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An Exploration of the Unique Factors Contributing to NP Burnout: NP Burnout
No full textAim This study aimed to explore unique factors contributing to nurse practitioner (NP) burnout.
Background Burnout is a significant issue affecting healthcare professionals, including nurse practitioners, which can lead to negative outcomes like decreased quality of care, reduced job satisfaction, and increased intent to leave the profession. While common burnout factors like high workload and dysfunctional team dynamics are well-documented, nurse practitioners may face unique challenges that further exacerbate these issues.
Methods A qualitative descriptive approach was used, involving four focus groups with 23 NPs from four Canadian provinces. Transcripts from the focus groups were analyzed through content analysis to identify recurring themes.
Findings The analysis revealed that, in addition to common burnout factors, NPs experience unique challenges. Key themes that emerged included Undervalued Professional Worth, Lack of Autonomy, and Organizational and Systems Pressures.
Conclusion The issues identified in this study underscore the need for strategies aimed at mitigating NP burnout. Addressing these unique challenges could improve job satisfaction, enhance the quality of care, and reduce NPs’ intent to leave the professio
Healthcare Needs of Provincially Uninsured Migrant Families with Newborn Infants: A Qualitative Descriptive Study
No full textAim: This project aimed to explore the healthcare needs of provincially uninsured migrant families with newborns receiving care at a nurse practitioner (NP)-led clinic in Montreal, Quebec, Canada. The findings of this study are intended to guide primary healthcare professionals and administrators in understanding and addressing the specific needs of these families, enabling them to tailor their services appropriately.
Background: Newborns of provincially uninsured migrant families in Quebec can experience delays in accessing provincial health insurance, preventing timely access to primary care services. In Montreal, a publicly funded NP-led clinic was created to enable newborns without provincial health insurance to access recommended well-baby visits in the first 4 months of life. There exists a paucity of literature on the specific healthcare needs of uninsured families with newborn infants, making tailored care difficult.
Methods: A qualitative descriptive study was undertaken. Semi-structured interviews were conducted with the parents of provincially uninsured Quebec-born newborns being treated at a NP-led clinic. Ten interviews were conducted with a total of 13 participants between October 2023 and January 2024. Socio-demographic data were collected. Content analysis was undertaken to identify important themes.
Findings: Two overarching themes were identified including (a) healthcare service needs related to newborn care, maternal postpartum care, and family healthcare; (b) healthcare access needs related to navigating the local healthcare system, transportation, and provincial health insurance.
Conclusion: Provincially uninsured migrant families with newborns in Quebec face barriers to accessing healthcare. This study provides information on the healthcare services and access-related needs of these families and provides recommendations including how NP-led clinics can facilitate access to the healthcare services needed by these families
Advanced Practice Nurses’ Experiences in Sustaining Practice During a Prolonged Global Crisis
No full textAbstract
Aim: To understand advanced practice nurses’ experiences during the COVID-19 pandemic and identify strategies that may support their coping and wellbeing while sustaining clinical practice.
Background: Advanced practice nurses are registered nurses with graduate level education who provide essential care to individuals, families and communities across the globe. Nurse practitioners, clinical nurse specialists and other designations are part of the broader Advanced Practice Nurse population. The COVID-19 pandemic provided a unique opportunity to study their coping, wellbeing and practice sustainability.
Methods: Qualitative description was used to analyze narrative responses to questions administered within a survey circulated at two points of time within the COVID-19 pandemic.
Findings: Supports and opportunities provided by practice settings and employers were found to be helpful in the early months of the pandemic. However, beyond six months of global crisis response advanced practice nurses began to identify more closely with supports external to the work team and practice setting. These included time with others, meditation, mindfulness, hiking, yoga and time off. Some maladaptive behaviours, including increased alcohol use, were also identified during phase two (late pandemic) data collection. Experiences of support from employers and colleagues were variable and may have been linked to pre-existing conditions in the employee/workplace relationship.
Conclusion: Advanced practice nurse coping, wellbeing and clinical practice benefitted from in-workplace supports such as information sharing, team activities, relationships with colleagues and feeling supported by employers in the early phases of a system crisis. In later phases external supports and time away from the practice setting were described as being more helpful. This work suggests there is a tipping point where approaches to supporting advanced practice nursing professionals in a prolonged crisis should move from workplace initiatives to activities external to the practice setting
Challenges Faced by Nurse Practitioners in Chronic Disease Management
No full textAim: This integrative review will explore existing research and determine nurse practitioners\u27 (NPs) roles, perspectives, and challenges related to chronic disease management. It will inform NPs, healthcare policymakers, educators, and researchers about the current state of knowledge about NPs working in chronic disease. Discussion will include suggestions for enhancing and strengthening NP roles in chronic disease management.
Background: Chronic diseases heavily burden healthcare systems and cause global patient suffering. NPs are critical in managing these conditions and can enhance access to evidence-informed care. Improving NP-delivered chronic disease care will boost patient health, reduce morbidity, and lessen the strain on healthcare systems.
Methods: Electronic databases PubMed, CINHAL, and Google Scholar were searched for peer-reviewed publications. After meeting the inclusion criteria, 10 studies were evaluated using a 10-domain quality assessment framework. Themes were used to categorize key study findings, structure discussion, identify knowledge gaps, and inform recommendations.
Findings: NPs are vital contributors to primary healthcare and extensively manage chronic disease. There is an opportunity to strengthen various aspects of NP practice related to chronic disease management. These include system prioritization of chronic care and related services, enhanced specialist collaboration and support, caseload management to enhance efficiency, and role clarity in NP-supportive work environments. Addressing these issues through reforms, policy, education, and organizational support can empower NPs to manage chronic diseases better, shifting towards a holistic, patient-centred approach to chronic illness delivered within a well-designed system offering evidence-informed care.
Conclusion:This integrative review identified opportunities to strengthen support for system-wide efficient, evidence-informed, NP-led care of chronic disease patient populations. Findings may inform educational programs, practice settings, the NP profession, and system leaders regarding the next steps in supporting NPs as an essential resource for patient-centred chronic disease management.
Keywords: chronic disease management, chronic care, nurse practitioner, barriers, opportunities, challenges, nurse practitioner-led
Addressing Vaccine Hesitancy. Use of a Case Study to Evaluate Change in Family Nurse Practitioner Student’s Confidence with Managing Vaccine Hesitant Parents
No full textAim: Evaluate family nurse practitioner (FNP) students’ change in confidence regarding vaccine hesitancy topics after completing a case study learning module on addressing vaccine hesitancy.
Background: Vaccine hesitancy is the hesitancy to accept widely available vaccines. It has been a growing issue, exacerbated by the COVID-19 pandemic. Providing the proper education to FNP students on how to address vaccine hesitancy will increase their confidence regarding having those conversations with patients in practice.
Methods: Quasi-experimental design utilizing a case study learning module. Participants were FNP students. The pre/post-intervention survey consisted of nine questions measuring confidence regarding: passive vs. active immunity, benefits of vaccines, vaccine safety, vaccine preventable diseases and their complications, differentiating vaccine hesitancy from vaccine refusal, using open communication, addressing patient/parent concerns, and vaccine resources. The case study learning module provided education on vaccines and addressing vaccine hesitancy with patients/parents.
Findings: The average baseline confidence levels of participants (n=70) ranged from 77.15 to 88.32 out of 100. Participants with previous experience with vaccines/training reported higher baseline confidence levels than those without. The categories in which differences were statistically significant were vaccine safety (p < 0.05), complications associated with vaccine preventable diseases (p < 0.05), and providing a patient/parent with vaccine resources (p < 0.05). Additionally, there was a statistically significant (p < 0.05) increase in confidence in all nine categories after module completion, for participants who complete both the pre and post surveys (n=35).
Conclusions: Providing education and training to FNP students increases their confidence regarding addressing vaccine hesitancy with patients/parents.
Key Words: vaccine hesitancy, case study, FNP student
Optimizing Patient Care: A Novel Panel Size Calculator for Primary Care Nurse Practitioners
No full textAim This study aimed to develop and validate a novel panel size calculator tailored for primary care nurse practitioners (NPs) within a government-run health authority. It did not include NPs working in other care models, allowing for a focus on patient complexity and provider workload within an organizational context.
Background Panel size, the number of patients assigned to each healthcare provider, is a crucial measure in primary care. It influences patient care quality and provider satisfaction, impacting accessibility, comprehensiveness, and continuity of care. Striking a balance between manageable panel size and optimal patient care remains a global challenge.
Methods A quality improvement methodology was employed, commencing in 2019. Collaboration between the NP leadership team and the FHA Data Analytics team led to the creation of a panel size calculator. Literature reviews and expert consultations informed the integration of clinical, psychosocial, and workload dimensions into the complexity model. The calculator was validated using real-world data from diverse primary care settings.
Findings The calculator developed included clinical and psychosocial complexity, along with provider-specific factors. The expert panel suggested a 70/30 non-complex/complex patient mix for longitudinal care, adjusted to 50/50 for typical FHA clinics. They also recommended staffing ratios of clinic support staff to ensure efficient care delivery.
Conclusion The novel panel size calculator provides a robust framework for evidence-based panel size determination, supporting patient-centered care and provider satisfaction. Future application of the calculator in diverse settings and ongoing interdisciplinary collaboration will be essential to address emerging challenges and enhance primary care delivery
Use of Population Data to Characterize Racialized and Non-Racialized Ontarians Who Self-Report a Past Hysterectomy
No full textNorth American researchers report that women who undergo a hysterectomy for benign conditions are threatened by health disparities. Few studies have examined race and health in Ontario women who underwent a past hysterectomy. The purpose of this descriptive correlational study was to describe and compare health features of racialized and non-racialized women. Using the most appropriate Canada’s Community Health Survey (CCHS) dataset, this study’s sample consisted of all Ontario residing female respondents (n = 1,730) who self-reported having had a hysterectomy with no cancer history. Socio-demographic and health-related variables were extracted in accordance with the Gender and Equity Health Indicator Framework (Clark & Bierman, 2009). Chi-squares and z-scores were calculated to compare racialized and non-racialized women health indicators. Many of the significant differences were found within the non-medical determinants of health domain. Study implications reinforce the need for aggregated gender data by race in Ontario to address health equity.Des chercheurs nord-américains rapportent que des disparités en santé menacent des femmes qui subissent une hystérectomie en raison de troubles bénins. Peu d’études ont porté sur la race et la santé des Ontariennes qui ont eu une hystérectomie. Cette étude a pour but de décrire et de comparer les caractéristiques des femmes racialisées et non racialisées qui ont déclaré avoir eu une hystérectomie. Tiré des séries de données les plus appropriées de l’Enquête sur la santé dans les collectivités canadiennes, l’échantillon utilisé comprenait toutes les répondantes résidant en Ontario (n = 1 730) qui ont déclaré avoir eu une hystérectomie sans antécédents de cancer. Les variables sociodémographiques et liées à la santé ont été extraites conformément au Gender and Equity Health Indicator Framework (Clark et Bierman, 2009). Les chi carrés et les écarts réduits ont été calculés pour comparer les indicateurs de la santé des femmes racialisées et non racialisées. Beaucoup de différences importantes ont été trouvées dans les déterminants de la santé non médicaux. Les conclusions de l’étude renforcent la nécessité de disposer de données agrégées sur le genre selon la race en Ontario pour aborder l’équité en santé
Experiences of Survivors and Families Following a Sudden Cardiac Arrest: A Metasummary
No full textSudden cardiac arrest, abrupt cardiovascular collapse with loss of vital signs, is a leading cause of death. The uptake of emerging evidence, however, optimizes survival rates. For those who survive, and their family members, life can involve enduring physical, mental, cognitive, and social alterations which warrant evidence-informed interventions by health and social service providers. The study purpose was to aggregate published qualitative evidence to yield an understanding of survivors\u27 and family members\u27 life experiences following hospital discharge after a cardiac arrest. The study design, metasummary, was suitable for describing survivors’ and their family members’ experiences following the paradigm life-altering cardiac event. Nineteen primary studies, with a population of 288 adults, met the inclusion criteria. Extraction, abstraction, and aggregation of findings yielded eight topical categories labelled: acknowledging life has changed; confronting mortality; regaining former life; interacting within the family, interacting within the broader social context; involving healthcare providers; evolving health status; and enacting a new life. These topical categories combine to represent two overarching themes - seeking wholeness and being connected. Survivorship relies on pragmatic support from and connection with family, friends, peers, and healthcare providers to address the complexity of challenges following cardiac arrest. Amid these challenges, the early development of individualized recovery plans have the potential to promote continuous and comprehensive care for survivors and families. Further, strengthening interprofessional service planning and delivery, integrating innovative technologies, and tailoring comprehensive care based on individual needs of both survivors and their family has the potential to address wellbeing following cardiac arrest. To be provided if accepted for publication
Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?
No full textPurpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs.
Methods: Using data from the College of Physicians & Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones.
Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD.
Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy
Understanding COVID-19 Vaccine Education for Long-Term Care Workers: An Environmental Scan
No full textAim: We sought to understand educational interventions delivered to long-term care home staff in Ontario, Canada, about COVID-19 vaccines.
Background: Vaccinating staff in long-term care homes is critical to protecting workers and vulnerable residents from COVID-19. However, significant COVID-19 vaccine hesitancy was observed amongst healthcare workers globally when they were first introduced. While knowledge exists around why healthcare workers may express hesitancy towards vaccines, there remains an evidence gap on the delivery of educational interventions for promoting COVID-19 vaccine uptake in this population.
Methods: We conducted an environmental scan consisting of 15 structured interviews with nurse practitioners and management in long-term care homes about education implemented to address staff vaccine hesitancy. We also extracted data from 3 relevant articles identified through a scoping review.
Findings: One-to-one informal conversations were the primary method of delivering education, often supplemented with formal presentations and written information. Facilitators of the education were often peers, nurse practitioners, and directors of care. Equity, diversity, and inclusion (EDI) (e.g., providing education in multiple languages) were considered in some programs but rarely embedded in most formal delivery. The most common barrier to providing education was time constraints.
Conclusions: This environmental scan highlights a range of educational initiatives that were introduced to boost vaccine confidence among workers in the long-term care sector during the COVID-19 pandemic. While there have been limited formal evaluations of these initiatives, there are informal lessons learned from these interventions that may be informative for the design of future vaccine education programs