How do nurse practitioners work in primary health care settings? A scoping review

Abstract

Abstract:Objectives: This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes.Design: A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Results: 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). ConclusionsThe majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change.

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

“… 46 For example, nurse practitioners caring for patients with complex clinical needs may center their care around disease management, care coordination, or symptom control following defined guidelines. 47 We found that patients with more chronic conditions had a greater number of visits when cared for by nurse practitioners than physicians. Such care patterns could be consistent with more intense, high-touch care management visits, 24 , 26 or they could signal the need for more visits to achieve the same goals.…”

“…1 , 2 , 10 Nurse practitioners may provide patient care that is intensive and coordinated across the health care system which could especially benefit patients with complex clinical needs. 24 , 47 Increasing the role of nurse practitioners in some settings—including small physician practices or practices not owned by a larger health care system—could ease the burden on primary care. Given the increasing role of nurse practitioners, even for clinically and socially complex patients, provider groups may benefit from proactively offering guidance or continuing medical education for practices on optimal workflows to integrating nurse practitioners.…”

Cargas de trabalho na Estratégia Saúde da Família: interfaces com o desgaste dos profissionais de enfermagem

“…In the FHS, work is carried out by FH teams composed of at least one doctor and one nurse, preferably specialists in family health, a nursing technician or assistant and community health agents (CHAs), and each team is responsible for 2,000 to 3,500 people (1) . Nursing professionals have a central role in PHC, as they contribute to improve the social determinants of health and illness, especially when assisting people in situations of vulnerability and promoting access to health services (3)(4)(5)(6)(7) .…”

Nursing strategies for child health surveillance

“…A study 16 pointed out the work of nurses in PHC incorporates promotion activities aimed at improving the social determinants of health, in situations of vulnerability, with advanced skills that include coordination, education, counseling, collaboration, connecting clients with services and advocacy. It further emphasized the importance of individual and community interventions resulting in increased access to care, reduced costs and salutogenic characteristics of empowerment for social changes 16 .…”