Title. Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice. Aim. This paper is a report of a study conducted to uncover nurses' perceptions of the contexts of caring for acute stroke survivors. Background. Nurses coordinate and organize care and continue the rehabilitative role of physiotherapists, occupational therapists and social workers during evenings and at weekends. Healthcare professionals view the nursing role as essential, but are uncertain about its nature. Method. Ethnographic fieldwork was carried out in 2006 on a stroke unit in Canada. Interviews with nine healthcare professionals, including nurses, complemented observations of 20 healthcare professionals during patient care, team meetings and daily interactions. Analysis methods included ethnographic coding of field notes and interview transcripts. Findings. Three local domains frame how nurses understand challenges in organizing stroke care: 1) space, 2) time and 3) interprofessional practice. Structural factors force nurses to work in exceptionally close quarters. Time constraints compel them to find novel ways of providing care. Moreover, sharing of information with other members of the team enhances relationships and improves 'interprofessional collaboration'. The nurses believed that an interprofessional atmosphere is fundamental for collaborative stroke practice, despite working in a multiprofessional environment. Conclusion. Understanding how care providers conceive of and respond to space, time and interprofessionalism has the potential to improve acute stroke care. Future research focusing on nurses and other professionals as members of interprofessional teams could help inform stroke care to enhance poststroke outcomes.
Introduction: In collaboration with the Alberta Medical Association's Physician Learning Program we developed individualized physician reports and held a group feedback session on rheumatoid arthritis (RA) performance measures (PM) to facilitate treat-to-target (T2T) strategies and evaluated physician experiences with this process. Methods: 5 PMs addressing T2T concepts from an established Canadian quality framework were operationalized for physician practice reports at 2 university-affiliated rheumatology clinics. Rheum4U, a quality improvement and research platform, was the data source. The audit results were reviewed in a facilitated group feedback session. Rheumatologists provided experiential feedback on the process through survey and/or an interview. Transcripts from interviews were analyzed using a 6-step thematic analysis. Results: 11 of 12 eligible rheumatologists consented to receive practice reports and provided feedback through surveys (n = 5) and interviews (n = 6). The practice reports from Rheum4U
Triage RNs require appropriately designed triage environments and computer technology that enable them to secure real time knowledge of the ED to maintain situation awareness.
Emergency department (ED) wait times, length of stay, and overcrowding are common issues in developed health care systems in many countries. These ED issues are multifactorial in nature and require further evaluation in an attempt to provide consistent, adequate health care to each patient. Authors in countries, such as Australia and the United Kingdom, have attempted to address the concerns of increasing wait times, length of stay, and overcrowding by establishing nurse practitioners (NPs) into the ED who practice in domains traditionally dominated by physicians. Unfortunately, Canadian health care system leaders lack experience in implementing the unique role of the NP in the ED. In addition, emergency department fast track (FT) models have been studied and operationalized in Australia and the United States to streamline care for less acute patients. However, it is evident from review of the literature that NPs, in the Canadian health care system, are underutilized within FT units. Despite the fact that NPs have been practicing since the 1960s, there remains confusion by the public and even health care professionals about their role, scope of practice, and capabilities. The purpose of this article is to provide a greater understanding of the NP role in Canada with the intent to elucidate current barriers and facilitators to having NPs practice in the ED setting through appraisal of national and international literature sources. The article also illustrates how FT units streamline patient care and are suitable areas for NP practice within the ED. In addition, the authors describe how assessment, implementation, and evaluation of the role of NPs in the ED might be facilitated through the use of a Participatory Evidence-informed Patient-focused Process for Advanced practice nursing role development, implementation, and evaluation (PEPPA framework).
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