Hospital-Based Nurse Practitioner Practice: An Exploration of Interprofessional Teams.

Nurse practitioner (NP) roles within hospital teams are evolving worldwide. However, understanding of their practice within the context of interprofessional (IP) teamwork remains limited. This two-phase study undertaken within Ontario, Canada provides a new multi-perspective understanding of the value of NP practice within IP hospital teams. Constructivist grounded theory, a modification of the classic methodology, guided an interpretive approach based in exploration of process and meaning construction, privilege and power exposure, and juxtaposition with extant theory. A conceptual rendering of NP practice was determined through supplemental analysis of 30 team member focus groups. This new perspective emerged as three practice foci: easing others’ workload, holding patient care together, and evolving practice. Phase two substantiated and expanded the team member rendering through exploration of perceptions of 17 hospital-based (HB) NPs, exposure of privilege and power influences, and congruence with theoretical aspects of IP teamwork and collaboration. The study offers four new discoveries: a team perspective framework of HB NP practice, dimensions of the HB NP role position within hospital teams, explanation of why HB NP role clarity remains elusive, and an emerging theory of HB NP IP practice. The emerging theory illuminates three practice foci that are distinct yet hold relationships of interest: evolving NP role and advancing the specialty, focus on team working, and holding patient care together. The emerging theory provides understanding of HB NP actions deemed of value within IP teams and identifies the HB NP role as pivotal in promoting IP work. The study provides pragmatic and useful new knowledge that is of interest to NPs, healthcare providers, hospital leaders, and academics. The categories provide foci that may aid in assessing needs, envisioning role enactment or change, and considering role outcome measures. Sub-categories emphasize how HB NPs can practice to the full extent of their value, including promotion of IP practice. Privilege and power awareness may aid in effective role integration and conflict resolution. The emerging theory provides a new perspective to enhance NP curricula. Further research may use or test the framework to continue building knowledge of this expanded nursing role

Management of pain during mechanical ventilation weaning: The nature of nurse decision-making.

Despite extensive knowledge of pain and pain management, it remains common for critical care nurses to withhold sedation from patients for extended periods of time prior to, and during, weaning from mechanical ventilation. Using the research method of Grounded Theory, insight into the importance of pain management during weaning and the nature of decision-making related to pain management was sought. Ten critical care nurses from a moderate sized urban Canadian hospital were interviewed for their perceptions on pain and its management during weaning from mechanical ventilation. The findings from the study support a theory of decision-making that is a dynamic and continuous process of knowledge gathering, interpretation, and action. Within this process, two sets of nurse beliefs were identified that influence nurse decision making. The strength of the two beliefs, in combination with nursing experience, create numerous lines of decision-making within the Belief-Decision Continuum and generate the potential to switch lines of decision-making during the process. The results of this study suggest that nurse beliefs may be more powerful than empirical evidence indicating that nurse beliefs may provide an answer to why pain management education has been unable to change critical care nurses\u27 practice. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis2001 .H87. Source: Masters Abstracts International, Volume: 40-03, page: 0679. Adviser: A. Snowdon. Thesis (M.Sc.)--University of Windsor (Canada), 2001

Nurse practitioner interactions in acute and long-term care : an exploration of the role of knotworking in supporting interprofessional collaboration

BACKGROUND: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. METHOD: Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of "knotworking" to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. RESULTS: Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. CONCLUSIONS: Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed

Health professionals' and patients' perceptions of patient-centered care : a comparison

Rationale, aims and objectives: This study aimed to compare health professionals’ and patients’ perceptions of patient-centered care (PCC) practice. Methods: PCC was operationalized into three components: (i) holistic, (ii) collaborative and (iii) responsive care. In a cross-sectional design, a sample of 401 health professionals and 500 patients in acute care settings in Ontario, Canada completed a valid and reliable measure of PCC. Results: The results showed that patients had lower ratings of PCC than health professionals, indicating that patients viewed their care as holistic, collaborative and responsive to a low-moderate extent; this contrasted with a more positive view by health professionals, suggesting a high level of PCC enactment (all p’s 0.05; effect sizes range: 0.38 to 0.88). Discussion and Conclusion: Although methodological, clinical and contextual factors have been suggested, additional research is needed to further explore the mechanisms underlying these differences. Collaboration among management, professionals and patients would promote a collective development of guidelines to deliver PCC

The role of nurse practitioners in hospital settings : implications for interprofessional practice

Expansion of the nurse practitioner (NP) role worldwide indicates a need to understand how the role functions in interprofessional healthcare teams. Through the adoption of a mixed methods approach that gathered on-site tracking and observation, self-recorded logs of consultations and focus group interviews of team members and NPs, we describe the extent of role activity and the nature of interprofessional practices of 46 NPs and their team members in nine hospital sites across the province of Ontario, Canada. Findings outline the nature of the NP role activities, which largely focused on providing clinical care, with the support of their team, to a range of patients across the study settings. We discuss how 'embedding' the NP in this way appears to contribute to utilization of expertise of all professions as well as enabling team members to promote evidence-based practices. We argue that the use of NPs augments interprofessional role utilization through their desire to consult with a range of professionals and the capacity to perform holistic care for patients that is not limited to traditional nursing boundaries

The value of the hospital-based nurse practitioner role : development of a team perspective framework

There is a need to understand nurse practitioner (NP) interprofessional practice within hospital teams to inform effective role integration and evolution. To begin this understanding a supplementary analysis of 30 hospital team member focus groups was carried out using constructivist grounded theory methodology. This conceptual rendering of the team members' shared perspective of NP actions provides insight into the meaning and importance of the NP role. Participants emphasized three hospital-based (HB) NP practice foci as the meaning of role value; easing others' workload, holding patient care together and evolving practice. Trust emerged as a pre-requisite condition for HB NP role efficacy. A team member perspective framework of HB NP practice is presented as the first stage in developing a model of HB NP interprofessional practice within hospitals. The framework provides multiple perspectives to the meaning and value of the HB NP role beyond basic role description. The framework may be used by healthcare professionals, operational leaders, academia and HB NPs to enhance role respect and understanding

A description of nurse practitioners' self-report implementation of patient-centered care

This study aimed to describe the nurse practitioners’ self-reported implementation of patient-centered care (PCC) and factors that influence their delivery of PCC. It was guided by a conceptualization of PCC that identified three components that distinguish PCC (i.e. holistic, collaborative, and responsive care) and respective activities that operationalize them. A sample of 149 nurse practitioners employed in acute and long term care settings, in Ontario Canada, completed a valid and reliable measure of the extent to which they implemented the three PCC components. The results indicated that the majority of respondents reported engagement in most activities reflective of the PCC components, most of the time, and that experienced nurse practitioners performed a large number of these activities. Further research should examine the contribution of each PCC component, as implemented by nurse practitioners and other members of the healthcare team, to patient-oriented outcomes.</jats:p

Development of a measure to assess healthcare providers' implementation of patient-centered care

BACKGROUND: Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability. METHODS: Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items' content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively. RESULTS: The CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC. LINKING EVIDENCE TO ACTION: The PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers' implementation of PCC in their usual practice