating other healthcare professionals in the interest of PD’s. Overall, PCN mentioned tasks in all facets of PD’s lives: from the expected nursing care and far beyond.Conclusions: Besides providing nursing care, PCN are also helping with different tasks related to daily living. This “beyond standard” - care enhances the likelihood of PD to keep on living in their homes for a longer period of time. PCN seem to play a crucial role in activating other healthcare professionals to meet the healthcare needs of PD. More extensive research should be carried out to gain insight in healthcare needs of PD and the challenges PCN come across in their care for this population. Findings can be used to align pre-qualification training and education of (future) PCN with the (unmet) needs of PD.

Attitudes toward, familiarity with, and use of clinical guidelines in general and the national Hypertension Guideline were studied. A questionnaire study was conducted before and after an educational program (VALTIT) among primary and secondary care nurses in Päijät-Häme, Finland. The program included centralized training sessions and interactive local workshops. Prior to the program, a majority of nurses had a positive attitude toward guidelines but used guidelines seldom. Primary care nurses were better aware of the Hypertension Guideline than secondary care nurses, but the guideline was poorly used by both groups. At the follow-up, familiarity with the Hypertension Guideline and use of guidelines increased among primary care nurses. In future, primary care nurses will have a more autonomous role in patient care and should participate in clinical guideline development and related research. Our study has shown they are a potential target of such interventions.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): King Baudouin Foundation Belgium Background, Self-care in Heart Failure (HF) is important to prevent rehospitalisation and to improve Quality of Life (QoL).1, 2 Therefore, it is necessary that HF-patients receive continuous education and self-care support, both in the hospital as at home.3 In Belgium, multidisciplinary (Mdisc-) HF-programmes are not yet broadly implemented, nor does a national HF-DMP exists. Specialist HF-nurses are not readily available and GPs report that they do not have time for patient education . 4,5 GPs identified trained primary care nurses (PCN) as their preferred partner to take on patient education and self-care support.5 However, currently, these nurses are not trained to take on this role.5 Purpose To develop an evidence-based HF-educator training for primary care nurses. Methods The training was developed in 10 consecutive steps: Step 1, a working group with representatives of Belgian HF-cardiologists, HF-nurses, PCN and the nursing department of a university of applied sciences was established. Step 2, in preparation of this working group, M., a PCN and primary care HF-nurse, reviewed the curriculum of the specialist HF-nurse training to identify the (non-) relevant topics for PCN training. She presented her findings during working group 1 in which we decided to consult the primary health care professionals. Step 3, one group interview with PCN, one interview with a GP and a diabetes educator took place. A short interview guide was developed. The main conclusions were that PCN have limited awareness for HF, it should be a short in time training, psychosocial aspects are very important, PCN should be able to detect signs and symptoms of HF, a basic module on HF must be included. Step 4, presentation of these results to the working group. Step 5, development of an organisational framework Step 6, a subgroup consisting of one specialist HF-nurse, one HF-educator- and HF-nurse in primary care developed a programme based on the results of the interviews, the HFA-curriculum and the organisational framework. Step 7, this programme was presented to and approved by the working group Step 8, representatives of the university of applied sciences will implement the programme as part of their life-long learning programme. Step 9 and 10: pilot and evaluation. Results The PCN HF-educator education will take 20h in 3 consecutive weeks. Participants will receive a theoretical introduction in HF followed by intensive practical training on patient-education, self-care and psychosocial support. In March 2022 the first pilot will take place. Conclusions Continuous education is important to support patients in their self-care and self-management. Therefore, it is necessary to train and support primary health care professionals in order to prepare them for this tasks. We presented a co-creative methodology to develop and implement a training for health care professionals.

Job titles and education requirements of registered nurses in primary care: An international document analysis

IntroductionThe novel coronavirus 2019 or COVID-19 pandemic has brought about a global public health crisis. Primary care (PC) nurses render first line care, or refer for more specialised services.AimTo investigate the preparedness of PC nurses for COVID-19 in the Western Cape.SettingThe Western Cape province of South Africa.MethodsWe administered an online survey, with closed and open-ended questions, to 83 Stellenbosch University postgraduate PC nursing students and alumni working in the Western Cape, between 03 July and 01 September 2020.ResultsThe results indicated that 43.3% of participants were confident about the infection, prevention, and control (IPC) training they received and 56.7% felt prepared to provide direct care to suspected cases of COVID-19. Primary care nurses were more comfortable to triage (78.3%) than to manage persons with COVID-19 (42.2%), indicating that they may not be functioning to the full capacity of their education and training. Adequate infrastructure was reported by less than a third of the participants (30.1%) and 59.1% reported that personal protective equipment (PPE) was always available. Primary care nurses needed support in coping with stress (57.8%) although few (14.5%) reported access to mental health services.Conclusion Primary care nurses were not prepared optimally for the COVID-19 pandemic. Challenges included adequate training, infrastructure, the availability of personal protective equipment, COVID-19 testing of health care workers and management support. Primary care nurses need comprehensive support to manage stress and anxiety.

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

Chronic liver diseases are very common worldwide and represent a major healthcare issue (GBD 2013 Mortality and Causes of Death Collaborators, 2015). Chronic liver diseases are characterized by inflammation of the liver, which may be secondary to distinct etiological factors, including hepatitis C or B infection, increased alcohol consumption, or non-alcoholic fatty liver disease (NAFLD). This article is protected by copyright. All rights reserved.

Introduction: In the northern part of Belgium, 21,518 of 129,021 disabled patients (DP) were waiting to receive residential care. Due to waiting lists for DP, Belgian government promotes a shift towards primary care. This shift results in specific needs for primary care professionals (general practitioners, primary care nurses (PCN) and informal caregivers). The objective of this research was to detect nursing care, communication and educational needs of PCN to treat their DP and their informal caregivers. Methods: A questionnaire was constructed by a multidisciplinary team of primary care professionals (4 general practitioners and 20 PCN) in different consensus meetings. Disabilities are defined as physical and/or intellectual impairment. The questionnaire was sent electronically to participants. Analysis is performed using SPSS 22.0. Results: 1,547 questionnaires were mailed, 617 PCN responded (response rate = 40%). PCN are delivering care to 16 patients (+/-10) of which 5 DP (+/-6). 408 PCN have contact with at least half of informal caregivers. Most PCN (n = 582) report overburdening of informal caregivers due to an overload of tasks (72%). Personal hygiene and administering medication are most frequent administered care. Communication with DP and primary health care professionals is evaluated as very good. Most reported educational needs are dealing with behavioral problems (84%), functional loss (84%) and acquired brain injury (74%). There is no significant difference in educational needs of PCN nursing exclusively at home versus at least in residential care facilities. Conclusion: PCN prefer education on dealing with behavioral problems, which corresponds to previous studies. An educational program can be designed to ensure PCN have necessary skills to ensure high quality care for DP and a reduced overburdening of informal caregivers.

Review question/objective This review asks “What is the experience and effectiveness of nurse practitioners in orthopaedic settings”? The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators. The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings. Types of participants Nurse practitioner is an expanded form of advanced practice.11 For the purpose of this systematic review the International Council of Nurses (ICN) definition20 of nurse practitioner will apply whereby a Nurse Practitioner/Advanced Practice Nurse is defined as a Registered Nurse with expert knowledge, complex decision making skills and possessing competency for expanded practice. Importantly the practice of nurse practitioner/advanced practice nurse is characterised further by the “context and/or country” that they practice within.20 Therefore an ‘orthopaedic’ nurse practitioner is defined in accordance with the above definition and with a specific scope of practice (as authorised) within a relevant and specific ‘orthopaedic’ setting. The quantitative and qualitative components of this review will consider studies that include orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings. The textual component of this review will consider publications that pertain to orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings, where there exists a particular focus on the ‘orthopaedic’ aspect of nurse practitioner practice. Types of intervention(s)/phenomena of interest The quantitative component of this review will examine interventions of orthopaedic nurse practitioner specific care. For this systematic review, orthopaedic nurse practitioner specific care refers to those aspects of care the orthopaedic nurse practitioner is responsible for and/or records as performance outcomes such as: occasions of service/numbers seen; time to and length of nurse practitioner consultation; time to nurse practitioner intervention; referral patterns and other measures of intervention effectiveness. The qualitative component of the review will examine as phenomena of interest the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The text and opinion component of the review will examine opinions on the effectiveness and experience of nurse practitioners in orthopaedic settings including role development, implementation and evaluation of nurse practitioners in orthopaedic settings. Types of outcomes The quantitative component of this review will consider as primary outcomes the following patient outcomes: • patients’ level of pain • pressure injury • urinary tract infection • patient satisfaction • in-hospital patient mortality • hospital readmission • patients’ health-related quality of life • functional status • malnutrition score • constipation • wound care/complications • other clinical complications • morbidity • other patient encounter data that characterise orthopaedic nurse practitioner practice • other relevant nurse-sensitive outcome data The quantitative component of this review will consider as secondary outcomes the following nurse related outcomes or process indicators/outcomes: • orthopaedic nurse practitioner satisfaction • key stakeholder (health professional) satisfaction • specialised knowledge/skill translation • hospital length of stay • cost benefit