Enhanced primary care provided by a nurse practitioner candidate to aged care facility residents: A mixed methods study

Craswell, Alison; Wallis, Marianne; Coates, Kaye; Marsden, Elizabeth; Taylor, Andrea; Broadbent, Marc; Nguyen, Kim‐Huong; Johnston-Devin, Colleen; Glenwright, Amanda; Crilly, Julia

doi:10.1016/j.colegn.2019.08.009

Cited by 10 publications

(10 citation statements)

References 28 publications

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“…This, in turn, helped care partners move forward in accepting the impending EOL. Findings from our study correlate with other studies that demonstrated an increase in ACP discussion where NPs were involved in the residents' care team [20][21][22], with one study showing a 300% increase in the number of residents with ACP discussions [20]. Similar to the findings in our study, Campbell and colleagues also found that NPs were part of the collective approach in ensuring residents were frequently assessed, especially those in the last stage of their life [43].…”

Section: Discussionsupporting

confidence: 90%

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Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic

Vellani

Boscart

Escrig-Piñol

et al. 2021

JPM

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Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.

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Section: Discussionsupporting

confidence: 90%

“…Empirical evidence demonstrates that palliative care provided by NPs in various settings was effective in improving persons' emotional and mental wellbeing as well as their quality of life [19]. NPs also increase ACP [20][21][22] and provide effective management of EOL symptoms [23,24].…”

Section: Introductionmentioning

confidence: 99%

Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic

Vellani

Boscart

Escrig-Piñol

et al. 2021

JPM

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“…Overall care. Three studies evaluated the addition of a NP in collaboration with the primary care physician (median: n = 101, range: 45 to 325) compared to usual/standard care [40,41], or internal or external control medication review meetings [42] (median: n = 135, range: 99 to 1,056). One study reported an improved quality of life [40], and there were mixed results across the three studies regarding ED transfers.…”

Section: Main Findings-healthcare Services Deliverymentioning

confidence: 99%

Models of provider care in long-term care: A rapid scoping review

et al. 2021

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Introduction One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents. Methods We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer. Results A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory. Conclusion Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.

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“…By contrast, acute models [eg Residential In-Reach (RIR) or hospital in the nursing home] models provide acute care within RAC as a substitute for emergency presentation or hospitalization, to ease the growing demands on hospital services 14 , 17 , 18 , 19 , 20 , 21 , 22 ; others (eg, enhanced primary care) also demonstrate corollary benefits such as opportunistic advance care planning and RAC staff education. 22 …”

mentioning

confidence: 99%

“…15,16 By contrast, acute models [eg Residential In-Reach (RIR) or hospital in the nursing home] models provide acute care within RAC as a substitute for emergency presentation or hospitalization, to ease the growing demands on hospital services 14,17e22 ; others (eg, enhanced primary care) also demonstrate corollary benefits such as opportunistic advance care planning and RAC staff education. 22 This study reports service data for a tertiary referral hospital in Melbourne, Australia. Our hospital's RIR service was established in 2009 and restructured in 2014.…”

mentioning

confidence: 99%

Integration of Inpatient and Residential Care In-Reach Service Model and Hospital Resource Utilization: A Retrospective Audit

Kwa

Storer

et al. 2021

Journal of the American Medical Directors Association

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Objective In parts of Australia, Residential In-Reach (RIR) services have been implemented to treat residential aged care (RAC) residents for acute conditions in their place of residence to avoid preventable hospital presentation. Our service was initiated in 2009 and restructured in 2014. We compared acute healthcare resource utilization (RIR activity and emergency hospital presentations) by RAC residents under 2 RIR models of care. Design Acute RAC RIR service model of care was changed from existing nurse/emergency physician-led service to nurse/geriatrician-led service and incorporate inpatient liaison nurse consultant into the team. Setting RAC episodes and hospital presentations from a single tertiary referral hospital and its associated RAC RIR service. Methods Retrospective audit comparing RIR activity, hospital presentations, and associated costs from 2 12-month periods, prior to and postimplementation. Data were expressed as a proportion of the total number of RAC beds in the hospital RIR catchment. Results After implementation of the new model of care, RIR episodes of care increased from 589 to 985 (15.3 vs 24.7 episodes/100 RAC beds, P < .001). Emergency department (ED) presentations fell from 1616 to 1478 (41.9 vs 37.2 presentations/100 RAC beds, P < .001). There were fewer unplanned ED presentations by RIR patients (2.4% vs 0.8%, = 0.03) and fewer 28-day ED re-presentations (16.8% vs 13.7%, P = .01) under the new model of care. ED cost [$AUD 30,830 vs $28,030/100 RAC beds ($USD 21,344 vs $19,407), P < .001] and inpatient admission costs [$145,607 vs $117,531/100 RAC beds ($USD 100,814 vs $81,380), P < .001] were each lower in the second period. Conclusions and Implications In the 12 months following implementation of the new model of care, an increase in RIR activity, and a decrease in ED presentations was observed. Further research is necessary to validate these retrospective findings and better evaluate clinical outcomes and consumer satisfaction of the service.

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Enhanced primary care provided by a nurse practitioner candidate to aged care facility residents: A mixed methods study

Cited by 10 publications

References 28 publications

Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic

Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic

Models of provider care in long-term care: A rapid scoping review

Integration of Inpatient and Residential Care In-Reach Service Model and Hospital Resource Utilization: A Retrospective Audit

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