Nursing activities for patients with chronic disease in family medicine groups: A multiple-case study.

Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple-case study was performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in-depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse-physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple-case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration.

A case study exploring the effectiveness of an innovative "5Q Care Test" to determine whether patients with complex needs require health or social care.

A case study was conducted in 2016 to evaluate the effectiveness of an innovation to enable people with "complex" care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment. The setting was a rural district general hospital in England, where the quality outcomes and cost-effectiveness of the CHC assessment being conducted in hospital were giving cause for concern. The NHS CHC Framework advocates conducting these assessments in the community where a more accurate indication of long-term care can be determined. The "5Q Care Test" was collaboratively developed with health and social care partners, care providers, and CHC interest groups, including users of the services. It was implemented as a tool to support moving the CHC assessment into the community, as it enabled practitioners to swiftly determine patients' appropriate initial care pathway out of hospital. A full economic impact analysis was conducted 7 months after the tool was introduced. The results showed significant improvement in the quality and cost-effectiveness of the "5Q Care Test," with a reduction in the hospital length of stay, which is known to be associated with improved outcomes for patients and financial savings.

A case study exploring employment factors affecting general practice nurse role development.

AIM: The aim of this study was to explore the factors affecting role development in practice nursing in the United Kingdom. BACKGROUND: General practice is currently central to National Health Service reform, producing favourable conditions for the practice nurse role to be further strengthened and developed. However, the literature has continued to describe evidence that practice nurses are a disempowered, isolated group with many constraints reducing their ability to respond to opportunities to develop their role. The rationale for conducting the study was therefore to provide a greater understanding about the constraining factors and their influence on practice nurses wishing to develop their role. METHOD: The method used to conduct the research followed a case approach, as the subject being investigated was complex with multiple inter-related factors and the approach was exploratory. The cases comprised six UK general practices and the participants within each case were a practice nurse, a GP and a practice manager. FINDINGS: A combination of factors was found to contribute to the way the practice nurse role evolves. These are education, practice culture, practice nurse personal characteristics and empowerment. Empowerment holds the key to maximising the conditions favourable to practice nurse role evolution. This is not, however, a 'single' factor; it represents the combined synergistic effects of practice culture and practice nurse personal characteristics on creating an empowering environment. The inter-relationship between these was captured in a framework and given the title 'empowering employment principles'. CONCLUSION: The 'empowering employment principles' illustrate the features most conducive to role evolution, thus providing a tool for practice nurses and their employers to enhance opportunities for nurses to develop their role.

Integrating care across a challenged local health economy: the West Norfolk Health and Social Alliance.

A Health and Social Care Alliance established in 2012 and selected as a national 'Integration Pioneer' site is exploring how integration can address local system challenges faced in many health economies across the UK. The original programme focused on data gathered from the evaluation of the national Integration Care Organisation pilots - there were three in West Norfolk - about patient experience, aiming to develop stronger early community interventions in a more coordinated way to keep people independent longer. The early programme initiatives have created a firm partnership, innovative services and a good foundation on which to build, which has been a strength as the local health economy now faces a huge financial and clinical sustainability challenge in its current configuration. A transformation programme is therefore being developed to address the challenges and identify solutions through integration and innovation for the sustainability of a small rural locality.