Patient compliance with telephone triage recommendations: a meta-analytic review.

OBJECTIVE: To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. METHODS: Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). RESULTS: Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. CONCLUSION: Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. PRACTICE IMPLICATIONS: We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.

Nurses' experiences with telephone triage and advice: a meta-ethnography.

AIMS: This study is a meta-ethnography of nurses' experiences with telephone triage and advice and factors that facilitate or impede their decision-making process. BACKGROUND: Telephone triage and advice services are a rapidly expanding development in health care. Unlike traditional forms of nursing practice, telenurses offer triage recommendations and advice to the general public without visual cues. DATA SOURCES: Published qualitative research on telephone triage and advice were sought from interdisciplinary research databases (1980-2008) and bibliographical reviews of retrieved studies. REVIEW METHODS: Our systematic search identified 16 relevant studies. Two researchers independently reviewed, critically appraised, and extracted key themes and concepts from each study. We followed techniques of meta-ethnography to synthesize the findings, using both reciprocal and refutational translation to compare similar or contradictory findings, and a line-of-arguments synthesis. RESULTS: We identified five major themes that highlight common issues and concerns experienced by telenurses: gaining and maintaining skills, autonomy, new work environment, holistic assessment, and stress and pressure. A line-of-arguments synthesis produced a three-stage model that describes the decision-making process used by telenurses and highlights how assessments largely depend on the ability to 'build a picture' of the patient and the presenting health issue. CONCLUSION: Telenurses experience a range of common concerns and issues which either impede or facilitate the decision-making process. Although 'building a picture' of the patient is key to making assessments over the telephone, final triage decisions are influenced by balancing the conflicting demands of being both carer and gatekeeper to limited healthcare services.

Patient satisfaction with nurse practitioner care in emergency departments in Canada.

PURPOSE: To measure patient satisfaction with care delivered by nurse practitioners (NPs) in emergency departments (EDs) in Canada using a psychometrically valid survey. DATA SOURCES: All patients who received care from an NP in six participating EDs in Ontario province over a 1-week period were asked to complete a self-administered patient satisfaction survey designed specifically to assess satisfaction with NP care in EDs. CONCLUSIONS: One hundred and thirteen patients completed the survey. Principal components analysis of the survey revealed three factors or subscales: Attentiveness, Comprehensive care, and Role clarity. Scores on the three subscales indicated that patients were satisfied with Attentiveness (M = 3.72, SD = 0.38) and Comprehensive care (M = 3.52, SD = 0.49) and had a moderate understanding of Role clarity (M = 2.99, SD = 0.66). Participants with higher income levels reported higher levels of satisfaction with the attentiveness they received, whereas patients with previous experience with an NP reported higher levels of satisfaction with the comprehensive care they received. There was no appreciable increase in patient satisfaction with the NP based on age, gender, education, or health status. IMPLICATIONS FOR PRACTICE: These findings indicate that attentiveness, comprehensive care, and role clarity are reflected by the NP in emergency healthcare settings as indicated by the patient's responses to the survey. This study supports that meeting expectations is a critical component of patient satisfaction.

Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations.

OBJECTIVE: The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff. METHODS: We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach. RESULTS: Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided. CONCLUSIONS: Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs.

Overcoming the challenges of providing clinical/practice education.

The responsibility of educating increasing numbers of students presents major challenges for nursing education. The Canadian Association of Schools of Nursing (CASN) established a task force to examine the issues and barriers associated with provision of clinical/practice education for nursing students and to assist in the development of national guidelines for practice education. In this article, the authors present key findings and recommendations resulting from a literature review, a survey of member schools and a national forum on clinical practice education. All schools of nursing are encouraged to continue to develop innovative ways of providing practice experience to meet growing demands.

Understanding the role of nurse practitioners in Canada.

The practice of medicine and nursing continues to evolve as a result of changes in knowledge, technology and health care needs. New areas of specialization have developed and, in particular, the roles and duties of registered nurses have been expanded. This expansion has enabled nurses with advanced education and skills to function as independent and interdependent clinicians who practise in partnership with physicians and other health care professionals.

Caregiving by family and friends of adults receiving dialysis.

This study examined the activities of caregivers of adults on dialysis and explored how these behaviors evolved over time. Using a grounded theory methodology, interviews were conducted with 37 caregivers. Caregivers shared a rich repertoire of caregiving abilities and activities that were often supported by a strong knowledge base. Caregiving activities fell into in five interdependent dimensions: appraising, advocating, juggling, routinizing, and coaching. Caregivers also described specific caregiving tasks, including dialysis- related activities, management of diet, medications and symptoms, and personal care. These findings have important implications for nephrology nurses in planning care that acknowledges and supports the contributions of "lay" caregivers.

The primary care nurse practitioner: advocate for self care.

PURPOSE: To critically analyze the role of the primary care nurse practitioner (NP) as advocate in promoting health through self care. DATA SOURCES: Selected philosophical and theoretical texts and articles, scientific literature, professional standards, and ethical arguments. CONCLUSIONS: Philosophical reasoning and nursing theory must be used to validate and direct human practice. If self-care and well-being are desirable as an end and are defined as a movement toward self-determination, then the philosophical goal of the NP must be the protection and promotion of self care and autonomy through client advocacy. IMPLICATIONS FOR PRACTICE: The role of the NP must be defined by its philosophy of care rather than by its function. The influence of philosophical reasoning, nursing, and critical social theory impact the ability of the NP to promote self-care through advocacy. Understanding the lived experience is an essential component of advocacy.