Helping the helpers: Understanding information and support needs of caregivers in underserved communities.

Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.

Maternity and postpartum care: perspectives.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes.

Quality of Care for Patients With Diabetes and Mulitmorbidity Registered at Nurse Practitioner-Led Clinics.

Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics. Methods An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines. Results Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.

Characteristics of Nurse Practitioner Practice in Family Health Teams in Ontario, Canada.

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

Communication technology and healthcare.

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes.

Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics.

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students' self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students' age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Implementation of an Advanced Access Scheduling System in Primary Healthcare: One Clinic's Experience.

Advanced access scheduling is a system designed to allow patients to be seen same day or next day or in the future according to their preference. The scheduling system has been associated with patients being seen earlier in the course of illness and patients being hospitalized less often. The advanced access system focuses on timely access to primary healthcare, ideally within 48 hours. A group of Ontario primary healthcare nurse practitioners recently implemented the system at a newly established nurse practitioner-led clinic. The team's experiences with the implementation of the advanced access scheduling system are reviewed. The team's experiences are then compared and contrasted with what has been published on the scheduling system to date. The article approaches the subject matter from the perspectives of primary healthcare providers, clerical staff and administrators. Advanced access has become a timely subject in primary care, given the chronic shortages of service and funding constraints and the need for enhanced effectiveness.

Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers.

AIMS: To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams. BACKGROUND: Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning. METHODS: Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS). RESULTS: The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility. CONCLUSION: Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member.