Attitudes towards advanced nursing roles in primary dementia care - Results of an observational study in Germany.
Alzheimer's
advanced nursing practice
advanced nursing roles
collaborative care
delegation
dementia
general practitioner
nursing
substitution
tasks
Journal
Journal of advanced nursing
ISSN: 1365-2648
Titre abrégé: J Adv Nurs
Pays: England
ID NLM: 7609811
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
05
10
2020
received:
12
12
2019
accepted:
18
11
2020
pubmed:
12
12
2020
medline:
22
6
2021
entrez:
11
12
2020
Statut:
ppublish
Résumé
To demonstrate the attitudes of general practitioners (GPs), nurses, persons with dementia, and caregiver towards suitable tasks and qualification needs for and the acceptance and impact of advanced nursing roles in German dementia primary care. Observational study using a questionnaire survey with 225 GPs, 232 nurses, 211 persons with dementia, and 197 caregivers, conducted between December 2017-August 2018. A questionnaire was generated that includes specific assessment, prescription, and monitoring tasks of advanced nursing roles in dementia primary care as well as qualification requirements for and the acceptance and the impact of advanced nursing roles. Data were analysed using descriptive statistics. Group differences were assessed using the Fisher's exact test. Advanced nursing roles were highly appreciated across all groups. Assessment and monitoring tasks were rated as highly suitable, and prescription authorities as moderately suitable. Nurses felt less confident in assessment and monitoring, but more confident in prescribing as practitioners expected. Patients and caregivers would appreciate a takeover of tasks by nurses; nurses and practitioners preferred a delegation. A dementia-specific qualification was rated as best suitable for advanced nursing roles, followed by 'no specific qualification' if medical tasks that only can be carried out by practitioners were delegated and an academic degree if tasks were substituted. Advanced nursing roles were rated as beneficial, strengthening the confidence in nursing care and improving the cooperation between professionals and the treatment. Practitioners assumed that advanced nursing roles would improve job satisfaction of nurses, which was not confirmed by nurses. There is an extended consensus towards the enlargement of advanced nursing roles, represented by high endorsement, acceptance, and willingness to reorganize tasks. Results debunk the common notion that German practitioners would be reluctant towards advanced nursing roles and a takeover of current practitioner tasks, supporting the implementation of advanced nursing roles in Germany. 目的: 证明全科医师 (GP) 、护士、痴呆症患者和照料人员对德国痴呆症初级护理中高级护理角色的合适任务和资质需求、接受程度和影响的态度。 设计: 2017年12月至2018年8月期间, 采用问卷调查的方式, 对225名全科医师、232名护士、211名痴呆症患者和197名照料人员进行了观察性研究。 方法: 生成问卷调查表, 其内容包括痴呆症初级护理中高级护理角色的具体评价、处方和监测任务, 以及高级护理角色的资质要求、接受程度和影响。采用描述性统计进行数据分析。采用费希尔精确检验方式来评估组间差异。 结果: 所有群组均高度支持高级护理角色。评价和监测任务被评为高度合适, 且开处方权限被评为中等合适。在评价和监测方面, 护士缺乏信心, 但对医师所期望的处方工作更有信心。患者和照料人员对护士接管任务表示支持; 护士和执业医师更喜欢授权。对于高级护理角色, 特定于痴呆症的资格被评为最适合, 其次是‘无特定资格’ (如果医疗任务只能由执业医师执行, 则进行委托; 如果任务被替代, 则涉及学术学位) 。高级护理角色被评价为是有益的, 其增强了护理方面的信心, 提高了专业人员与治疗之间的协作。执业医师认为高级护理角色可以提高护士的工作满意度, 但这一点没有得到护士的证实。 结论: 我们对高级护理角色的扩大化有一个广泛共识, 这代表着我们对高级护理角色的高度认可、接受、以及重新安排任务的意愿。 影响: 研究结果推翻了德国执业医师不愿意从事高级护理角色和接管现有执业医师任务的普遍观念, 支持执行德国高级护理角色。.
Autres résumés
Type: Publisher
(chi)
目的: 证明全科医师 (GP) 、护士、痴呆症患者和照料人员对德国痴呆症初级护理中高级护理角色的合适任务和资质需求、接受程度和影响的态度。 设计: 2017年12月至2018年8月期间, 采用问卷调查的方式, 对225名全科医师、232名护士、211名痴呆症患者和197名照料人员进行了观察性研究。 方法: 生成问卷调查表, 其内容包括痴呆症初级护理中高级护理角色的具体评价、处方和监测任务, 以及高级护理角色的资质要求、接受程度和影响。采用描述性统计进行数据分析。采用费希尔精确检验方式来评估组间差异。 结果: 所有群组均高度支持高级护理角色。评价和监测任务被评为高度合适, 且开处方权限被评为中等合适。在评价和监测方面, 护士缺乏信心, 但对医师所期望的处方工作更有信心。患者和照料人员对护士接管任务表示支持; 护士和执业医师更喜欢授权。对于高级护理角色, 特定于痴呆症的资格被评为最适合, 其次是‘无特定资格’ (如果医疗任务只能由执业医师执行, 则进行委托; 如果任务被替代, 则涉及学术学位) 。高级护理角色被评价为是有益的, 其增强了护理方面的信心, 提高了专业人员与治疗之间的协作。执业医师认为高级护理角色可以提高护士的工作满意度, 但这一点没有得到护士的证实。 结论: 我们对高级护理角色的扩大化有一个广泛共识, 这代表着我们对高级护理角色的高度认可、接受、以及重新安排任务的意愿。 影响: 研究结果推翻了德国执业医师不愿意从事高级护理角色和接管现有执业医师任务的普遍观念, 支持执行德国高级护理角色。.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1800-1812Subventions
Organisme : Innovation Funds of the Federal Joint Committee (GBA)
ID : 01VSF16028
Informations de copyright
© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
Références
Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2016). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings and quality of care. BMJ Quality & Safety, 26(7), 559-568. https://doi.org/10.1136/bmjqs-2016-005567
Alzheimer's Disease International. (2015). Dementia statistics.
Applebaum, R., & Phillips, P. (1990). Assuring the quality of in-home care: The "other" challenge for long-term care. Gerontologist, 30(4), 444-450. https://doi.org/10.1093/geront/30.4.444
Arlt, S., Lindner, R., Rösler, A., & von Renteln-Kruse, W. (2008). Adherence to medication in patients with dementia: Predictors and strategies for improvement. Drugs and Aging, 25(12), 1033-1047. https://doi.org/10.2165/0002512-200825120-00005
Austrom, M. G., Carvell, C. A., Alder, C. A., Gao, S., Boustani, M., & LaMantia, M. (2016). Workforce development to provide person-centered care. Aging & Mental Health, 20(8), 781-792. https://doi.org/10.1080/13607863.2015.1119802
Black, B. S., Johnston, D., Rabins, P. V., Morrison, A., Lyketsos, C., & Samus, Q. M. (2013). Unmet needs of community-residing persons with dementia and their informal caregivers: Findings from the maximizing independence at home study. Journal of the American Geriatrics Society, 61(12), 2087-2095. https://doi.org/10.1111/jgs.12549
Bryant-Lukosius, D., & Dicenso, A. (2004). A framework for the introduction and evaluation of advanced practice nursing roles. Journal of Advanced Nursing, 48(5), 530-540. https://doi.org/10.1111/j.1365-2648.2004.03235.x
Bryant-Lukosius, D., DiCenso, A., Browne, G., & Pinelli, J. (2004). Advanced practice nursing roles: Development, implementation and evaluation. Journal of Advanced Nursing, 48(5), 519-529. https://doi.org/10.1111/j.1365-2648.2004.03234.x
Buchan, J., & Calman, L. (2005). Skill-mix and policy change in the health workforce. Nurses in Advanced Roles, 64. https://doi.org/10.1787/18152015
Bundesvereinigung, K. (2016). Deutschlandweite Projektion 2030 - Arztzahlentwicklung in Deutschland. National Association of Statutory Health Insurance Physicians.
Darmann-Finck, I. R. (2018). Qualität und Qualifikation: Schwerpunkt Akademisierung der Pflege. In K. K. Jacobs, A. Kulhmey, S. Greß, J. Klauber, & A. Schwinger (Eds.), Pflege-report 2018 (pp. 163-169). Springer.
Delamaire, M. G. L. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries. OECD Health Working Papers, p. 54.
Dreier, A. et al. (2015). Expectations, requirements and limitations of future task sharing between the nursing profession and the medical profession: Results from the Care-N Study M-V. Pflege, 28(5), 287-296.
Dreier, A., Thyrian, J. R., Eichler, T., & Hoffmann, W. (2016). Qualifications for nurses for the care of patients with dementia and support to their caregivers: A pilot evaluation of the dementia care management curriculum. Nurse Education Today, 36, 310-317. https://doi.org/10.1016/j.nedt.2015.07.024
Dreier-Wolfgramm, A., Michalowsky, B., Austrom, M. G., van der Marck, M. A., Iliffe, S., Alder, C., Vollmar, H. C., Thyrian, J. R., Wucherer, D., Zwingmann, I., & Hoffmann, W. (2017). Dementia care management in primary care: Current collaborative care models and the case for interprofessional education. Zeitschrift Fur Gerontologie Und Geriatrie, 50(Suppl. 2), 68-77. https://doi.org/10.1007/s00391-017-1220-8
Eichler, T., Thyrian, J. R., Dreier, A., Wucherer, D., Köhler, L., Fiß, T., Böwing, G., Michalowsky, B., & Hoffmann, W. (2014). Dementia care management: Going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. International Psychogeriatrics, 26(2), 247-256. https://doi.org/10.1017/S1041610213001786
Eichler, T., Thyrian, J. R., Fredrich, D., Köhler, L., Wucherer, D., Michalowsky, B., Dreier, A., & Hoffmann, W. (2014). The benefits of implementing a computerized intervention-management-system (IMS) on delivering integrated dementia care in the primary care setting. International Psychogeriatrics, 26(8), 1377-1385. https://doi.org/10.1017/S1041610214000830
Fitzmaurice, D. A., Moger, A., & Storey, K. (2015). General practice nursing: Revisited and reinvigorated. British Journal of General Practice, 65(639), e636-e637.
Galvin, J. E., Valois, L., & Zweig, Y. (2014). Collaborative transdisciplinary team approach for dementia care. Neurodegener Dis Manag, 4(6), 455-469. https://doi.org/10.2217/nmt.14.47
Hallberg, I. R., Cabrera, E., Jolley, D., Raamat, K., Renom-Guiteras, A., Verbeek, H., Soto, M., Stolt, M., & Karlsson, S. (2016). Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care. Dementia, 15(5), 931-957. https://doi.org/10.1177/1471301214548520
Hinkle, D. W. (2003). Applied statistics for the behavioral sciences. Houghton Mifflin College Division.
Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324(7341), 819-823. https://doi.org/10.1136/bmj.324.7341.819
Jakimowicz, M., Williams, D., & Stankiewicz, G. (2017). A systematic review of experiences of advanced practice nursing in general practice. BMC Nursing, 16, 6.
Jeschke, S. (2010). Die Rolle von akademischen Pfl egekräften in der direkten Patientenversorgung - Eine notwendige Entwicklung? Pflege, 63(1), 19-22.
Kajander-Unkuri, S., Meretoja, R., Katajisto, J., Saarikoski, M., Salminen, L., Suhonen, R., & Leino-Kilpi, H. (2014). Self-assessed level of competence of graduating nursing students and factors related to it. Nurse Education Today, 34(5), 795-801. https://doi.org/10.1016/j.nedt.2013.08.009
Karimi-Shahanjarini, A., Shakibazadeh, E., Rashidian, A., Hajimiri, K., Glenton, C., Noyes, J., Lewin, S., Laurant, M., & Colvin, C. J. (2019). Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: A qualitative evidence synthesis. Cochrane Database Systematic Review, 4, CD010412. https://doi.org/10.1002/14651858.CD010412.pub2
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. A. H. (2018). Nurses as substitutes for doctors in primary care. Cochrane Database Systematic Review, 7, CD001271. https://doi.org/10.1002/14651858.CD001271.pub3
Lehwaldt, D. (2013). Advanced practice nursing: Eine qualitativ hochwertige Versorgung. Praxisbeispiel Herz-Thoraxchirurgische. Pflege. PflegeLeben, 2(13), 14-18.
Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review: MCRR, 61(3), 332-351. https://doi.org/10.1177/1077558704266821
Lovink, M. H. et al. (2017). Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: Protocol for a realist evaluation case study. British Medical Journal Open, 7(6), e015134.
Lovink, M. H., Laurant, M. G., van Vught, A. J., Maassen, I., Schoonhoven, L., Persoon, A., & Koopmans, R. T. (2019). Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: A realist evaluation case study. British Medical Journal Open, 9(5), e028169.
Martin-Misener, R. et al. (2015). A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes. Journal of Clinical Nursing, 24(9-10), 1327-1337.
Michalowsky, B., Kaczynski, A., & Hoffmann, W. (2019). The economic and social burden of dementia diseases in Germany - A meta-analysis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. https://doi.org/10.1007/s00103-019-02985-z
Michalowsky, B., Xie, F., Eichler, T., Hertel, J., Kaczynski, A., Kilimann, I., Teipel, S., Wucherer, D., Zwingmann, I., Thyrian, J. R., & Hoffmann, W. (2019). Cost-effectiveness of a collaborative dementia care management - Results of a cluster-randomized controlled trial. Alzheimer's & Dementia, 15(10), 1296-1308. https://doi.org/10.1016/j.jalz.2019.05.008
Michalowsky, B., Xie, F., Kilimann, I., Teipel, S. J., Thyrian, R., & Hoffmann, W. (2019). Cost-effectiveness of a collaborative dementia care management - Results of a cluster-randomized controlled trial. Alzheimer's & Dementia, 15(7), P1637. https://doi.org/10.1016/j.jalz.2019.06.4881
Morgan, C., Barry, C., & Barnes, K. (2012). Master's programs in advanced nursing practice: New strategies to enhance course design for subspecialty training in neonatology and pediatrics. Advances in Medical Education and Practice, 3, 129-137.
Morilla-Herrera, J. C. et al. (2016). A systematic review of the effectiveness and roles of advanced practice nursing in older people. International Journal of Nursing Studies, 53, 290-307.
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W.-Y., Cleary, P. D., Friedewald, W. T., Siu, A. L., & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. The Journal of the American Medical Association, 283(1), 59-68. https://doi.org/10.1001/jama.283.1.59
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., & Karagiannidou, M. (2016). World Alzheimer report 2016. Improving healthcare for people living with dementia - Coverage, quality and costs now and in the future. AID.
Prince, M., Wimo, A., Guerchet, M., Ali, G-C., Wu, Y-T., & Prina, M. (2015). World Alzheimer Report 2015. The Global Impact of Dementia. An Analysis of Prevalence, Incidence, Cost and Trends.
Pulcini, J., Jelic, M., Gul, R., & Loke, A. Y. (2010). An international survey on advanced practice nursing education, practice and regulation. Journal of Nursing Scholarship, 42(1), 31-39. https://doi.org/10.1111/j.1547-5069.2009.01322.x
Reilly, S., Miranda-Castillo, C., Malouf, R., Hoe, J., Toot, S., Challis, D., & Orrell, M. (2015). Case management approaches to home support for people with dementia. Cochrane Database of Systematic Reviews, 1, CD008345. https://doi.org/10.1002/14651858.CD008345.pub2
Robinson, S. G. P. (2007). Nursing education and regulation: International profiles and perspectives. Retrieved from http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf
Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. (2007). Kooperation und Verantwortung - Voraussetzungen einer zielorientierten Gesundheitsversorgung. http://dipbt.bundestag.de/dip21/btd/16/063/1606339.pdf
Sastre-Fullana, P., De Pedro-Gómez, J. E., Bennasar-Veny, M., Serrano-Gallardo, P., & Morales-Asencio, J. M. (2014). Competency frameworks for advanced practice nursing: A literature review. International Nursing Review, 61(4), 534-542. https://doi.org/10.1111/inr.12132
Satu, K.-U., Leena, S., Mikko, S., Riitta, S., & Helena, L.-K. (2013). Competence areas of nursing students in Europe. Nurse Education Today, 33(6), 625-632. https://doi.org/10.1016/j.nedt.2013.01.017
Schober, M., & Affara, F. (2008). Advanced Nursing Practice (ANP). (S. de Geest & R. Spirig, Eds.). Verlag Hans Huber.
Sheer, B., & Wong, F. K. (2008). The development of advanced nursing practice globally. Journal of Nursing Scholarship, 40(3), 204-211. https://doi.org/10.1111/j.1547-5069.2008.00242.x
Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One, 12(2), e0170651. https://doi.org/10.1371/journal.pone.0170651
Somme, D., Trouve, H., Dramé, M., Gagnon, D., Couturier, Y., & Saint-Jean, O. (2012). Analysis of case management programs for patients with dementia: A systematic review. Alzheimer's & Dementia, 8(5), 426-436. https://doi.org/10.1016/j.jalz.2011.06.004
StataCorp. (2014). Stata statistical software: Release 13. StataCorp LP.
Sterne, J. A. et al. (2009). Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. British Medical Journal, 338, b2393.
Teleform Enterprise. (2013). Teleform - Datenerfassung. Electric Paper Informationssysteme GmbH.
Thyrian, J. R., Fiß, T., Dreier, A., Böwing, G., Angelow, A., Lueke, S., Teipel, S., Fleßa, S., Grabe, H. J., Freyberger, H. J., & Hoffmann, W. (2012). Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): Study protocol for a randomised controlled trial. Trials, 13, 56.
Thyrian, J. R., Hertel, J., Wucherer, D., Eichler, T., Michalowsky, B., Dreier-Wolfgramm, A., Zwingmann, I., Kilimann, I., Teipel, S., & Hoffmann, W. (2017). Effectiveness and safety of dementia care management in primary care: A randomized clinical trial. JAMA Psychiatry, 74(10), 996-1004. https://doi.org/10.1001/jamapsychiatry.2017.2124
Ullmann, P. L. D. (2013). Hochschulische Masterprogramme im Kontext der modernen Pflegebildung - die nationale Perspektive. I Darmann-Finck, M Hülsken-Giesler, Hrsg.
van den Berg, N., Meinke, C., Heymann, R., Fiß, T., Suckert, E., Pöller, C., Dreier, A., Rogalski, H., Karopka, T., Oppermann, R., & Hoffmann, W. (2009). AGnES: Supporting general practitioners with qualified medical practice personnel: Model project evaluation regarding quality and acceptance. Deutsches Ärzteblatt International, 106(1-2), 3-9.
Wimo, A., Guerchet, M., Ali, G.-C., Wu, Y.-T., Prina, A. M., Winblad, B., Jönsson, L., Liu, Z., & Prince, M. (2017). The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimer's & Dementia, 13(1), 1-7. https://doi.org/10.1016/j.jalz.2016.07.150
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction and cost in the emergency and critical care settings: A systematic review. Human Resources for Health, 15(1), 63.