Is partnership with GPs the way forward for practice nurses?
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Humans↗
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Effective partnerships. Bringing nursing research alive in the practice setting.
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British Columbia↗
Veterinary education with career emphasis: a partnership with private, public, and corporate veterinary practice.
The Virginia-Maryland Regional College of Veterinary Medicine responded to the Pew-sponsored National Veterinary Education Program by proposing a Center for Government and Corporate Veterinary Medicine. The Center is currently providing, through elective course offerings and practical experiences, a senior clinical curriculum that permits career emphasis in a number of species areas, in addition to a unique program for graduates wishing to enter the field of public and corporate veterinary medicine. The Center is also developing post-veterinary medicine. The Center is also developing post-veterinary school education for advanced degrees (PhD, MS) and residency training in public and corporate fields, and for midcareer updating and changes of career emphasis.
Career Choice↗
Practice nurses and the care of patients receiving depot neuroleptic treatment: views on training, confidence and use of structured assessment.
The movement of care into the community for the mentally ill with severe and enduring problems has important implications for primary care services. This paper reports the findings from an interview with practice nurses working in south-west London, United Kingdom, who had participated in a randomised control trial to investigate the effectiveness of training and structured assessment on clinical and social outcomes of patients receiving maintenance medication of depot antipsychotics. The aim of the interview was to explore current practice, attitudes, confidence and priorities for training in relation to these patients. Thirty-nine nurses were interviewed. The majority of practice nurses received scant referral information and worked without protocols. Even though these nurses had received the training, and as a result of the study had increased awareness of the problems of the severely mentally ill, there was a significant relationship between inadequate knowledge of schizophrenia to carry out the task of medication management and lack of confidence. Although the small size of the sample does not permit generalization, important questions are raised for further practice development and research, including the future training needs of practice nurses and partnership relationships with mental health professionals for supervision and support.
Antipsychotic Agents↗
Nursing care models increase care quality while reducing costs.
Unique models of care delivery, such as the Nursing Care Partnership model for practice used at the Denver Nursing Project in Human Caring, have demonstrated a reduction in inpatient admissions, mean length of stay, and total charges. This descriptive study identified and described clients' (N = 75) perceptions of care and explored the cost-effectiveness of this model. Findings suggest nursing care partnerships play a key role in reducing healthcare costs by providing services in a more cost-efficient setting and by having an impact on client utilization of services. Savings in potential hospital costs were estimated at $1,590,384 for 1993.
Adult↗
Tax reform legislation and the formation of optometric group practices.
Tax reform legislation through 1987 was analyzed for its impact on whether a partnership form of group practice or a professional corporation form is more advantageous from a federal tax standpoint. The effect of new tax legislation on pension plan contributions and on the deductibility of fringe benefits is delineated and discussed. Several miscellaneous changes in the law affecting group practice modes are discussed. Even though the individual income tax rates are now slightly lower than the corporate income tax rates, there is still life left in the professional corporation form of group practice if the Subchapter S election is made.
Group Practice↗
Making sense of the voices.
Hearing voices is a common occurrence, and an experience of many people in psychiatric/mental health care. Nurses are challenged to provide care, which is empowering and helps people who hear voices. Nursing practice undertaken in partnership with the voice hearer and informed by a working explanatory model of hallucinations offers greater helping potential. This paper uses Slade's (1976. The British Journal of Social and Clinical Psychology 15, 415-423.) explanatory model as a framework for exploring interventions which may assist people in exerting some control over the experience and which might be used alongside pharmacological interventions. Principles and practical ideas for how nurses might assist people to cope with and make sense of the experience are explored.
Adaptation, Psychological↗
A collaborative model of community health nursing practice.
This paper discusses a strategic collaborative partnership between a Western Australian university and a community health service based on a Practice-Research Model. The partnership has involved a senior academic (0.2 FTE) working in the community health setting as a Nurse Research Consultant since 1998. The first section of the paper draws on the nursing literature on collaborative models and describes the broad background to the partnership and development of the Model. The second section presents in detail the results of a recent evaluation that involved a brief survey and follow-up interviews to determine community health nurses' understanding and perceptions of the partnership Model. Three main themes emerged from the interviews: (1) Advancement of learning captured the extent to which the Nurse Research Consultant position helped to educate nurses and promote and develop research and best-practice; (2) Job satisfaction and self-confidence encompassed the extent to which participants felt nursing management were supportive of their professional education and pursuit of best-practice solutions, and (3) Situational opportunity, which reflected the more negative comments expressed by participants and related mostly to the restricted availability of Nurse Research Consultant and a focus on mainstream research priorities. The results suggest that the partnership Model provided the nurses with the opportunity to develop an increased understanding of the role of research in clinical practice and confidence in their own ability to reflect on current nursing practice. This allowed them to identify clinical problems in order to deliver and evaluate best-practice solutions, as evidenced by a change in attitude from the previous evaluation. However, it was also noted that the operational performance of the Model needs continual monitoring to ensure that all nurses have equitable access opportunities.
Adult↗
Resident partnerships: an effective strategy for training in primary care.
BACKGROUND AND OBJECTIVES: To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies. METHODS: We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships. RESULTS: A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules. CONCLUSIONS: Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.
Family Practice↗
The importance of validating the diagnosis of coronary heart disease when measuring secondary prevention: a cross-sectional study in general practice.
PURPOSE: To compare levels of recorded risk factors and drug treatment between patients with validated and non-validated diagnoses of coronary heart disease (CHD) in Northern Ireland. METHODS: Patients with a nitrate prescription in the previous year or a CHD Read code were identified from computer records of 25 practices, stratified by partnership size and area board. Computer and paper records of a random sample of 10% of these were searched for specified criteria to validate the diagnosis of CHD. The diagnosis was considered valid if the patient was found to have one or more positive investigations for CHD. Records of blood pressure, cholesterol, blood sugar, body mass index and drugs prescribed were taken into account. RESULTS: The combined practice population was 151,071; 7338 (4.86%) were identified by the computer search as meeting the defined entry criteria for CHD. Among the 10% random sample the diagnosis of CHD could not be validated for 36.5% (265/727). Significantly more patients with a validated than non-validated diagnosis had recorded cholesterol levels below 5.0 mmol/l (55.8 vs. 34.5%, p < 0.001) and were prescribed aspirin (75.3 vs. 40.8%, p < 0.001), beta-blockers (51.5 vs. 28.3%, p < 0.001), angiotensin-converting-enzyme inhibitors (29.2 vs. 15.5%, p < 0.001) and lipid-lowering drugs (50.9 vs. 23.0%, p < 0.001). A recent nitrate prescription had a higher predictive value for validated CHD than a Read code for CHD alone (71.2 vs. 53.1%, p < 0.001). No other significant differences were found between the two groups regarding the extent or levels of recorded risk factors. CONCLUSIONS: Patients with a validated diagnosis of CHD appear to be better managed than those whose diagnosis has not been confirmed. Validation of diagnosis has important implications for assessing the provision of secondary prevention and for clinical governance.
Adolescent↗
The association of some practice characteristics with antibiotic prescribing.
BACKGROUND: Antibiotic prescribing in general practice is often considered inappropriate, and its volume excessive. Considerable variation in antibiotic prescribing volume and costs exists among practices. OBJECTIVE: To investigate some factors behind the variation in antibiotic prescribing among general practices, by examining the contribution to this variation of the level of deprivation in the practice population, training status, partnership status, and fundholding status. METHOD: Analysis of prescribing data (PACT) from 351 practices in the Mersey region for the year ending March 1991 and the year ending March 1994; prescribing data standardized for variation in practice population demography. Use of multiple linear regressions to investigate the variation among practices in standardized prescribing volume and standardized prescribing costs, in both years. RESULTS: Level of deprivation, training status and partnership status contributed to the models explaining variation in prescribing volume. The same variables contributed to the model explaining variation in prescribing costs in the year ending March 1991. For the year ending March 1994, level of deprivation, training status, and fundholding status contributed to all models. CONCLUSION: Higher levels of antibiotic prescribing occur in practices serving more deprived communities, in single-handed practices, and in non-training practices. These higher levels of prescribing may be due to higher levels of morbidity, but may also reflect the organization and attitudes of these practices.
Journal Article↗
"It takes a village": understanding concurrent sexual partnerships in Seattle, Washington.
BACKGROUND: Sexually transmitted infections (STIs) are efficiently spread via concurrent partnerships. GOAL: This study identifies patterns of concurrency in Seattle STI clinics and community samples to enhance partner notification and counseling. STUDY DESIGN: Semistructured interviews with heterosexuals (108 with gonorrhea, chlamydial infection, or nongonococcal urethritis and 120 from high STI prevalence and randomly selected neighborhoods) were tape-recorded, transcribed, and analyzed for content. RESULTS: Six main forms of concurrency were identified: experimental, separational, transitional, reciprocal, reactive, and compensatory. Experimental concurrency, overlapping short-term partnerships, was most common. Men practiced concurrency to avoid becoming partnerless during partnership disintegration; more women, especially STI patients, reported reactive concurrency, recruiting new partners rather than leaving partners with other partners. Concurrency clustered by age and when occurring during separation and transitioning between partners was socially acceptable. CONCLUSIONS: Prevalence of concurrent partnerships in all groups studied suggests linkages to individuals' life stage and some social acceptability. STI programs should develop prevention messages to reflect different forms of concurrency.
Adult↗
Discussing cardiopulmonary resuscitation with patients.
The British Medical Association and the Royal College of Nursing acknowledge that patients should be involved in the decision-making process regarding cardiopulmonary resuscitation (CPR) in order to gain compliance with any decision made on their behalf. In the past, it was apparent that decisions concerning the eligibility of patients for CPR were being made arbitrarily and older people were being treated unfairly in respect of their consideration for this intervention. This article reviews literature associated with patient involvement in decision-making regarding CPR and 'do not resuscitate' orders and how an assessment and rehabilitation unit promoted this activity as usual practice. In order to enhance partnership with patients and promote best possible practice in respect of CPR decision making the authors suggest a strategy that includes (1) evaluating documentation (2) development of a patient information leaflet and (3) an education programme for healthcare personnel.
Advance Directives↗
Disability and oppression: some implications for nurses and nursing.
Since the 1970s organizations of disabled people have defined disability as a form of oppression. However, despite nurses (along with other professionals) increasingly being viewed as part of this experience of oppression, British nursing literature has to date largely failed to conceptualize disability in these terms. In this paper the five faces of oppression identified by Young are modified to include discrimination and developed to provide a framework in which evidence of the oppression experienced by disabled people may be analysed. It is argued that if nurses and the nursing profession are to challenge and reduce oppression then this should be via a process of awareness of the nature of disability, reflection on practice and development in partnership. Accordingly, an agenda is identified which has implications for nursing practice, education and research. It is stressed that if nursing is not to be viewed as irrelevant to the needs of disabled people or as part of the process by which they are oppressed then it is vital that this agenda is heeded.
Attitude of Health Personnel↗
Relational conversation as method for creating partnerships: pilot study.
AIM: This paper reports a pilot study testing the intervention, Self-Care TALK, whose aim was to describe communication skills used by an advanced practice nurse to create partnerships with caregivers. The communication process and examples of skills used in creating partnerships are described. BACKGROUND: Decades of exploring nurse-client relationships provide a knowledge base for describing a structure and process for building partnerships. Self-Care TALK functions as a vehicle for an education and support partnership. Self-Care TALK, a theory-derived intervention, is based on the Self-Care for Health Promotion in Aging model. Implementation of the intervention was evaluated in a pilot study in 2003, with older spouse caregivers of persons with early dementia. METHODS: Pilot testing of Self-Care TALK followed Lichstein's criteria of tracking three phases of intervention: delivery, receipt and enactment. Henson's communication elements for establishing partnership relationships provided a guide for advanced practice nurse communication. Self-Care TALK was delivered during six phone conversations with caregivers for a total of 36 phone conversations. All phone conversations were audiotape recorded. Field notes were taken during each conversation. Data analysis followed a qualitative descriptive process of comparative analysis in which communication skills were compared across conversations. Categories of skills were named based on communication elements that dominated the category. Communication skills were compared to literature addressing communication and nurse-client partnerships. FINDINGS: Communication examples described the structure for interaction (Self-Care TALK protocol), process of interaction (relational conversation) and caregiver identified outcomes (intentions to enact self-care). CONCLUSION: Conversations to create partnerships depended on one theme: language that supported relational conversation. Four communication skills illustrated the how of relational conversation: listening with intent, affirming emotions, creating relational images, and planning enactment.
Adaptation, Psychological↗
Integrating practice issues in managed care into the curriculum: a Delphi survey.
PURPOSE: This project evolved from a partnership between an advanced practice nurse (APN) graduate program and a care management insurer. The purpose of this Delphi survey was to identify (a) role components germane to the practice of APNs in managed care and (b) topics reflecting these components in the curriculum. DATA SOURCES: Data were gathered from two expert panels, clinician preceptors and faculty members. Each panel had 11 members: 11.3% and 100%, respectively, of the target populations of clinicians and faculty in the partnering agencies. CONCLUSIONS: There was considerable congruence between the panels on the survey. IMPLICATIONS FOR PRACTICE: Case vignettes could be used as a vehicle for discussion of the broader issues of population approaches to specific problems. Faculty could partner with clinicians to develop cases for discussion of evidence-based practice. Faculty and clinicians could create preceptorships focused on business management, postgraduate fellowships within managed care systems, and regular opportunities to dialogue about curriculum and essential attributes of APN graduates.
Boston↗
Substance abuse providers' assessment of the Massachusetts Behavioral Health Program: year 6.
Substance abuse providers surveyed after Year 6 of the Massachusetts Behavioral Health Plan reported better treatment outcomes and access than in previous years. The Massachusetts Behavioral Health Partnership's clinical practices helped to improve quality of care. Its review process was highly rated. Coordination of substance abuse and mental health services was favorable, but was unfavorable with primary care. Staffing and organizational changes are described. Comparisons of outpatient and detoxification providers' responses with previous mental health and substance abuse surveys are made.
Ambulatory Care↗
Promoting partnership.
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Cooperative Behavior↗