Advanced practice profiles and work activities of nurse navigators: An early-stage evaluation

Spooner, Amy J.; Booth, Natasha; Downer, Tai-Rae; Gordon, Louisa G.; Hudson, Adrienne; Bradford, Natalie; O’Donnell, Chris; Geary, Alanna; Henderson, Robyn; Franks, C.; Conway, Aaron; Yates, Patsy; Chan, Raymond Javan

doi:10.1016/j.colegn.2018.05.003

Cited by 14 publications

(19 citation statements)

References 21 publications

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“…They acted as both an educational resource, care coordinator, and emotional support, facilitating a sense of empowerment and security within families. This finding is consistent with the literature describing the role of nurses in supporting seamless discharge from hospital to home [36,37]. Similar to other studies, parents in this case sample also identified other parents as an important source of support [38].…”

Section: Discussionsupporting

confidence: 92%

Improving transitions in care for children with complex and medically fragile needs: a mixed methods study

2020

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Background: Children with medical complexity are a small yet resource intensive population in the Canadian health care system. The process for discharging these children from hospital to home is not yet optimal. The overall goal of this project was to develop recommendations to be included in a provincial strategy to support transitions in care for children with complex and medically fragile needs. Methods: A wide assortment of stakeholders participated in this mixed method, multiphase project. During Phase 1, data was gathered from a range of sources to document families' experiences transitioning from an inpatient hospital stay back to their home communities. In Phase 2, pediatricians, nurses, and health administrators participated in key stakeholder interviews to identify barriers and facilitators to a successful transition in care for children and families with complex care needs. A multi-sector consensus meeting was held during Phase 3 to discuss study findings and refine key recommendations for inclusion in a provincial strategy. Results: Six case studies were developed involving children and families discharged home with a variety of complex care needs. Children ranged in age from 15 days to 9 years old. Nine telephone interviews were conducted in Phase 2 with pediatricians, nurses, and administrators from across the province. A variety of interinstitutional communication challenges were described as a major barrier to the transition process. A consistent message across all interviews was the need for improved coordination to facilitate transitions in care. The consensus meeting to review study findings included physicians, nurses, paramedics, senior administrators, and policy analysts from different health and government sectors and resulted in six recommendations for inclusion in a provincial strategy. Conclusions: This project identified policy and practice gaps that currently exist related to transitions in care for children with complex and medically fragile needs and their families. Our collaborative patient-centred approach to understanding how children and families currently navigate transitions in care provided a foundation for developing recommendations for a provincial wide strategy.

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Section: Discussionsupporting

confidence: 92%

Improving transitions in care for children with complex and medically fragile needs: a mixed methods study

2020

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“…The NNs were experienced registered nurses (most had > 11 years’ experience) and approximately half had post-graduate qualifications (Spooner et al , 2018). At the time of this study, 29 NNs were employed at the participating Hospital and Health Services districts.…”

Section: Methodsmentioning

confidence: 99%

Do nurse navigators bring about fewer patient hospitalisations?

Gordon

Spooner

Booth

et al. 2019

JHOM

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Purpose Nurse navigators (NNs) coordinate patient care, improve care quality and potentially reduce healthcare resource use. The purpose of this paper is to undertake an evaluation of hospitalisation outcomes in a new NN programme in Queensland, Australia. Design/methodology/approach A matched case-control study was performed. Patients under the care of the NNs were randomly selected (n=100) and were matched to historical (n=300) and concurrent (n=300) comparison groups. The key outcomes of interest were the number and types of hospitalisations, length of hospital stay and number of intensive care unit days. Generalised linear and two-part models were used to determine significant differences in resources across groups. Findings The control and NN groups were well matched on socio-economic characteristics, however, groups differed by major disease type and number/type of comorbidities. NN patients had high healthcare needs with 53 per cent having two comorbidities. In adjusted analyses, compared with the control groups, NN patients showed higher proportions of preventable hospitalisations over 12 months, similar days in intensive care and a smaller proportion had overnight stays in hospital. However, the NN patients had significantly more hospitalisations (mean: 6.0 for NN cases, 3.4 for historical group and 3.2 for concurrent group); and emergency visits. Research limitations/implications As many factors will affect hospitalisation rates beyond whether patients receive NN care, further research and longer follow-up is required. Originality/value A matched case-control study provides a reasonable but insufficient design to compare the NN and non-NN exposed patient outcomes.

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“…Nurse navigators do not remove the responsibility of the specialist team but rather bring together numerous clinicians to pay attention to the needs of the patient as an individual (Owczarzack et al, 2016;Harvey et al, 2017). During the pilot stage of the specific navigator program of Queensland, NNs were found to assist in streamlining care while also developing a relationship with the patient that increased the supporting mechanisms including valuing, improving health literacy and patient coping skills (Spooner et al, 2018).…”

Section: Person-centredmentioning

confidence: 99%

“…In 2016, the Nurse Navigator (NN) program was introduced to Queensland Health, with funding guaranteed for four years (Queensland Health, 2018b;Spooner et al, 2018). This nurse-led program focuses on coordinating care services for people with chronic and complex health conditions across specialty services (Queensland Health, 2018b).…”

Section: Introductionmentioning

confidence: 99%

Person-centred rhetoric in chronic care: a review of health policies

Sobolewska

Byrne

Harvey

et al. 2020

JHOM

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PurposeThe purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.Design/methodology/approachA qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.FindingsAlthough the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.Research limitations/implicationsGiven that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.Practical implicationsThis research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.Originality/valueGiven the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

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Advanced practice profiles and work activities of nurse navigators: An early-stage evaluation

Cited by 14 publications

References 21 publications

Improving transitions in care for children with complex and medically fragile needs: a mixed methods study

Improving transitions in care for children with complex and medically fragile needs: a mixed methods study

Do nurse navigators bring about fewer patient hospitalisations?

Person-centred rhetoric in chronic care: a review of health policies

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