A unique practice model for Nurse Practitioners in long‐term care homes

McAiney, Carrie; Haughton, Dilys; Jennings, Jane; Farr, Dave; Hillier, Loretta M.; Morden, Pat

doi:10.1111/j.1365-2648.2008.04628.x

Cited by 48 publications

(39 citation statements)

References 21 publications

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“…The majority of participants emphasized the value of the NP in helping to avoid unnecessary hospitalization, a finding confirmed in previous quantitative research [2,13-15]. Participants emphasized how not only were cost savings important, but so too was saving residents and their usually older family members from physical and emotional strain of unnecessary trips to the hospital.…”

Section: Discussionsupporting

confidence: 57%

“…Nurse practitioners (NPs) have provided services in some long term care (LTC) homes in the Unites States since the 1970s [1], in Canada since 2000 [2,3], and only recently in the United Kingdom [4]. This trend has helped address critical issues in LTC homes such as the increasing proportion of older residents with complex health problems, limited physician services, inadequate quality of care, and escalating healthcare costs [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

et al. 2013

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BackgroundResearch evidence supports the positive impact on resident outcomes of nurse practitioners (NPs) working in long term care (LTC) homes. There are few studies that report the perceptions of residents and family members about the role of the NP in these settings. The purpose of this study was to explore the perceptions of residents and family members regarding the role of the NP in LTC homes.MethodsThe study applied a qualitative descriptive approach. In-depth individual and focus group interviews were conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional content analysis was used to identify themes and sub-themes.ResultsTwo major themes were identified: NPs were seen as providing resident and family-centred care and as providing enhanced quality of care. NPs established caring relationships with residents and families, providing both informational and emotional support, as well as facilitating their participation in decision making. Residents and families perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary hospitalization.ConclusionsThe perceptions of residents and family members of the NP role in LTC are consistent with the concepts of person-centred and relationship-centred care. The relationships NPs develop with residents and families are a central means through which enhanced quality of care occurs. Given the limited use of NPs in LTC settings, there is an opportunity for health care policy and decision makers to address service inadequacies through strategic deployment of NPs in LTC settings. NPs can use their expert knowledge and skill to assist residents and families to make informed choices regarding their health care and maintain a positive care experience.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

et al. 2013

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“…The NPs delivering a nursing model of care situated within the HA service was instrumental in upskilling ACF staff (nursing and allied health) facilitating their confidence and ability to work to fulfil their scope of practice which in turn positively impacted on workplace satisfaction. Enhanced staff clinical confidence promoted earlier assessment and referral to the NP and ultimately HA, an observation reflected in other studies that report fewer hospital admissions when ACFs employ an NP [50]. …”

Section: Discussionmentioning

confidence: 96%

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service

Dwyer

Craswell

Rossi

et al. 2017

BMC Health Serv Res

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BackgroundReducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.MethodsDonabedian’s structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.ResultsStructural dimensions identified included the ‘in-reach’ nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.ConclusionsThis study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.

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“…[23,25,[32][33][34] However, the majority of studies to date examining the utility of an EPHR have been done in outpatient settings where there is often a complete absence of the type of nursing care plans required within acute and LTC environments. Unlike within an outpatient setting, within a LTC setting nurses assume a significant portion of the direct care requirements.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike within an outpatient setting, within a LTC setting nurses assume a significant portion of the direct care requirements. [32] It is possible that this finding may be specific to LTC only and may be linked to the increased role that nurses and particularly nurse practitioners assume over the clinical care of patients, [33] however given the paucity of research it is difficult to discern. Consistent with the current study findings, Thede (2009) identified that caregivers require very specific consideration when the elements of an EPHR are being constructed and indicated that nurses should play a very significant role in any EPHR development.…”

Section: Discussionmentioning

confidence: 99%

Family attitudes towards an electronic personal health record in a long term care facility

Nippak

Isaac

Geertsen

et al. 2015

JHA

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Objective: To explore the perceptions of family members regarding the importance of an electronic personal health record (EPHR) called MyChart as a healthcare information source to support the care of their loved ones within a long term care (LTC) facility in Toronto, Ontario. Methods: One hundred and fifty eight family members of the patients in six LTC units at the hospital were given a survey to determine their perceptions regarding the utility of the content items within an EPHR that was recently adopted by the LTC institution. Results: The response rate was 41% (n = 65). Many family members (n = 48) felt it was important to have access to their loved one's EPHR. Respondents ranked test results (38%; n = 25), doctor's clinical notes (26%; n = 17), medication lists (15%; n = 10) and upcoming appointments (11%; n = 7) as the number one most important content item that they would want to have access to. In addition to the standard content items found within an EPHR, family members requested electronic access to a variety of additional medical content items that are not currently offered within the EPHR, such as status alerts. Overall, they felt that an EPHR would enhance communication between the care team and the family, however 30% of family members identified concerns linked to security and confidentiality of the electronic health record information. Conclusions: Family members felt that an EPHR would be an important tool in the LTC facility to assist with information exchange between care providers and the family. It is important to consider that the additional information requested beyond what is traditionally found in an EPHR as well as the specific communication concerns raised, may be limited to a LTC setting.

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A unique practice model for Nurse Practitioners in long‐term care homes

Abstract: Practice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.

Cited by 48 publications

References 21 publications

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service

Family attitudes towards an electronic personal health record in a long term care facility

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