Poghosyan Lusine, Dougherty Maura, Martsolf Grant R, Featherston Kyle, Porat-Dahlerbruch Josh, Borson Soo, Sadak Tatiana, Wang Siqing, O'Reilly-Jacob Monica
Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA.
Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, 315B Victoria Building, 3500 Victoria Building, Pittsburgh, PA, 15261, USA.
BMC Prim Care. 2025 May 15;26(1):164. doi: 10.1186/s12875-025-02855-5.
More than 55 million people worldwide have dementia, and every year, 10 million new cases are diagnosed. In the United States (U.S.) alone, 6.9 million Americans ages 65 and older have dementia. Health systems are searching for innovative solutions to expand the primary care system's capacity to care for these patients. Advanced practice nurses such as nurse practitioners (NPs) are vital to increasing primary care capacity to meet the need, yet primary care NPs often face structural, organizational, and workforce challenges. More specifically, little is known about NPs who care for dementia patients in primary care settings. This study explored the practice structural capabilities, organizational context, and job outcomes (i.e., burnout, job dissatisfaction, and intent to leave the practice) among NPs providing care for patients with dementia in U.S. primary care practices.
We conducted a national cross-sectional survey of NPs using modified Dillman methods. Between 2021 and 2023, NPs working in primary care practices who cared for patients with dementia received a mail and online survey. Additional survey mailings, emails, postcard reminders, and phone calls encouraged non-respondents to participate. In total, 968 NPs responded across 847 practices. We estimated a response rate of 16.4-36.4%.
NPs reported that the quality of dementia care in their practices is poorer than the overall care provided. About 45% of NPs indicated that dementia care in their practices is less than "very good," while only 17% reported that the overall care delivered falls below that standard. Additionally, NPs reported significant deficits in practice structural capabilities for dementia care and challenges with administration within their organization. The findings show that over a third of NPs report burnout.
Given the projected growth in the number of patients with dementia and the growing workforce of NPs worldwide, policy and practice efforts should be directed toward strengthening primary care practices to provide quality care for dementia patients. Bolstering NP workforce capacity and supporting NP roles in dementia care could improve organizational capacity to provide dementia care. However, widespread burnout among NPs found in our study could undermine their contribution to the dementia care workforce.
全球有超过5500万人患有痴呆症，每年有1000万新病例被诊断出来。仅在美国，就有690万65岁及以上的美国人患有痴呆症。卫生系统正在寻找创新解决方案，以扩大初级保健系统照顾这些患者的能力。诸如执业护士（NPs）等高级实践护士对于提高初级保健能力以满足需求至关重要，但初级保健执业护士经常面临结构、组织和劳动力方面的挑战。更具体地说，对于在初级保健环境中照顾痴呆症患者的执业护士了解甚少。本研究探讨了在美国初级保健机构中为痴呆症患者提供护理的执业护士的实践结构能力、组织背景和工作成果（即职业倦怠、工作不满和离职意愿）。
我们使用改良的迪尔曼方法对执业护士进行了全国性横断面调查。在2021年至2023年期间，在初级保健机构工作且照顾痴呆症患者的执业护士收到了邮件和在线调查。额外的调查邮件、电子邮件、明信片提醒和电话鼓励未回复者参与。共有968名执业护士在847个机构中做出了回应。我们估计回复率为16.4%-36.4%。
执业护士报告称，他们机构中痴呆症护理的质量比所提供的整体护理质量差。约45%的执业护士表示，他们机构中的痴呆症护理不到“非常好”，而只有17%的人报告所提供的整体护理低于该标准。此外，执业护士报告称，在痴呆症护理的实践结构能力以及机构内的管理方面存在重大不足。研究结果表明，超过三分之一的执业护士报告有职业倦怠。
鉴于预计痴呆症患者数量的增长以及全球执业护士劳动力的增加，政策和实践方面的努力应致力于加强初级保健机构，以便为痴呆症患者提供优质护理。增强执业护士劳动力能力并支持他们在痴呆症护理中的角色，可能会提高机构提供痴呆症护理的能力。然而，我们研究中发现执业护士普遍存在职业倦怠，这可能会削弱他们对痴呆症护理劳动力的贡献。
