Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Kilpatrick, Kelley; Jabbour, Mira; Tchouaket, Éric; Acorn, Michelle; Donald, Faith; Hains, Sylvie

doi:10.1111/jan.13962

Cited by 23 publications

(34 citation statements)

References 31 publications

(45 reference statements)

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“…This paper reports on the findings from field notes and a prospective cohort study of residents receiving NP care. Findings from the qualitative descriptive study describing the views of providers and managers are reported elsewhere [54].…”

Section: Aimsmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Aimsmentioning

confidence: 99%

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

et al. 2020

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“…A cost savings analysis was completed using a prospective observational study as part of a quality improvement project in six long-term care facilities in Qu ebec, Canada (Kilpatrick et al, 2020).…”

Section: Designmentioning

confidence: 99%

“…Each site sent anonymized extractions each week to the research coordinator who reviewed the submissions to ensure that no data were missing. Each site coordinator was contacted to clarify any questions (Kilpatrick et al, 2020).…”

Section: Data Collectionmentioning

confidence: 99%

“…Those laws are under revision (McCann & Ministre de la Sant e et des Services sociaux, 2019). In long-term care, nurse practitioners assess residents' condition in planned and unexpected situations (e.g., fall, infection, fever), adjust medications, order and interpret diagnostic tests, and provide ongoing chronic illness care depending on the resident's condition (Kilpatrick et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis

2020

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Background: Internationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Qu ebec Canada where roles are new. Purpose: To evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Qu ebec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs). Methods: A cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated. Findings: The median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4.

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“…Studies have identified that provider judgements or beliefs about team functioning and effectiveness are influenced by processes that include decision-making, communication, cohesion, care coordination, problem-solving, a focus on the needs of patients and families, as well as role clarity and trust among team members 16,17. The measurement of these team processes has been a critical challenge because of the financial and human resources required and the lack of validated instruments.…”

Section: Introductionmentioning

confidence: 99%

<p>Team Functioning And Beliefs About Team Effectiveness In Inter-Professional Teams: Questionnaire Development And Validation</p>

Kilpatrick¹,

Paquette²,

Bird³

et al. 2019

JMDH

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PurposeFew validated instruments are available to measure team functioning in acute and primary care teams. To address this, we developed a questionnaire measuring healthcare provider perceptions of team effectiveness (Provider-PTE) and assessed its psychometric properties.Patients and methodsEmpirical evidence and a conceptual model were used for item generation. The 41-item self-completed questionnaire was developed. A cross-sectional survey of healthcare providers (n=283) across a range of settings was performed. Psychometric properties were assessed for French and English language questionnaires using Cronbach alpha (α) for reliability, the feedback form for face validity, expert opinion for content validity, and the known-group technique for construct validity. Responsiveness was examined by comparing scores in high and low functioning teams.ResultsThe mean time needed to complete the questionnaire was less than 9 mins. Respondents were typically female (84%), and employed full time (80%) in urban settings (82%). Cronbach α values were as follows: Team Processes = 0.88; PTE-Overall = 0.91; Outcomes = 0.72. Significant differences were found by professional group (p = 0.017), length of time in the team (p = 0.025), and presence of nurse practitioners. Responses to Outcomes varied by employment status (p = 0.017). Differences were identified in high and low functioning teams (p<0.001). Feedback indicated that two questions related to team meetings needed to be added.ConclusionThe study produced evidence of validity for English and French language Provider-PTE questionnaires. The revised 43-item instrument represents an important contribution by providing a validated questionnaire to measure team functioning across a range of settings that is consistent with a conceptual framework.

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Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Cited by 23 publications

References 31 publications

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

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

Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis

<p>Team Functioning And Beliefs About Team Effectiveness In Inter-Professional Teams: Questionnaire Development And Validation</p>

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