Integration of nurses in general practice: A thematic synthesis of the perspectives of general practitioners, practice nurses and patients living with chronic illness.
chronic disease
clinical competence
general practice
general practitioners
interprofessional relations
nurse practitioners
nurse's role
patient-centred care
primary health care
qualitative research
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
09
04
2019
revised:
10
09
2019
accepted:
20
10
2019
pubmed:
13
11
2019
medline:
4
3
2020
entrez:
13
11
2019
Statut:
ppublish
Résumé
To explore the views of general practitioners, practice nurses and patients on interprofessional collaboration in general practice and to understand to what extent the nurse-doctor relationship meets their needs and expectations. To address future challenges of primary health care, there is a need for integrated interprofessional collaboration care systems with a patient-centred focus. Worldwide, there is an integration of nurses in general practice. However, in a transitioning Belgian context little is known about the perspectives of three key stakeholder groups. The results of four qualitative descriptive primary studies were triangulated and a secondary analysis resulted in a thematic synthesis within a pragmatic research paradigm. Primary data were collected through individual, semi-structured interviews with 7 general practitioners, 19 practice nurses and 21 patients living with chronic illness in 26 primary care centres with different nurse integration levels. We conducted a secondary analysis for the thematic synthesis of the different stakeholders' perspectives. This study was reported in accordance with the COREQ checklist. Four overarching themes were found as follows: vision and mission at general practice level, patient-centred care, practice nurse role development and interprofessional collaboration. Interprofessional collaboration within general practice ensures better response to patient needs. Evolution of the practice nurse role to autonomous decision-making can be facilitated by clear vision and mission, team communication, complementarity of responsibilities and trust-based professional relationships. The key for patient-centred care in a well-organised practice is a clear vision and mission and well-defined task description for interprofessional collaboration. General practice is urging for systematic guidance for the sustainable integration of a practice nurse. Our study highlights opportunities and challenges to nurse integration in general practice from key stakeholders' perspectives, which can inform other transitioning contexts.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
To explore the views of general practitioners, practice nurses and patients on interprofessional collaboration in general practice and to understand to what extent the nurse-doctor relationship meets their needs and expectations.
BACKGROUND
BACKGROUND
To address future challenges of primary health care, there is a need for integrated interprofessional collaboration care systems with a patient-centred focus. Worldwide, there is an integration of nurses in general practice. However, in a transitioning Belgian context little is known about the perspectives of three key stakeholder groups.
DESIGN
METHODS
The results of four qualitative descriptive primary studies were triangulated and a secondary analysis resulted in a thematic synthesis within a pragmatic research paradigm.
METHODS
METHODS
Primary data were collected through individual, semi-structured interviews with 7 general practitioners, 19 practice nurses and 21 patients living with chronic illness in 26 primary care centres with different nurse integration levels. We conducted a secondary analysis for the thematic synthesis of the different stakeholders' perspectives. This study was reported in accordance with the COREQ checklist.
RESULTS
RESULTS
Four overarching themes were found as follows: vision and mission at general practice level, patient-centred care, practice nurse role development and interprofessional collaboration. Interprofessional collaboration within general practice ensures better response to patient needs. Evolution of the practice nurse role to autonomous decision-making can be facilitated by clear vision and mission, team communication, complementarity of responsibilities and trust-based professional relationships.
CONCLUSIONS
CONCLUSIONS
The key for patient-centred care in a well-organised practice is a clear vision and mission and well-defined task description for interprofessional collaboration. General practice is urging for systematic guidance for the sustainable integration of a practice nurse.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
Our study highlights opportunities and challenges to nurse integration in general practice from key stakeholders' perspectives, which can inform other transitioning contexts.
Types de publication
Journal Article
Langues
eng
Pagination
251-264Informations de copyright
© 2019 John Wiley & Sons Ltd.
Références
Afzali, H. H. A., Karnon, J., Beilby, J., Gray, J., Holton, C., & Banham, D. (2014). Practice nurse involvement in general practice clinical care: Policy and funding issues need resolution. Australian Health Review, 38, 301 https://doi.org/10.1071/AH13187
Ball, J., Maben, J., & Griffiths, P. (2015). Practice nursing: What do we know? British Journal of General Practice, 65(630), 10-11. https://doi.org/10.3399/bjgp15X683041
Belgian Health Care Knowledge Centre (2012). Position paper: Organisation of care for chronic patients in Belgium (KCE Reports 190A). Brussels: Retrieved from https://kce.fgov.be/sites/default/files/atoms/files/KCE_190C_organisation_care_chronic_patients_Position%20Paper_0.pdf
Brault, I., Kilpatrick, K., D’Amour, D., Contandriopoulos, D., Chouinard, V., Dubois, C.-A., … Beaulieu, M.-D. (2014). Role clarification processes for better integration of nurse practitioners into primary healthcare teams: A multiple-case study. Nursing Research and Practice, 2014, 170514. https://doi.org/10.1155/2014/170514
Chan, B. C., Perkins, D., Wan, Q., Zwar, N., Daniel, C., Crookes, P., & Harris, M. F. (2010). Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals. International Journal for Quality in Health Care, 22(6), 519-524. https://doi.org/10.1093/intqhc/mzq057
Charafeddine, R., Demarest, S., Drieskens, S., Gisle, L., Tafforeau, J., & Van der Heyden, J. (2011). Highlights of the Belgian HEALTH INTERVIEW SURVEY 2008. Retrieved from https://his.wiv-isp.be/Shared%20Documents/Summary_2008.pdf
Clark, L. (2008). Clinical leadership: values, beliefs and vision. Nursing Management (Harrow, London, England: 1994), 15, 30-35. https://doi.org/10.7748/nm2008.11.15.7.30.c6807
Contandriopoulos, D., Brousselle, A., Dubois, C.-A., Perroux, M., Beaulieu, M.-D., Brault, I., … Sansgter-Gormley, E. (2015). A process-based framework to guide nurse practitioners integration into primary healthcare teams: Results from a logic analysis. BMC Health Services Research, 15(1), 78. https://doi.org/10.1186/s12913-015-0731-5
Creswell, J. W., & Clark, V. L. P. (2011). Designing and Conducting Mixed Methods Research (2nd ed.). Los Angeles: SAGE Publications.
Dini, L., Sarganas, G., Boostrom, E., Ogawa, S., Heintze, C., & Braun, V. (2012). German GPs' willingness to expand roles of physician assistants: A regional survey of perceptions and informal practices influencing uptake of health reforms in primary health care. Family Practice, 29(4), 448-454. https://doi.org/10.1093/fampra/cmr127
Fabrellas, N., Sánchez, C., Juvé, E., Aurin, E., Monserrat, D., Casanovas, E., & Urrea, M. (2013). A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care. BMC Family Practice, 14, 61-61. https://doi.org/10.1186/1471-2296-14-61
Fortin, M., Hudon, C., Haggerty, J., van den Akker, M., & Almirall, J. (2010). Prevalence estimates of multimorbidity: A comparative study of two sources. BMC Health Services Research, 10(1), 111. https://doi.org/10.1186/1472-6963-10-111
Freund, T., Everett, C., Griffiths, P., Hudon, C., Naccarella, L., & Laurant, M. (2015). Skill mix, roles and remuneration in the primary care workforce: Who are the healthcare professionals in the primary care teams across the world? International Journal of Nursing Studies, 52(3), 727-743. https://doi.org/10.1016/j.ijnurstu.2014.11.014
Gielen, S. C., Dekker, J., Francke, A. L., Mistiaen, P., & Kroezen, M. (2014). The effects of nurse prescribing: A systematic review. International Journal of Nursing Studies, 51(7), 1048-1061. https://doi.org/10.1016/j.ijnurstu.2013.12.003
Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of Advanced Nursing, 73(8), 1958-1969. https://doi.org/10.1111/jan.13274
Jakimowicz, M., Williams, D., & Stankiewicz, G. (2017). A systematic review of experiences of advanced practice nursing in general practice. BMC Nursing, 16(1), 6. https://doi.org/10.1186/s12912-016-0198-7
Jonker, C. M., van Riemsdijk, M. B., & Vermeulen, B. (2011). Shared Mental Models. Paper presented at the Coordination, Organizations, Institutions, and Norms in Agent Systems VI, Berlin, Heidelberg.
Kringos, D., Boerma, W., Bourgueil, Y., Cartier, T., Dedeu, T., Hasvold, T., … Groenewegen, P. (2013). The strength of primary care in Europe: An international comparative study. British Journal of General Practice, 63(616), e742-750. https://doi.org/10.3399/bjgp13X674422
Kringos, D. S., Boerma, W. G. W., Hutchinson, A., Allen Saltman, R. B., & Richard, B. (2015). Building primary care in a changing Europe: Case studies (9789264285064). Copenhagen (Denmark) Retrieved from https://apps.who.int/iris/handle/10665/170391
Kringos, D. S., Boerma, W., van der Zee, J., & Groenewegen, P. (2013). Europe's strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood), 32(4), 686-694. https://doi.org/10.1377/hlthaff.2012.1242
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018). Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews, 7, Cd001271. https://doi.org/10.1002/14651858.CD001271.pub3
Lewin, S., Booth, A., Glenton, C., Munthe-Kaas, H., Rashidian, A., Wainwright, M., … Noyes, J. (2018). Applying GRADE-CERQual to qualitative evidence synthesis findings: Introduction to the series. Implementation Science, 13(1), 2. https://doi.org/10.1186/s13012-017-0688-3
Mahomed, R., St John, W., & Patterson, E. (2012). Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice. Journal of Advanced Nursing, 68(11), 2538-2549. https://doi.org/10.1111/j.1365-2648.2012.05953.x
Martin, J., McCormack, B., Fitzsimons, D., & Spirig, R. (2014). The importance of inspiring a shared vision. International Practice Development Journal, 4(2), 1-15.
Martínez-González, N. A., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing, M., & Rosemann, T. (2014). Substitution of physicians by nurses in primary care: A systematic review and meta-analysis. BMC Health Services Research, 14(1), 214. https://doi.org/10.1186/1472-6963-14-214
Martínez-González, N. A., Tandjung, R., Djalali, S., & Rosemann, T. (2015). The impact of physician-nurse task shifting in primary care on the course of disease: A systematic review. Human Resources for Health, 13(1), 55. https://doi.org/10.1186/s12960-015-0049-8
Matthys, E., Remmen, R., & Van Bogaert, P. (2017). An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: What can we learn in primary care? BMC Family Practice, 18(1), 110. https://doi.org/10.1186/s12875-017-0698-x
Matthys, E., Remmen, R., & Van Bogaert, P. (2019). Practice nurse support and task suitability in a general practice: A cross-sectional survey in Belgium. Journal of Interprofessional Care, 33(6), 661-669. https://doi.org/10.1080/13561820.2019.1569602
Matthys, J., Elwyn, G., Van Nuland, M., Van Maele, G., De Sutter, A., De Meyere, M., & Deveugele, M. (2009). Patients' ideas, concerns, and expectations (ICE) in general practice: Impact on prescribing. British Journal of General Practice, 59(558), 29-36. https://doi.org/10.3399/bjgp09X394833
McInnes, S., Peters, K., Bonney, A., & Halcomb, E. (2015). An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing, 71(9), 1973-1985. https://doi.org/10.1111/jan.12647
Parker, D., Maresco-Pennisi, D., Clifton, K., Shams, R., & Young, J. (2016). Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: Results from a systematic review. International Journal of Evidence-Based Healthcare, 14(2), 41-52. https://doi.org/10.1097/xeb.0000000000000080
OECD/European Observatory on Health Systems and Policies. (2017). Belgium: Country Health Profile 2017. In State of Health in the EU. Paris: OECD Publishing.
Riisgaard, H., Nexoe, J., Le, J. V., Sondergaard, J., & Ledderer, L. (2016). Relations between task delegation and job satisfaction in general practice: A systematic literature review. BMC Family Practice, 17(1), 168. https://doi.org/10.1186/s12875-016-0565-1
Roland, M., & Nolte, E. (2014). The future shape of primary care. British Journal of General Practice, 64(619), 63-64. https://doi.org/10.3399/bjgp14X676960
Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review. BMC Family Practice, 14(1), 132. https://doi.org/10.1186/1471-2296-14-132
Sroczynski, M., & Dunphy, L. M. (2012). Primary care nurse practitioner clinical education: Challenges and opportunities. Nursing Clinics of North America, 47(4), 463-479. https://doi.org/10.1016/j.cnur.2012.08.001
Supper, I., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y., & Letrilliart, L. (2015). Interprofessional collaboration in primary health care: A review of facilitators and barriers perceived by involved actors. Journal of Public Health (Oxf), 37(4), 716-727. https://doi.org/10.1093/pubmed/fdu102
Tacconelli, E. (2010). CRD's guidance for undertaking reviews in health care. Lancet Infectious Diseases, 10, 226-226. https://doi.org/10.1016/S1473-3099(10)70065-7
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042
Vrijens, F., Françoise, R., Cécile, C., Anja, D., Cécile, D., Pascale, J., Pascal, M. (2015). Performance of the Belgian Health System - Report 2015 (D/2016/10.273/03). Brussels: Retrieved from https://kce.fgov.be/sites/default/files/page_documents/KCE_259C_performancereport2015.pdf
Walker, L., Clendon, J., & Nelson, K. (2015). Nursing roles and responsibilities in general practice: Three case studies. Journal of Primary Health Care, 7(3), 236-243. https://doi.org/10.1071/HC15236
Wallyn, S., & Massant, D. (2017). Reorganise primary care in Flanders Region: Change management and process 2010-2017. International Journal of Integrated Care, 17(5), 270. https://doi.org/10.5334/ijic.3581
Watts, S. A., & Lucatorto, M. (2014). A review of recent literature - nurse case managers in diabetes care: equivalent or better outcomes compared to primary care providers. Current Diabetes Reports, 14(7), 504 https://doi.org/10.1007/s11892-014-0504-2
Wen, J., & Schulman, K. A. (2014). Can team-based care improve patient satisfaction? A systematic review of randomized controlled trials. PLoS ONE, 9(7), e100603. https://doi.org/10.1371/journal.pone.0100603
Wilson, V. (2014). Research methods: Triangulation. Evidence Based Library and Information Practice, 9(1), 74-75. https://doi.org/10.18438/B8WW3X
World Health Organization (2010). Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: World Health Organization Press.
World Health Organization (2013). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf;jsessionxml:id=E960247D9234E092B0E4A762ADFACC8A?sequence=1
World Health Organization (2018). Facts Sheet: Noncommunicable diseases. Retrieved from http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
World Health Organization (2018). Facts Sheet: Primary Health Care. Retrieved from http://www.who.int/news-room/fact-sheets/detail/primary-health-care
Young, J., Eley, D., Patterson, E., & Turner, C. (2016). A nurse-led model of chronic disease management in general practice: Patients' perspectives. Australian Family Physician, 45(12), 912-916.