Scientific Centre for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands.
Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
BMJ Open. 2019 May 24;9(5):e028169. doi: 10.1136/bmjopen-2018-028169.
This study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.
A multiple-case study was conducted that draws on realist evaluation principles.
Seven nursing homes in the Netherlands PARTICIPANTS: The primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78).
Data collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.
An optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.
Collaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.
本研究旨在深入了解在不同背景下，养老院中如何通过护士从业者（NPs）、医师助理（PAs）或注册护士（RNs）替代老年护理医师（ECPs），以及在何种背景下何种模式有助于感知医疗保健质量。其次，本研究旨在深入了解有助于通过 NPs、PAs 或 RNs 替代 ECPs 的最佳模式的要素。
进行了一项多案例研究，借鉴了现实主义评估原则。
荷兰的 7 家养老院
主要参与者是在 7 家不同养老院工作的 NPs（n=3）、PAs（n=2）和 RNs（n=2），次要参与者包括 ECPs（n=15）、医生（MDs）（n=2）、管理人员/经理/主管（n=11）、护理团队成员（n=33）和居民/亲属（n=78）。
数据收集包括：（1）观察 NPs/PA/RN 和 ECP/MD，（2）与所有参与者进行访谈，（3）NPs/PA/RN、ECPs/MDs 和管理人员/经理填写的问卷，以及（4）收集内部政策文件。
一个最佳的 ECP 替代模式似乎是专业人员在很大程度上自主地替代 ECP，ECP 和替代人员之间进行良好平衡的协作，以及维持医疗保健质量。这种模式在 2 个 NP 案例和 1 个 PA 案例中被观察到。使 NPs 和 PAs 能够按照这种最佳模式工作的要素包括：基于信任与 ECP 合作；积极主动、果断和善于沟通，并得到组织领导者的授权，作为独立的专业人员开展工作。
ECP 和 NPs 或 PA 之间基于信任的协作是成功替代 ECP 的关键要素。养老院中的 NPs、PAs 和 RNs 可能都以其独特的方式具有价值，与他们的职业、教育和能力相匹配。
