Hunter Kathleen F, Murphy R Sheli, Babb Maureen, Vallee Chantale
Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, AB.
Senior Operating Officer, Rural Services, Covenant Health, Edmonton, AB.
Nurs Leadersh (Tor Ont). 2016;29(3):61-70. doi: 10.12927/cjnl.2016.24893.
The study aim was to determine benefits and challenges of a community initiative to introduce the nurse practitioner (NP) role in rural primary care. We used a mixed-methods, participatory action research design. Data collection included surveys, interviews, patient record data and shadow billing data. Patient, physician and healthcare professional (HCP) surveys were followed by interviews of survey participants and key local informants. Descriptive statistics were used to summarize survey and patient record data, and content analysis was used to analyze interview data. Benefits, challenges and recommendations were the result of mixed-methods synthesis. Forty-one patients, one HCP and four physicians returned surveys, with 14 patients, one HCP, two local leaders and the NP participating in interviews. The NP provided primary care to 10% of clinic patients in a flexible service delivery model. A high proportion of patients had chronic health concerns. Patient outcomes were generally positive, and patients expressed satisfaction with care. Being connected to the community was important to role implementation. Benefits included increased access to cost-effective, quality primary care. Challenges were funding, limited role understanding and potential for role isolation. Recommendations highlight the need for local community buy-in and provincial support in sustaining the innovation.
该研究的目的是确定一项社区倡议在农村初级保健中引入执业护士（NP）角色的益处和挑战。我们采用了混合方法参与式行动研究设计。数据收集包括调查、访谈、患者记录数据和影子计费数据。在患者、医生和医疗保健专业人员（HCP）调查之后，对调查参与者和当地关键信息提供者进行了访谈。描述性统计用于总结调查和患者记录数据，内容分析用于分析访谈数据。益处、挑战和建议是混合方法综合分析的结果。41名患者、1名HCP和4名医生回复了调查问卷，14名患者、1名HCP、2名当地领导人和NP参与了访谈。NP以灵活的服务提供模式为诊所10%的患者提供初级保健。很大一部分患者有慢性健康问题。患者的治疗结果总体呈阳性，患者对护理表示满意。与社区建立联系对角色实施很重要。益处包括增加了获得具有成本效益的优质初级保健的机会。挑战包括资金、对角色的理解有限以及角色孤立的可能性。建议强调当地社区支持和省级支持对维持这一创新的必要性。
