In primary care, a crossover of role boundaries between GPs and advanced nurse practitioners (ANPs) has led to a lack of role definition. This article analyses the findings from a study that attempted to define the distinctiveness of the ANP and GP roles. Two ANPs and two GPs from a training practice took part in the study. Consultations were recorded, transcribed and analysed using a qualitative methodology. Patient conversations were divided into six phases of the consultation: opening; history-taking; physical examination; diagnosis; management; and closing. Practitioner–patient interactions and behaviour were examined in each of the phases. Two typical extracts are highlighted: one between a GP and patient, and the other between an ANP and patient. ANPs interwove expert nursing skills throughout each interview, making their nursing identity clearly visible to patients. This study identified that GPs work in a different style to that of nurses, with ANPs working to diminish social distance from patients rather than creating it; this positions ANPs more in line with nursing than with medicine.
Until recently, workplace violence and aggression in health care had received little attention. Today, however, there are concerns about growing levels of violence towards health-care workers and in particular nurses. The government is now steadfast in tackling workplace violence and helping NHS staff to apply a zero tolerance approach to reduce risk and ensure the welfare of their employees? This article highlights the issues regarding the application of zero tolerance policies and principles to practice. It looks specifically at the consequences of excluding patients from primary care services and in particular at a scheme that has been set up by one general practice to provide an alternative GP service for patients within the Heart of Birmingham Teaching Primary Care Trust. Initial evaluation of this initiative indicates that patients are being successfully rehabilitated back into the community and suggests that further research is urgently needed to draw conclusions about this project, as well as similar health care services that endeavour to prevent and deal with unacceptable and aggressive behaviour in the workplace.
The NHS is suffering from a serious shortage of qualified medical staff. One possible solution is to introduce medical care practitioners (MCPs) (USA-style physician assistants) into the healthcare team. This article examines the history and role of PAs, as well as some of the issues concerning the role, and how other health professionals might perceive it. The article also describes one MCP programme that has already started in Britain at Wolverhampton University. The use of MCPs in the UK appears to offer a potential solution to reduce the current skill shortage in this country.
Much medical knowledge is contained within available literature, such as clinical guidelines and protocols. Recently, an interest has been developed in automatic content extraction to construct ontologies of this knowledge to make it more widely available. With groups of domain experts distributed geographically, and the growing amount of medical literature, an important challenge is to develop collaborative workflows to support ways for domain experts to contribute in the ontology learning process. This paper presents a collaborative workflow for ontology learning based on coupling an Ontology Learning Tool (OntoLancs) with and Ontology engineer (Protege) to provide semi-automatic support for text mining and a collaborative tool to model formal ontologies. The work presented in this paper was evaluated with a case study on a Clinical Practice Guideline of Diabetic Retinopathy. The major benefits of coupling OntoLancs with Protege are: a) a higher level of automation in the creation of domain ontologies and models, and b) strengthened communication and information exchange among domain experts that are physically distributed. Validations of user experiences indicate the applicability of our approach.
Hilary Paniagua outlines the concept of advanced nurse practice and how the advanced nurse practitioner's role differs from other types of nursing
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