Chouinard Véronique, Contandriopoulos Damien, Perroux Mélanie, Larouche Catherine
University of Montreal Hospital Centre (CHUM), University of Montreal Public Health Research Institute (IRSPUM), C.P. 6128 succ. Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.
University of Montreal, Faculty of Nursing, University of Montreal Public Health Research Institute (IRSPUM), Pavillon Marguerite-d'Youville, 2375, chemin de la Côte-Ste-Catherine, Quebec, H3T 1A8, Canada.
BMC Health Serv Res. 2017 Jun 26;17(1):437. doi: 10.1186/s12913-017-2363-4.
While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices.
This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches.
This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels.
Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.
虽然在初级医疗保健环境中更多地依赖执业护士可以提高服务效率和可及性，但他们的融入并非一帆风顺，这对注册护士和医生现有的角色定义构成了挑战。因此，制定适当的支持措施对于初级医疗保健执业护士的融入至关重要。本研究的主要目的是研究为支持不同医疗环境中初级医疗保健执业护士的实践发展而建立的不同结构和机制，并开发一个实用模型，用于识别和规划适当的支持措施。
本研究是加拿大魁北克省一项关于初级医疗保健执业护士的大型多中心研究的一部分。它聚焦于三个已融入一名或多名初级医疗保健执业护士的医疗环境。选择案例研究以涵盖地点、组织环境和初级医疗保健执业护士融入阶段方面的最大差异。研究结果基于对每个初级医疗保健环境中现有文件的分析以及对每个临床团队关键人员的半结构化访谈。采用主题分析和横断面分析方法对数据进行分析。
本文确定了三种支持措施：临床支持、团队支持和系统支持。这一三级分析表明，在实际中，初级医疗保健执业护士的融入本质上是一项基于团队的多层次工作。尽管存在省级实施计划，但这三个环境采用了非常不同的实施结构和措施，并且在三个层面上涉及不同的行为主体。结果还表明，护理部门在所有三个层面都发挥了决定性作用。
基于这些发现，我们建议支持措施应适应每个组织的环境和经验，并在整个融入过程中根据需要进行调整。我们还强调将这种方法与一个强大的协调机制相结合的重要性，该机制涉及对护理专业角色和实践范围有深入了解的管理人员。使初级医疗保健执业护士融入框架更加灵活，并明确和加强高级护理管理人员的作用可能是成功融入的关键。
