A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities

Abstract

Background: To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. Methods: Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. Results: Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. Conclusions: The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.

Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

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Global inequity in nursing education: a call to action

“…NPs have consistently demonstrated high-level, high-quality care for individuals in acute and community-based settings, improve quality measures while decreasing cost expenditures, and show high rates of individual's satisfaction matched by an increased number of return visits when compared with other primary care providers. [66][67][68][69][70] Their biopsychosocial approach to patient and community care, in conjunction with their advanced training, make them an ideal workforce population to act on the social determinants through evidence, intensive clinical experience, and the skills needed to track and improve health outcomes.…”

Identifying indicators sensitive to primary healthcare nurse practitioner practice: a review of systematic reviews protocol

“…Internationally, the primary healthcare nurse practitioner (PHCNP) role has been examined across countries and healthcare settings (eg, long-term care, primary care, home care) to understand how PHCNPs provide care. [1][2][3][4] PHCNPs are nurses prepared at the graduate level with in-depth clinical expertise who provide primary healthcare (PHC) services to different populations. 5 Researchers [6][7][8][9] have conducted several systematic reviews of PHCNP roles to understand their contributions to patient care.…”