University of Melbourne, Melbourne East General Practice Network, Melbourne, Australia.
J Health Serv Res Policy. 2010 Apr;15 Suppl 2:26-34. doi: 10.1258/jhsrp.2009.009099. Epub 2010 Feb 22.
A significant focus of current health policy in Australia is to expand both the number and role of general practice nurses. Multiple new payment incentives have been instituted to encourage the use of practice nurses. This study explored the way these policies have framed their work.
Multimethod research using observation, workspace photographs and interviews with nurses, doctors and managers collected through rapid appraisal in 25 practices in two states, followed by case studies of the role of nurses in seven practices over one year.
Many respondents reported unanticipated benefits in general practice functioning and teamwork as a result of employing a nurse, though this had not been a policy aim. Within funding constraints, nurses created new roles and manipulated old roles to fit their personal understanding of patient care. Policy initiatives targeting practice nurses are often based around tasks and system issues, rather than the personal creation of care and quality that patients require and nurses seek. Incentives in this study were targeted at both the uptake of nurses and specific nursing activities.
Policy development and funding structures would benefit from better understanding of nurses as agents of connectivity (rather than simply as performers of tasks) as well as the nature of teamwork in practices.
澳大利亚当前卫生政策的一个重要重点是扩大全科医生护士的数量和角色。已经制定了多项新的支付激励措施来鼓励使用执业护士。本研究探讨了这些政策制定其工作的方式。
采用多方法研究，在两个州的 25 家诊所中进行快速评估，收集护士、医生和经理的观察、工作空间照片和访谈，然后对护士在七个诊所中的角色进行为期一年的案例研究。
许多受访者报告说，由于雇用了一名护士，全科医生的运作和团队合作有了意想不到的好处，尽管这不是政策目标。在资金限制内，护士创造了新的角色，并操纵旧的角色，以适应他们对患者护理的个人理解。针对执业护士的政策举措通常围绕任务和系统问题展开，而不是患者和护士所需的个人护理和质量的创造。本研究中的激励措施针对护士的参与和特定的护理活动。
政策制定和资金结构将受益于更好地理解护士作为连接者（而不仅仅是简单地执行任务）以及实践中团队合作的性质。
