Experience of primary care nurses applying nurse-led management of patients with acute minor illnesses.

AIM: The aim of this study is to determine the experience of primary health care nurses regarding the application of nurse-led management in patients with acute minor illnesses. BACKGROUND: Nursing leadership of care for acute minor illnesses is a new challenge faced by nurses in Spain. DESIGN: Qualitative, hermeneutical, interpretive phenomenological approach is used. The Consolidated criteria for reporting qualitative research guidelines were applied. METHODS: Twenty primary care nurses participated; three focus group discussions and nine semi-structured interviews were conducted between November 2019 and October 2020. All the focus group discussions and interviews were recorded, transcribed verbatim and analysed using content analysis. RESULTS: Seven main themes emerged from the focus group discussions and interviews: concept, perception of the other actors, practice, history and social context, competencies, training, and legality. CONCLUSION: The study shows the diversity and complexity of nurses' experience when applying nurse-led management in acute minor illnesses. This work has helped to show the gaps perceived by nurses, including the lack of training in the treatment of conditions historically attended by physicians, the lack of definition of the legal framework and the limitations on nurse prescribing. It also highlighted the power of the nursing profession in terms of autonomy, competencies and role expansion.

Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña / Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia

Objetivo: Conocer la experiencia de las enfermeras de atención primaria en la aplicación de la gestión enfermera de la demanda (GED). Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Atención primaria de Cataluña. Participantes: Enfermeras de atención primaria de Cataluña. Se estimó una muestra de 394 participantes alcanzando 405. La obtención de datos fue desde octubre de 2021 hasta enero de 2022. Mediciones principales: Se realizó un cuestionario ad hoc, el cual exploraba aspectos referentes a la experiencia de aplicación de la GED: definición y manejo del programa, formación y aspectos legales del programa. Resultados: Las enfermeras entienden la GED como un triaje. Además, consideran que la implantación de la prescripción enfermera no mejora la aplicación de la GED. Manifiestan una falta de formación especialmente las enfermeras más noveles. La formación ideal en GED, consideran, debería incluir fisiopatología y supuestos prácticos. Siete de cada 10 enfermeras desconocen el marco legal que ampara la GED y les provoca inseguridad no conocerlo. Seis de cada 10 han dejado de ser resolutivas por miedo a las repercusiones legales. Las enfermeras que sí conocen el marco legal son las que han dejado de resolver en menor proporción. Conclusiones: Se constata la necesidad de formación general en la GED y en los aspectos legales que dan cobertura al programa especialmente en las enfermeras más jóvenes y con menos experiencia en atención primaria. De esta manera se mejorará la aplicación y aceptación del rol autónomo enfermero en la gestión de enfermedades agudas leves.(AU)

Objective: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). Design: Observational, cross-sectional descriptive study. Location: Primary care in Catalonia. Participants: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. Main measurements: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. Results: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. Conclusions: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.(AU)

Empleo y resolución de la Gestión Enfermera de la Demanda en Cataluña / Use and resolution of Nurse Demand Management in Catalonia

Introducción: la gestión enfermera de la demanda (GED) es la atención a los problemas agudos leves liderada por la enfermera y llevada a cabo en los centros de atención primaria de Cataluña desde el 2009. El objetivo del estudio es evaluar el grado de implantación y resolución de la GED en los centros del Institut Català de la Salut. Métodos: estudio observacional descriptivo transversal. El ámbito de estudio ha sido el de atención primaria del Institut Català de la Salut de Cataluña. Análisis de datos secundarios. Los datos han sido extraídos de la plataforma Longview. Las variables de estudio han sido en cuanto a la GED: el número de visitas, la resolución, los motivos de consulta y protocolos implantados en los equipos. Resultados: la GED en el territorio catalán presenta variabilidad en los porcentajes de resolución entre las diferentes gerencias territoriales. Los protocolos pediátricos presentan mayor resolución que los de adultos. Los protocolos con mayor resolución son los relacionados con la práctica usual de la enfermera, y los menos, los que históricamente resolvía el médico. Por último, existe correlación positiva entre los protocolos implementados y el número de usuarios visitados por la enfermera. Conclusiones: el liderazgo enfermero en la atención a enfermedades agudas leves es una práctica afianzada por las enfermeras de atención primaria; aunque existe heterogeneidad en la resolución de los motivos de consulta especialmente entre los que habitualmente atendía la enfermera y los que históricamente resolvía el médico. (AU)

Introduction: Nursing leadership in users with acute minor illnesses (NLAMI) is the attention given by nurse to people with acute problems carried out in primary care centers in Catalonia since 2009. The aim of the study is to evaluate the degree of resolution of the NLAMI in the centers of the Institut Català de la Salut. Methods: cross-sectional descriptive observational study. The scope of the study was the primary care of the Institut Català de la Salut in Catalonia. Secondary data analysis. The data were extracted from the Longview platform. The study variables were related with NLAMI: number of visits, resolution, reasons for consultation and protocols implemented in the health centers. Results: The NLAMI is implemented in the Catalonia and there is variability in the percentages of resolution between territories. Pediatric protocols have higher resolution than adult protocols. The most resolved protocols are those related to the usual practice of the nurse, and the least resolved protocols are those historically resolved by the physician. Finally, there is a positive correlation between the protocols implemented and the number of users visited by the nurse. Conclusions: the leadership in the care of acute minor illnesses is an established practice of primary care nurses and there is heterogeneity in the resolution of the reasons for consultation, especially between those usually attended by the nurse and those historically resolved by the physician. (AU)

[Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia]. / Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña.

OBJECTIVE: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). DESIGN: Observational, cross-sectional descriptive study. LOCATION: Primary care in Catalonia. PARTICIPANTS: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. MAIN MEASUREMENTS: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. RESULTS: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. CONCLUSIONS: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.

Análisis de concepto: gestión enfermera de la demanda / Concept analysis: Nurse demand management

La gestión enfermera de la demanda (GED) es un concepto emergente que requiere una clarificación útil no solo para los profesionales y usuarios sino también para gestores. La GED nació en 2009 tras la necesidad de reorganizar los flujos de la demanda, pero se ha convertido en algo más que en eso. Se entiende la GED como un programa liderado por la enfermera de Atención Primaria para atender a personas con enfermedades agudas leves. La enfermera, bajo un protocolo consensuado y dentro de su ámbito competencial, puede ser autónoma en la atención al paciente y en la resolución de problemas agudos leves. Por tanto, siguiendo la filosofía de Atención Primaria, tanto el médico como la enfermera son los profesionales que darán continuidad en el proceso salud-enfermedad del usuario a lo largo de su vida. Este artículo ha sido escrito según la metodología descrita por Wilson

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson

[Concept analysis: Nurse demand management]. / Análisis de concepto: gestión enfermera de la demanda.

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson.