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Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study
- Source :
- BMJ Open, BMJ Open, 9, e028169, BMJ Open, 9, 5, pp. e028169, BMJ Open, 9, BMJ Open, 9(5). BMJ Publishing Group
- Publication Year :
- 2019
-
Abstract
- ObjectivesThis study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.DesignA multiple-case study was conducted that draws on realist evaluation principles.SettingSeven nursing homes in the NetherlandsParticipantsThe primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78).Data collectionData collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.ResultsAn optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.ConclusionsCollaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.
- Subjects :
- Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1]
physician assistant
Nurses
nursing homes
Research Support
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
03 medical and health sciences
0302 clinical medicine
Physicians
Surveys and Questionnaires
Journal Article
Homes for the Aged
Humans
realist evaluation
Nurse Practitioners
030212 general & internal medicine
Non-U.S. Gov't
Netherlands
Quality of Health Care
Medicine(all)
030504 nursing
Research Support, Non-U.S. Gov't
Research
General Medicine
Physician Assistants
nurse practitioner
Research Design
skill mix change
Health Services Research
0305 other medical science
Subjects
Details
- ISSN :
- 20446055
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- BMJ Open
- Accession number :
- edsair.doi.dedup.....0d5369665a9a289cbb8860f00b2d046c