Aims and ObjectiveTo understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced.BackgroundFrequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40–50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients.DesignMixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2).MethodsEighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross‐sectional survey.ResultsFAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it.ConclusionsThe accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon.Relevance to Clinical PracticeThe frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support.Patient or Public ContributionThere was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.
The study of errors in the health system today is a topic of considerable interest aimed at reducing errors through analysis of the phenomenon and the conclusions reached. Errors that occur frequently among health professionals have also been observed among nursing students. True, in most cases they are actually “near errors,” but these could be a future indicator of therapeutic reality and the effect of nurses' work environment on their personal performance. There are two different approaches to such errors: (a) The EPP (error prone person) approach lays full responsibility at the door of the individual involved in the error, whether a student, nurse, doctor, or pharmacist. According to this approach, handling consists purely in identifying and penalizing the guilty party. (b) The EPE (error prone environment) approach emphasizes the environment as a primary contributory factor to errors. The environment as an abstract concept includes components and processes of interpersonal communications, work relations, human engineering, workload, pressures, technical apparatus, and new technologies. The objective of the present study was to examine the role played by factors in and components of personal performance as compared to elements and features of the environment. The study was based on both of the aforementioned approaches, which, when combined, enable a comprehensive understanding of the phenomenon of errors among the student population as well as a comparison of factors contributing to human error and to error deriving from the environment. The theoretical basis of the study was a model that combined both approaches: one focusing on the individual and his or her personal performance and the other focusing on the work environment. The findings emphasize the work environment of health professionals as an EPE. However, errors could have been avoided by means of strict adherence to practical procedures. The authors examined error events in the administration of medication by nursing students during 1999–2006 using narrative analysis and the qualitative triangulation method. The findings result in a recommendation to reconsider the mode of approaching errors in educational processes, the handling of errors in the clinical field, and improvement of the safety climate.
The question of whether nursing teachers should combine teaching in the classroom with work in the clinical field1 is the focus of much discussion. There are arguments in favour and against the efficacy of combining teaching and working in the clinical field during the training period of future nurses. The transition to academic teaching of nursing in colleges and universities has created a gap between the theory studied in the classroom and the reality practiced in the field. This fact is commonly documented in the professional literature. In order to help bridge this gap, several models aim to preserve the clinical competence and nursing skills of nursing teachers (Fisher, 2005). In this paper, I will present a survey examining the attitudes of nursing teachers whose main job is at a nursing school and of nurses who combine teaching at a nursing school with work in the clinical field as staff nurses. Participants in the survey also included a third group of students in an academics' retraining track. The goal of the survey was to examine attitudes of those involved in nursing and in nursing education towards the issue of clinical reliability of nursing teachers and its preservation and enhancement. The conclusions represent the personal attitudes of the participants and can serve as a possible model for adoption by the nursing leadership on a national level.1 The clinical field is any place where the nurse is employed: a hospital ward, community clinic, dialysis institute, or any other nursing care workplace.
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