Practice Nurses In Primary Care Research Articles

Timing of stroke survivors' hospital readmissions to guide APRNs in primary care

Background: Caring for patients after a neurovascular incident is common for advanced practice registered nurses (APRNs). Most neurological readmission studies focus on a small subset of neurovascular incident groups, but advanced practice nurses in primary care attend to a diverse neurovascular population and lack time to adequately search hospital records. Purpose: The aim of this study was to determine readmission risk factors after a neurovascular incident to guide APRNs in the primary care setting. Methodology: The study is a retrospective observational study that used a crude single predictor model to determine potential risks for readmission. Results: A total of 876 neurovascular participants were studied. Of these, only 317 experienced at least one hospital readmission, with 703 readmissions within 1 year, indicating some were readmitted more than once. Risks for readmission varied across neurovascular events. The main reasons for readmission were because of neurological, cardiovascular, and musculoskeletal complications. Conclusions: Stroke readmission rates are high and require intervention by APRNs. To prevent readmission includes timely follow-up within 30 days and should also include longitudinal follow-up beyond 90 days to prevent hospital readmission. Implications: Future studies are needed to create guidelines for APRNs that implement rehabilitation strategies to decrease hospital readmission for the neurovascular population that focus on interdisciplinary communication.

Process and effect evaluation of a referral aid for smoking cessation counselling in primary care: Findings of a randomized controlled trial.

This study explored the use and effects of a smoking cessation referral in: 1) practice nurses (PNs), and 2) smokers. The use of evidence-based smoking cessation interventions (EBSCIs) can double the likelihood of a successful smoking cessation attempt. A referral aid was developed to aid Dutch PNs in primary care in deciding which smokers are the most suitable for EBSCI. Two different studies were conducted: 1) a randomized controlled trial with a process evaluation (n=82) and effect evaluation (n=285) among smoking patients recruited by PNs (n=73), and 2) a process evaluation among a subgroup of PNs (n=40) from January 2019 to September 2020. Overall, the response in both groups was low. PNs found the referral aid materials clear and understandable. Smokers had similar but (slightly) less-positive opinions. The smokers in both groups did not differ in the amount of discussion and use of EBSCIs, nor on smoking abstinence. Further research should assess how to better involve PNs and smokers when recruiting for an RCT and how to foster effective counselling. Additional research should also look deeper into barriers to referral of both PNs and smokers, and how to stimulate referral to EBSCIs best and help smokers to make a decision; for example by implementing a simplified strategy both within the primary care setting and outside, by involving other healthcare professionals or options outside healthcare such as the workplace and social domain. The study was registered at the Netherlands Trial Register (NL7020, https://www.trialregister.nl/trial/7020).

Pain management in infant immunisation: A cross-sectional survey of UK primary care nurses.

Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. A total of 255 questionnaire responses were received. Over 90% (n=226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n=103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n=116) or often (30.6%, n=74). Most practices had no immunisation pain management policy (81.1%, n=184), and most PNs' previous training had not included pain management (86.9%, n=186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada

BackgroundFamily practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.MethodsThis mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses’ time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.DiscussionThis project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

Regional implementation of atrial fibrillation screening: benefits and pitfalls.

Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives. A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%). Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.

Understanding and supporting children and young people with eating disorders

Eating disorders can have devastating effects on individuals and families. Maddie Burton explains the crucial role practice nurses can play in identifying and supporting patients Children and young people's mental health conditions have continued to increase. The NHS Digital 2017 survey found that 1 in 8 children have a diagnosable mental health condition. During the current COVID-19 pandemic numbers are set to increase. Eating disorders make up a relatively small proportion of these statistics but have some of the most devastating effects on individuals and families. Anorexia nervosa, as discussed here, has the highest morbidity of any mental health condition. The issues are complex and a challenge to understand for both professionals and families, over typically a protracted period of illness. However, all work with children, young people and their families presents a ‘window of opportunity’ in being able to resolve issues within a developmental phase prior to the more concrete adult phase. The risk is highest for young people between the ages of 13 and 17 years. There are several theoretical models that aid understanding of how and why eating disorders emerge and are maintained. Practice nurses in primary care can have a crucial role in early identification and can be found to be less stigmatising than mental health professionals. Practice nurses can have an ongoing role in remaining involved with the young person and their family and as part of the wider specialist support system.

A qualitative study exploring the influence of clinic funding on the integration of family practice nurses in Newfoundland and Labrador.

AimThis study explores the contributions of family practice nurses in primary care across Newfoundland and Labrador funded by fee‐for‐service and alternate payment plans to examine the influence of funding arrangements on nursing roles/activities.DesignA qualitative descriptive design was employed.MethodsSemi‐structured telephone interviews were conducted between March‐July 2018 with physicians and Registered Nurses working in primary care settings in Newfoundland and Labrador. Interviews were transcribed verbatim, and a content analysis approach was used to identify recurring themes.ResultsClinic funding was instrumental in the integration of family practice nurses into primary care settings and influenced roles/activities. In fee‐for‐service practices, nurses work with physicians and focus on one‐on‐one patient care in office‐based settings, whereas nurses in alternate payment plans practices work more independently, in a wider range of settings and with emphasis on both individual and group‐based encounters. Compared with alternate payment plans practices, fee‐for‐service practices tend to be more restrictive due to physician billing requirements.

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

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

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

BackgroundThe increase in the number of chronically ill patients due to ageing is calling existing models of primary care (PC) into question. New care models have recently been implemented in Swiss PC and involve interprofessional teams. This paper aimed to investigate the practice of interprofessional collaboration between advanced practice nurses, registered nurses, and medical practice assistants within new models of PC in Switzerland using the National Interprofessional Competency Framework.MethodsAn ethnographic design comprising semi-structured interviews and non-participant observations was conducted. Sixteen interviews were conducted with care providers at their PC 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.ResultsOur analysis of interview and observational data 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 PC. 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 PC.ConclusionFrom the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss PC 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.

Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention

ProblemA recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care. BackgroundPreconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain. Aim and methodsThe aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women’s health and obesity prevention. DiscussionWhile several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk. ConclusionThere is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.

Addressing Substance Use in Adolescents: Screening, Brief Intervention, and Referral to Treatment

Adolescent substance use is a national public health crisis. The most commonly used substances among adolescents are nicotine, alcohol, and marijuana. Use of these substances during adolescence has serious adverse effects on brain development, with impairments that can endure into adulthood. Advanced practice nurses in primary care can address substance use in the adolescent population with the use of evidence-based interventions, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). This article describes trends in adolescent substance use and use of the SBIRT intervention for low, medium, and high-risk use in this population.

Active participation of patients with type 2 diabetes in consultations with their primary care practice nurses \u2013 what helps and what hinders: a qualitative study

BackgroundPatients with type 2 diabetes mellitus (T2DM) receiving primary care regularly visit their practice nurses (PNs). By actively participating during medical consultations, patients can better manage their disease, improving clinical outcomes and their quality of life. However, many patients with T2DM do not actively participate during medical consultations. To understand the factors affecting engagement of patients with T2DM, this study aimed to identify factors that help or hinder them from actively participating in consultations with their primary care PNs.MethodsTwo semi-structured focus groups and 12 semi-structured individual interviews were conducted with patients with T2DM (n = 20) who were undergoing treatment by primary care PNs. All interviews were transcribed verbatim and analyzed using a two-step approach derived from the context-mapping framework.ResultsFour factors were found to help encourage patients to actively participate in their consultation: developing trusting relationships with their PNs, having enough time in the appointment, deliberately preparing for consultations, and allowing for the presence of a spouse. Conversely, four factors were found to hinder patients from participating during consultations: lacking the need or motivation to participate, readjusting to a new PN, forgetting to ask questions, and ineffectively expressing their thoughts.ConclusionPatients lacked the skills necessary to adequately prepare for a consultation and achieve an active role. In addition, patients’ keen involvement appeared to benefit from a trusting relationship with their PNs. When active participation is impeded by barriers such as a lack of patient’s skills, facilitators should be introduced at an early stage.Trial registrationCurrent Controlled Trials NTR4693 (July 16, 2014).

Integrating Care: Developing a Primary Care Chronic Heart Failure Disease Management Program - a Tertiary Hospital/General Practice Partnership

Background: Patients with chronic heart failure (CHF) require regular assessment, monitoring and self-care support. Clinical care is predominantly delivered by general practitioners (GP), cardiologists, and hospital and community based CHF disease management programs (DMP) which although effective, reach only 20% of patients discharged from hospital. To improve accessibility, there have been calls for the development of primary care based CHF DMP. In support of this proposal, there is evidence to suggest primary care practice nurses (PN) are well placed to contribute to the clinical management of stable chronic disease. Aim: To develop a primary care based CHF DMP through a joint partnership between hospital and general practice clinicians. Method: GPs and PNs from six (6) general practices partnered with tertiary hospital based specialist CHF clinicians over a 12-month period to develop a primary care based CHF DMP. Results: Opportunities and barriers were identified and solutions implemented to inform a primary care based CHF DMP. Barriers included identification of CHF patients, limited resources to support self-care and limited scope of practice and professional support for practice nurses. Opportunities and solutions included standardising disease coding, incorporating an assessment and monitoring template within electronic patient management systems, identifying opportunities to expand the role of the practice nurse, development of self-care support resources and improved communication with hospital based CHF DMPs. Conclusion: Partnerships between hospital and primary care based clinicians can inform the development of a practice nurse supported primary care based CHF CDM to improve clinical management and support care integration.

Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England.

The incorporation of Human papillomavirus (HPV) testing into the English cervical screening programme has been met with fear and anxiety. Healthcare professionals need to be adequately informed about HPV to help alleviate patient concerns. The aim of this study was to evaluate the HPV training provided to practice nurses (PNs) and determine their level of HPV knowledge. A web-based survey was distributed to 147 General Practice surgeries in the Leicester, Leicestershire and Rutland regions, between May and July 2015. The survey explored four broad areas; demographics/level of experience, HPV knowledge, attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. A total of 128 surveys were completed, with 94 complete responses. Overall awareness of basic HPV facts was adequate; however, detailed, and in some cases basic, knowledge was lacking. 9.6% failed to identify that HPV can cause cervical cancer and 62.8% believed that HPV requires treatment. Not all PNs felt adequately informed about HPV and a need to improve the provision of training was identified. PNs play a key role in increasing public awareness of HPV and implementing cervical cancer screening. The provision of education to PNs needs to be a priority and current methods of training need to be re-evaluated.

Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14

SummaryBackgroundPrimary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK.MethodsWe did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis.FindingsThe dataset comprised 101 818 352 consultations and 20 626 297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007–08, to 5·16 in 2013–14. Consultation rates were highest in infants (age 0–4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10 000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64–8·65) to 9·22 min (9·22–9·23), and overall workload increased by 16%.InterpretationOur findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally.FundingDepartment of Health Policy Research Programme.

"It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care.

BackgroundPhysical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations.MethodsSemi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFive key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of ‘pre-trial’ and ‘delivery of the intervention’. Two additional ‘post-trial’ themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging.ConclusionDelivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting.Trial registrationPACE-Lift ISRCTN 42122561, PACE-UP ISRCTN 98538934.

A systematic review and comparison of functional assessments of community-dwelling elderly patients.

To provide advanced practice nurses in primary care with information about self-reported functional assessments and physical performance-based functional assessments of geriatric patients living alone within the community at greatest risk of functional decline. Databases searched include CINAHL, Healthsource: Nursing/Academic Edition, MEDLINE, PsycINFO, PsycARTICLES, Cochrane Library, and National Clearinghouse Guidelines. The review was limited to English, research, and the years 2000-2014. Key search words included geriatric, community-dwelling, functional assessment, activities and instrumental activities of daily living, Barthel Index, Katz Index, Lawton Scale, Vulnerable Elders Survey, Timed Up and Go Test, Gait Speed Test, Functional Reach Test, and primary care. Forty-three million individuals, age 65 and older, are currently living in the United States with numbers expected to double by 2050. Nurse practitioners will be at the forefront of assessing for functional decline and can use tools such as the Barthel Index and Gait Speed Test to improve elderly outcomes. Self-reported functional questionnaires and physical functional performance tests can quickly be completed in the office to track the risk of functional decline over time. Interventions, such as physical therapy or other community resources, can be initiated when needed to reduce negative outcomes of functional decline.

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

Objective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions.Design Cluster randomised controlled trial.Setting 36 general practices in the north...

To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review.

BackgroundIn this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care.MethodsMultiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers.ResultsEspecially in the last three years, many studies have been published. The majority of the studies were positive about PNs’ actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs’ role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this.ConclusionThe PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-014-0197-2) contains supplementary material, which is available to authorized users.

Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study.

To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined. In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05. PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A's, were stronger related to communication styles than patient characteristics. PNs reasonably complied with the Five A's Model. The quality of PNs' weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.