Competence and confidence in rural and remote nursing practice: A structural equation modelling analysis of national data.

AIMS AND OBJECTIVES: To empirically test a conceptual model of confidence and competence in rural and remote nursing practice. BACKGROUND: The levels of competence and confidence of nurses practising in rural settings have been highlighted as essential to the quality of health outcomes for rural peoples. However, there is limited research exploring these constructs in the context of rural/remote nursing practice. DESIGN: Structural equation modelling was used to verify the conceptual model with data from the cross-sectional pan-Canadian Nursing Practice in Rural and Remote Canada II Survey. The STROBE guidelines for cross-sectional research were followed in the design/reporting of this analysis. The sample consisted of 2,065 registered nurses and nurse practitioners who were working in direct rural/remote nursing practice. RESULTS: The maximum likelihood ratio χ2  = 0.0822, df = 2, p = 0.959 indicated model fit, with final model estimates explaining 53% of the variance in work confidence and 17% of the variance in work competence. The model also accounted for 40% of the variance in work engagement, 39% of the variance in burnout and 15% of the variance in perceived stress. The complexity of competence and confidence in rural nursing practice was evident, being influenced by nursing experience in rural settings, rural work environment characteristics, community factors and indicators of professional well-being. CONCLUSIONS: The factors influencing nurses' competence and confidence in rural/remote nursing practice are more complex than previously understood. Our model, created and tested using structural equation modelling, merits further research, to extend our understanding of how nurses can be prepared and supported for practice in rural and remote settings. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of supporting new nurses' exposure to rural nursing experiences, reducing professional isolation and improving decision-making support for those who are working at a greater distance from colleagues and/or those with fewer opportunities for interprofessional collaboration.

Descriptive study of association between quality of care and empathy and burnout in primary care.

BACKGROUND: The doctor-patient relationship is a crucial aspect of primary-care practice Research on associations between quality of care provision and burnout and empathy in a primary care setting could improve this relationship. METHODS: Cross-sectional study of family physicians (108) and nurses (112) of twenty-two primary care centers in the health district of Lleida, Spain. Empathy and burnout were measured using the Jefferson Physician Empathy Scale and the Maslach Burnout Inventory, while quality of care delivery was evaluated using Quality Standard Indicator scores. JPSE and MBI results were grouped into low, medium, and high scores to analyze associations with QSI scores and sociodemographic variables. RESULTS: The mean QSI score recorded for the family physicians and nurses was 665 (out of a total of 1000). Higher, albeit insignificant, QSI scores were observed for practitioners with high burnout. No differences were observed according to level of empathy (p > 0.05). The differences with respect to sex, age, and area of practice (urban vs rural center) were not significant. Practitioners with low empathy had higher QSI scores than those with high empathy (672.8 vs. 654.4) while those with high burnout had higher scores than those with low burnout (702 vs. 671). CONCLUSIONS: Burnout and empathy did not significantly influence quality of care delivery scores in 22 primary care centers. More studies, however, are needed to investigate the unexpected trend observed that suggests that physicians and nurses with higher levels of burnout provide higher quality care.

Are primary care providers implementing evidence-based care for breast cancer survivors?

OBJECTIVE: To describe the implementation of key best practice guideline recommendations for posttreatment breast cancer survivorship care by primary care providers (PCPs). DESIGN: Descriptive cross-sectional survey. SETTING: Southeastern Ontario. PARTICIPANTS: Eighty-two PCPs: 62 family physicians (FPs) and 20 primary health care nurse practitioners (PHCNPs). MAIN OUTCOME MEASURES: Twenty-one "need-to-know" breast cancer survivorship care guideline recommendations rated by participants as "implemented routinely," "aware of guideline recommendation but not implemented routinely," or "not aware of guideline recommendation." RESULTS: Overall, FPs and PHCNPs in our sample reported similar practice patterns in terms of implementation of breast cancer survivorship guideline recommendations. The PCPs reported routinely implementing approximately half (46.4%, 9.7 of 21) of the key guideline recommendations with breast cancer survivors in their practices. Implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care, such as mammography and weight management. Knowledge and practice gaps were highest for recommendations related to screening for and management of long-term effects such as fatigue and distress. There were only a few minor differences reported between FPs and PHCNPs. CONCLUSION: There are knowledge and practice gaps related to implementation of the key guideline recommendations for breast cancer survivorship care in the primary care setting that could be targeted for improvement through educational or other interventions.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.

BACKGROUND: Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. METHODS: In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. RESULTS: Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time. CONCLUSIONS: This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.

Educational role of nurse practitioners in a family practice centre: perspectives of learners and nurses.

OBJECTIVE: To examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional educational dynamics in a clinical teaching setting. DESIGN: A qualitative descriptive approach, using purposive sampling. SETTING: A family practice centre that is associated with an academic department of family medicine and is based in an urban area in southern Ontario. PARTICIPANTS: First-year (8 of 9) and second-year (9 of 10) family medicine residents whose training program was based at the family practice centre, and all NPs (4 of 4) who worked at the centre. METHODS: Semistructured interviews were conducted, which were audiotaped and transcribed. An iterative approach was used for coding and analysis. Data management software guided organization and analysis of the data. MAIN FINDINGS: Four interconnected themes were identified: role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. Although residents recognized NPs' value in team functioning and areas of specialized knowledge, they were unclear about NPs' scope of practice. Depending on residents' level of training, residents tended to respond differently to teaching by NPs. More of the senior residents believed they needed to think like physicians and preferred clinical teaching from physician teachers. Junior residents valued the step-by-step instructional approach used by NPs, and they had a decreased sense of vulnerability when being taught by NPs. Training in teaching skills was helpful for NPs. Barriers to providing optimal education included opportunity, time, and physician attitudes. CONCLUSION: The lack of an intentional orientation of family medicine residents to NPs' scope of practice and educational role can lead to difficulties in interprofessional education. More explicit recognition of the evolving professional identity of family medicine residents might decrease resistance to teaching by NPs and ensure that interprofessional teaching and learning strategies are effective. Faculty development opportunities for all educators are required to manage these issues, both to ensure teaching competencies and to reinforce positive interprofessional collaboration.

Meeting FNP students' and faculty clinical needs: Two perspectives.

Appropriate clinical practice sites with skilled preceptors are the backbone of family nurse practitioner (FNP) students' education. Faculty are also in need of practice sites to stay abreast of current clinical practice and maintain clinical hours for certification. The purpose of this article is to relate the process of developing a practice model to meet the needs of the FNP student and faculty. Academia and student life professionals collaborated to use an existing student health center on campus as an education site with an FNP nursing faculty member as a preceptor. This qualitative descriptive study presents reflections of the experience from the student perspective. Three main themes were identified: independence, confidence, and trust. Lessons learned from the faculty perspective are also reviewed. Benefits of the project ultimately outweighed barriers. The interdepartmental precepted practice experience completed its fourth successful year and maintains support through the university's student life division. The model may provide strategies, particularly for FNP programs and faculty in smaller universities, to increase and diversify clinical experiences and provide a faculty practice site.

The Developmental Screening Behaviors, Skills, Facilitators, and Constraints of Family Nurse Practitioners in Primary Care: A Qualitative Descriptive Study.

INTRODUCTION: Researchers have found that many primary care providers are not following developmental screening recommendations. Few studies exist on the screening behaviors of advanced practice nurses. METHODS: A qualitative descriptive study explored the screening behaviors, skills, and environmental facilitators/constraints of 24 family nurse practitioners (FNPs) who cared for pediatric patients from birth to 5 years of age in primary care settings. An inductive approach to content analysis was used to interpret the data. RESULTS: Five main themes emerged: (a) Developmental Screening Behaviors During Well-Child Visits, (b) Developmental Screening Behaviors When a Concern Was Raised, (c) Need for Additional Developmental Screening Skills, (d) Factors That Support Developmental Screening, and (e) Factors That Limit Developmental Screening. Sixteen subthemes supported the main themes. DISCUSSION: Most FNPs were not using standardized tools. Behaviors mainly consisted of actions that were informal. FNPs were not familiar with current recommendations, and they had difficulty describing most instruments.

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

OBJECTIVE: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). METHODS: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed-methods approach. RESULTS: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. CONCLUSION: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow-up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. IMPLICATIONS: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.

Perceptions of Family Nurse Practitioner Clinical Preceptors About Usefulness of Onsite Clinical Site Visits.

Clinical site visits are important for evaluating graduate nursing students' clinical success. This descriptive study surveyed family nurse practitioner preceptors' perceptions of modalities for conducting site visits. Results indicated that preceptors believe faculty should make at least 1 face-to-face site visit to observe a student during the semester. No preference for telephone or mobile technology for conducting site visits was identified. The study provides important considerations when designing guidelines for faculty site visits.

La superación de la enfermera en la atención integral a la familia con enfermo oncológico / The upgrade of the nurse in the comprehensive care to the family with oncological patients

RESUMEN Introducción: la enfermera que se desempeña en los consultorios de la Atención Primaria de Salud, asume la responsabilidad de propiciar una atención integral al familiar encargado del cuidado del enfermo oncológico. Objetivo: diseñar una propuesta de superación para el perfeccionamiento de la actuación de la enfermera en la atención integral a la familia con enfermo oncológico. Materiales y métodos: se efectuó una investigación de desarrollo en la Facultad de Ciencias Médicas de Matanzas Dr. Juan Guiteras Gener, durante el curso 2018-2019. Se utilizó una muestra de 23 enfermeras de los consultorios de la atención primaria del municipio de Matanzas. Se analizaron los documentos que avalan su desempeño profesional. Se diseñó una encuesta dirigida a la identificación de las necesidades de aprendizaje y una guía de observación para caracterizar el modo de actuación del profesional de Enfermería. Se aplicaron entrevistas a supervisoras y directivos. Resultados: el análisis de las encuestas aplicadas a la muestra seleccionada y las observaciones realizadas a las actividades en el hogar, permitieron detectar las necesidades de aprendizaje para el perfeccionamiento de la atención integral a la familia con enfermo oncológico. Las entrevistas realizadas a supervisoras y directivos corroboraron la necesidad de la propuesta. Conclusiones: se diseñó un curso de posgrado para el perfeccionamiento de la actuación de los profesionales de la Enfermería, relacionado con el cuidado integral a la familia con enfermos oncológicos en la Atención Primaria de Salud (AU).

ABSTRACT Introduction: the nurse who works in the primary health care consultations assumes the responsibility of providing comprehensive care to the relative who takes care of oncological patients. Objective: to design a proposal of upgrading to improve the performance of the nurse in the comprehensive care to the family with an oncological patient. Materials and methods: a development research was conducted in the Faculty of Medical Sciences Dr. Juan Guiteras Gener, of Matanzas, during the school year 2018-2019. The sample was 23 nurses from the primary health care offices of the municipality of Matanzas. The documents that support their professional performance were analyzed. A survey was designed to identify learning needs and also an observation guide to characterize the performance of the nursing professional. Interviews were conducted with supervisors and managers. Results: the analysis of the surveys applied to the chosen sample and the observations made to the activities carried out at home, made it possible to determine the learning needs for the improvement of the comprehensive care to the families with oncological patients. Interviews with supervisors and managers confirmed the necessity of the proposal. Conclusions: a postgraduate course was designed for the improvement of nursing professionals' performance, aimed to the comprehensive care to families with oncological patients in the primary health care (AU).

As habilidades sociais de enfermeiras gestoras em equipes de saúde da família / The social skills of nurses managers in family health teams / Habilidades sociales de enfermeras gerentes en equipos de salud familiar

A pesquisa, de natureza descritiva, investigou o repertório de habilidades sociais de enfermeiras responsáveis pela gestão de equipes de Saúde da Família. Foi aplicado o Inventário de Habilidades Sociais (IHS-Del Prette) e foram realizadas entrevistas semiestruturadas visando obter a autopercepção das oito participantes acerca de seus recursos e déficits nessas habilidades, sobretudo no que concerne às exigências do trabalho em atenção primária. Os resultados médios do grupo de gestoras foram analisados quanto ao escore total e aos cinco fatores do IHS-Del Prette. A categorização dos relatos obtidos nas entrevistas ocorreu à luz da Análise de Conteúdo de Bardin. Os resultados evidenciaram variadas classes de habilidades sociais, como empatia, assertividade, expressão de sentimentos positivos e resolução de problemas. Em contrapartida, observaram-se dificuldades para comunicação clara e eficaz e para mediar conflitos interpessoais. Destaca-se a relevância de investigações e experiências sistemáticas para o aprimoramento de habilidades interpessoais essenciais à gerência em saúde pública. (AU)

The present descriptive research investigated the repertoire of social skills of nurses responsible for the management of Family Health teams. The Social Skills Inventory (IHS-Del Prette) and semi-structured interviews were administered to obtain the self-perception of 8 participants about their resources and deficits in these skills, especially regarding the demands of primary care work. The mean scores of the group were analyzed in relation to the total score and the 5 IHS-Del Prette factors. The categorization of the reports obtained in the interviews took place in light of the Bardin Content Analysis. The results evidenced several classes of social skills, such as empathy, assertiveness, expression of positive feelings, and problem-solving. On the other hand, difficulties for clear and effective communication and mediation of interpersonal conflicts were observed. It is important to highlight the relevance of investigations and systematic experiments for the improvement of interpersonal skills essential to public health management. (AU)

La investigación, de naturaleza descriptiva, analizó el repertorio de habilidades sociales de enfermeras gerentes responsables en equipos de Salud Familiar. Se aplicó el Inventario de Habilidades Sociales (IHS-Del Prette) y se realizaron entrevistas semiestructuradas con el objetivo de obtener la autopercepción de ocho participantes, sobre sus recursos y déficits en estas habilidades, principalmente, en lo que respecta a las exigencias del trabajo en atención primaria. Los resultados promedio del grupo de gerentes fueron analizados en relación a la puntuación total y a los cinco factores del IHS-Del Prette. La categorización de los reportes obtenidos en las entrevistas se realizó a la luz del Análisis de Contenido de Bardin. Los resultados, evidenciaron varias clases de habilidades sociales, como empatía, asertividad, expresión de sentimientos positivos y resolución de problemas. En contrapartida, se observaron dificultades para una comunicación clara y eficaz y también para mediar en conflictos interpersonales. Se destaca la importancia de investigaciones y experiencias sistemáticas para el perfeccionamiento de habilidades interpersonales esenciales a la gerencia en salud pública. (AU)

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study.

BACKGROUND: The UK government has encouraged NHS services to obtain patient feedback to support the further development of patient-centred care. In 2009, the English GP Patient Survey included a sample of 5.5 million, but little is known about its potential utility in informing developments aimed at improving the quality of patients' experiences of primary care. AIM: To investigate primary care providers' response to feedback on patient experience from a national survey. DESIGN AND SETTING: Qualitative interview study in 10 general practices from four primary care trusts in England. METHOD: Semi-structured interviews were conducted with GPs, practice nurses, and practice managers (n = 37). Transcripts were analysed thematically. RESULTS: Although some participants reported making changes to their practice in response to the survey data, many expressed doubts about the credibility of the results. Key issues included: concerns about practical aspects of the survey, such as the response rate and representativeness of the sample; the view that it gave insufficient detail to facilitate change and failed to address some salient issues; and unease about the influence of political influences underpinning its introduction and use. CONCLUSION: Although, in general, primary care professionals have positive attitudes towards patient feedback, this study suggests a mismatch between the conventional demonstration of the objectivity of a questionnaire survey and the attitudes and experiences of those receiving the data. This is likely to prevent doctors from engaging constructively with the survey. These concerns may well militate against the potential of the survey to act as a simple means of capturing, and effectively using, feedback from patients.

Family nurse practitioner student perception of journal abstract usefulness in clinical decision making: a randomized controlled trial.

PURPOSE: To assess family nurse practitioner (FNP) student perception of research abstract usefulness in clinical decision making. DATA SOURCES: A randomized controlled trial conducted in a simulated environment with graduate FNP students of the Graduate School of Nursing, Uniformed Services University of the Health Sciences. Given a clinical case study and modified MEDLINE search tool accessible via an iPad device, participants were asked to develop a treatment plan and complete a data collection form. The primary measure was perceived usefulness of the research abstracts in clinical decision making regarding a simulated obese patient seeking to prevent type 2 diabetes. Secondary measures related to participant demographics and accessibility and usefulness of full-text manuscripts. CONCLUSIONS: The majority of NP students identified readily available research abstracts as useful in shaping their clinical decision making. The presence or absence of full-text manuscripts associated with the abstracts did not appear to influence the perceived abstract usefulness. The majority of students with full-text manuscript access in the timed simulated clinical encounter read at least one paper, but cited insufficient time to read full-text as a constraint. IMPLICATIONS FOR PRACTICE: Research abstracts at point of care may be valuable to FNPs if easily accessible and integrated into clinical workflow.