Escolar Documentos
Profissional Documentos
Cultura Documentos
Monique Mavronicolas
Abstract
Table of Contents
Abstract
.. 2
Table of Contents
3
Acknowledgements
.. 4
1.
1.1
1.2
1.3
2.
2.1
2.2
2.3
2.4
2.5
3.
Introduction
. 5
Background
.. 5
Research Aims
5
Outline of Chapters
. 6
Literature Review
. 7
Methodology
7
Nursing shortages and the impact on Patient Care
. 9
The role of Nurse Practitioners compared to General Practitioners
.. 13
Improving service delivery in Primary Healthcare
15
Discussion
. 16
Research Methodology
..
17
3.1
Introduction
18
3.2 Research Design
.. 18
3.3 Research Methods
. 19
3.3.1 Research Instrument
19
3.3.2 Sampling
21
3.3.3 Data Analysis
.. 22
3.4 Ethical Considerations
..
22
3.5 Conclusion
. 23
4.
Research Findings
25
4.1 Introduction
25
4.2 Quality of Frontline Patient Care
. 25
4.3 Nurse Practitioners relation to General Practitioners
. 28
4.4 Discussion
. 29
5.
Conclusion and Recommendations
. 30
5.1 Research Limitations
. 31
5.2 Summary of Research Findings
.. 31
5.3
5.4
5.5
33
Areas for Future Research
. 33
References
.. 40
Acknowledgements
I would like to thank the study respondents who offered their time and
invaluable insight towards this research study.
A special thanks also to East Surrey College and to the teachers who
offered advice and feedback during the planning and research phase.
A final thanks goes to my husband for his continued support and for
proofreading this study.
Chapter 1 Introduction
1.1
Background
Ever since the decrease in demand for the services of general
nurses have had to be recalled to lend their clinical expertise and help
train a young and inexperienced nursing workforce.
1.2
Research Aims
The study will take the form of empirical research. Due to the
constraints of the size of this small qualitative study, the sample group of
interviewees will provide data which will be limited to the perceptions of
these interviewees.
The aim of this research study is to assess Nurse Practitioners
perceptions of primary health care in the United Kingdom with a view to
their contribution to the health service industry and whether in their view,
this has any impact on the quality of service delivery in patient care.
These aims will be operationalised by means of the following specific
objectives:
I.
II.
III.
From examining the data generated by this research, it is hoped that the
outcome of this study will shed light on possible gaps in the public health
services.
1.3
Outline of Chapters
2.1
Methodology
This chapter aims to address the following research questions:
I.
II.
able to provide?
Do NP in any way provide the equivalent care services to that of
a GP? And lastly,
III.
To address the first research question, the first part of the literature
review will purposely discuss the issue of nursing supply and demand
issues, otherwise known as workforce gaps, which presently affect NHS
organisations and the consequential effect on patient care. Specifically,
reference will be made to studies which point towards nursing workforce
supply shortages, the related work-role demands placed on nurses and
the surveyed organizations having to recruit qualified nursing staff from
outside of the UK.
To address the second research question, the second part of the
literature review purposely identifies and addresses the perceived
elements of NPs working in primary health care, possibly providing
equivalent care to GPs with a view to ascertaining the respective level of
patient care outcomes such as patient satisfaction and quality of care.
Lastly, to address the third research question, the last part of the
literature review purposely discusses the need for strategic ways on how
to effectively strategize a forward looking framework for enabling NPs to
improve on primary health care service delivery. This strategy looks at
workforce redesign in a climate where the nature of health care work is
changing and a necessity exists to address skills in order to match future
health care needs and related demands.
10
2.2
6 per cent of nursing posts and outside of the US, figures reflect that they
make up as little as 1 per cent or less. Evidence suggests that a reason
for shortages in the field of advanced nursing can be attributed to the
fact that it is still a relatively new and unknown discipline and the fact
that postgraduate studies are needed in order to qualify in the field when
in some countries, nursing is just a vocational training programme (Lipley
2014).
Primary health care can be described as the first point of contact in the
health care system. Forming the cornerstone of Englands National Health
Services (NHS), the main source of health care is in general practice
(What is primary health care? n.d., para. 1). In terms of global standards
in health care and the availability of basic health care, the United
Kingdom affords a level of service which is ranked comparatively high
according to international standards. In fact, the Commonwealth Fund
survey, found people in Britain to have the best co-ordinated care, have
among the fastest access to GPs and suffer among the fewest medical
11
12
14
15
16
(GP). This means that they work with rather than for GPs with the
emphasis being on collaboration rather than substitution. In terms of
qualifications, they will have had a minimum training of a degree level.
Additionally, they will have been trained and are able to demonstrate
skills which include physical assessment, medical consultations,
diagnosis, health promotion and be able to support specific areas of long
term conditions which could include asthma and diabetes. The RCN
makes the recommendation for those wanting to become NPs to
undertake study and training to at least an honours degree level while
Advanced Nurse Practitioners (ANP), are typically able to offer the same
services of a nurse practitioner, but in addition will have a prescribing
qualification as well as a Masters degree (NHS Careers).
In a systemic peer review of an international study on nurse
practitioners, data revealed that there was low to moderate evidence to
suggest that despite patient health outcomes being similar for nurse
practitioners and doctors, the quality of care and patient satisfaction was
higher in relation to nurse practitioners compared with doctors. The study
also revealed that there was moderate quality evidence to suggest that
nurse practitioners undertook more investigations and had longer
consultations compared with doctors. The study was of nurse
practitioners working in primary healthcare involving initial assessment
and autonomous management of patients (Shey & Chopra 2008).
2.4
17
18
2.5
Discussion
There are numerous incentives and monitoring bodies in place in the
19
3.1
Introduction
This chapter discusses the method used in the research study.
Specifically, the first section discusses the research study design, followed
by detailing the importance of using key search words or terms when
selecting appropriate and related literature, the importance of using the
inclusion and exclusion criteria, as well as the design of the semistructured research interview schedule that will be used in the actual
research interviews. In addition to discussing the strengths and limitations
of selecting the research strategy, the sample size, recruitment and
selection of highly qualified research interviewees are discussed in detail.
After discussing how the gathered primary and secondary data will be
analyzed, the ethical considerations for this study are also mentioned in
this chapter. The last part of the chapter purposely discusses the
20
3.2
Research Design
A qualitative research design was chosen, because it allows the
3.3
Research Methods
Semi-structured interviews were selected for this study as the best
means for gathering empirical data and additionally, there are a few
reasons for selecting this method. Firstly, it is common for semi-structured
interviews to be conducted privately with the appropriate research
21
Mode of
Communicat
ion with the
Research
Interviewee
s
Qualificati
on of the
Research
Interviewe
e / Job
Title
Role &
Responsibilities
Number
of Years
in
Service
Face-to-Face
Interview
BSc
Nursing,
Advanced
University
Diploma/
Permanent
Nurse
Practitioner
Cytology
Immunisations,
Dressings and
Wound
Management,
Sexual Health,
Asthma, Diabetes,
ECG Plembotomy
8 years
experien
ce of
tradition
al PN
duties,
with 5
years as
Skype
Conference
MSc
postgraduat
e diploma:
Nurse
Practitioner
in Primary
12 years
of which
4 years
in
primary
23
Care/
Emergency
Nurse
Practitioner
MSc,
RNDipHE
/
Emergency
Nurse
Practitioner
department,
contribute towards
staff induction
programmes
care
Experience in X-Ray,
suture, plaster,
minor illness, minor
injury, prescribing,
paediatrics
experience
16 years
of which
over 5
years as
ENP
Face-to-Face
Interview
Face-to-Face
Interview
BSc (Hons)
Nursing/
Emergency
Nurse
Practitioner
Over 7
years
with just
over 2
years as
ENP
Face-to-Face
Interview
MSc Primary
Health Care/
Lead Nurse
Practitioner
Patient assessment
and clinical
examination,
extended and
supplementary
prescribing within
parameters of
prescribing
authority, working
with medical and
nursing teams,
managing patients
with chronic
diseases
14 years
Face-to-Face
Interview
BSc Hons
Nurse
Practitioner/
Advanced
Nurse
Practitioner/
Independent
Prescriber
2 years
as
Commun
ity
Nurse/
7 years
as an
ANP
Face-to-Face
Interview
Nurse
Practitioner/
Independent
Prescriber
Autonomous
assessment,
examination,
diagnosis and
management of
9 years
24
patients presenting
with acute and
chronic medical
conditions in both a
walk-in and booked
routine
appointments
setting
3.3.2 Sampling
Once a list of potential candidates was located, all of whom were
either currently employed in public health services or at some stage in
their career, their professional expertise and overall profile was carefully
reviewed by the researcher, before sending each of the potential research
candidates an introductory e-mail explaining the main purpose of the
study, the reasons for being invited to participate in the study, including
other research ethics required as a candidacy pre-requisite.
3.3.3 Data Analysis
As far as data and analysis of research findings is concerned, it is
deemed ethical not to fabricate, falsify or commit any signs of plagiarism
during the course of the research study (Marsden & Wright, 2010). To
avoid the likelihood of any such perils, the gathering of primary data from
the research interviews, was analyzed together with the gathered
secondary data.
3.4
Ethical Considerations
A number of ethical considerations governing the study, were
26
It is sometimes the case that third parties are interested in using the
gathered data presented in an academic study. This would understandably
present data usage considerations in accordance with regulation, in the
case of this particular study, in accordance with the Data Protection Act
(1998). As such, participants were informed about the likelihood of the
recorded data provided in this study, being archived or made available for
future research studies. Except for the subjective response from each of
the research interviewees, the research topic of this study was not
deemed sensitive in nature. To avoid plagiarism in any form, all
information found in peer-reviewed journals, academic books or relevant
organizational
websites,
were
paraphrased.
Likewise,
appropriate
3.5
Conclusion
The research respondents were found to be very helpful and
27
4.1
Introduction
The semi-structured interview schedule can be viewed under
28
4.3
31
Discussion
While it is challenging to ascertain whether the perceptions of a
33
5.1
Research Limitations
The small cross-section of Nurse Practitioners composing the study
cohort in this paper, despite the prevalence of NPs in most health care
settings in the UK, is reflective of the comparatively small number of NPs
not only presently employed in the United Kingdom, but also worldwide.
This provided an increased challenge in accumulating the total number of
respondents available to take part in this study and a larger test sample
would therefore provide important validating data in much needed future
research on the same topic. Additionally, the existence of a marked
ambiguity in defining what a Nurse Practitioner is in terms of their role and
function, added to the limited existing data available for purposes of and
use in this study.
5.2
the fact that their education and training, enabled them with a certain
proficiency to provide a good level of primary health care. There was a
consensus among the respondents that the problem with primary health
care in the UK, was with managing to provide a consistent standard of
34
35
While there are numerous factors which attribute to the workpressures and demands on nurse practitioners, such as hospital
overcrowding and misuse of A&E centres, the stark reality is that where
there is an aging UK population, given the current pressures on the NHS,
the cost of bed-based care will only compound the problem of an already
dwindling nursing workforce. When it comes to primary care on supported
self-management, more help is needed from cross-agency, interprofessional groups in order to alleviate the dependence on nurse
practitioners.
5.4
Key Recommendations
More research is needed in terms of developing and testing the data
36
References
Adams, S 2011 - NHS among best health care systems in the world available from:
http://www.telegraph.co.uk/news/health/news/8877412/NHS-amongbest-health-care-systems-in-the-world.html accessed on 7 February
2015
Adler, E & Clark, R 2011. An Invitation to Social Research: How It's Done.
Stamford, CT: Cengage Learning.
Aveyard, H 2010. Doing A Literature Review In Health And Social Care: A
Practical Guide. 2nd Edition. Berkshire: Open University Press.
37
Ball, C & McElligot, M 2003, Realising the potential of critical care nurses:
an exploratory study of the factors that affect and compromise the
nursing contribution to the recovery of critically ill patients,
Intensive and Critical Care Nursing Journal, vol. 19, no.4 , pp. 226
-238. Available from:
http://www.sciencedirect.com/science/article/pii/S096433970300054
5 accessed on 7 February 2015
Campbell, D 2014, NHS nurse shortage forces health service to recruit
overseas, The Guardian 17 December. Available from:
http://www.theguardian.com/society/2014/dec/17/nhs-nurseshortage-health-service-overseas [24 February 2015].
Cohen, L, Manion, L & Morrison, K 2011. Research Methods in Education.
Oxon OX: Routledge.
Competencies in nursing: Nurse practitioners. 2005. An RCN guide to the
nurse practitioners role, competencies and programme approval.
March 2005, p. 4. Available from:
http://www.rcn.org.uk/__data/assets [25 February 2015].
de Vaus, D 2002. Surveys in Social Research. 5th Edition. Leonards NSW:
Routledge.
Fink, A 2010. Conducting Research Literature Reviews: From the Internet
to Paper. 3rd Edition. CA: Sage Publications Inc.
Ham, C et al. 2012, Transforming the delivery of health and social care,
Kings Fund. Available from:
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/transfo
rming-the-delivery-of-health-and-social-care-the-kings-fund-sep-2012.pdf
[25 February 2015].
38
Imison, C & Bohmer, R 2013, NHS and social care workforce: meeting our
needs now and in the future?, The Kings Fund. Available from:
http://www.kingsfund.org.uk/time-to-think-differently/publications/nhs-andsocial-care-workforce [24 February 2015].
Consent
Form
East Surrey
College
Gatton
Point
London
Road
Redhill
Surrey
RH1 2JX
41
Tel: 01737
772611
5.
Name of Participant:
Signature:
Date:
Question 4: What are your views on the quality of care in the UK?
43
Question 6: What are the challenges which you face in your work
role?
44