Patient roles in primary care interprofessional teams: a constructivist grounded theory of patient and health care provider perspectives.

Health care providers are increasingly asked to work in interprofessional teams to enhance the care provided to and health outcomes of their patients. However, there is little evidence on how to include patients in meaningful roles on these teams to support their health monitoring and management. The purpose of this study was to gain insight into roles that patients can assume within their health care teams and to understand the conditions and processes required for patient roles to be enacted.

Enhancing Self-Care Management of Interdialytic Fluid Weight Gain in Patients on Hemodialysis: A Pilot Study Using Motivational Interviewing.

Patients receiving hemodialysis are challenged with restricting their fluid intake to ensure appropriate interdialytic weight gains. While nurses endeavor to promote selfcare, the ability to manage fluid gain rests on the patient's understanding and decision to limit fluid intake. A mixed-methods pilot study was undertaken to determine if motivational interviewing, a patient-centered, conversational, and collaborative approach to stimulating behavior change and resolving ambivalence, enhances self-care fluid management.

Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings.

There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals' characteristics (gender, work experience) and a contextual factor (caseload), with the professionals' PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada.

Diffusing Innovative Roles Within Ontario Hospitals: Implementing the Nurse Practitioner as the Most Responsible Provider.

Hospitals require identification of the most responsible provider (MRP) for care of admitted patients. Traditionally, the MRP has been a physician. However, legislation changes within Ontario authorize the nurse practitioner (NP) to admit and provide care for hospital in-patients.

Nurse Practitioner Role Value in Hospitals: New Strategies for Hospital Leaders.

Hospital leaders in Canada are continuously seeking new ways to meet patient needs and Ministry of Health priorities. One approach, integrating nurse practitioners (NPs) into the interprofessional team of caregivers, has demonstrated the quality outcomes hospital leaders seek. However, hospital leaders report there is limited information available to them to clearly know NP role value.

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.

A survey of interprofessional activity of acute and long-term care employed nurse practitioners.

Purpose: To describe activities of interprofessional (IP) care, a key aspect of high-quality care, performed by nurse practitioners (NPs) employed in acute and long-term care institutions.

Data Sources: We developed and tested a new theory-driven process tool to quantify NP everyday activities of IP care. We then invited NPs in acute and long-term care to complete the IP self-assessment tool (IPSAT).

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.

Labour saver or building a cohesive interprofessional team? The role of the nurse practitioner within hospitals.

Nurse practitioners (NP) are employed within hospital interprofessional (IP) teams in several countries worldwide. There have been some efforts to describe the nature of the NP role within IP teams largely focussing on how the role may augment care processes. Here, using a constructivist grounded theory approach, the perceptions of NPs about their role were compared and integrated into a previously published team perspective as the second phase of a larger study.

Hospital-based nurse practitioner roles and interprofessional practice: a scoping review.

This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized.

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.

The primary healthcare nurse practitioner in Ontario: a workforce study.

The role of the primary healthcare nurse practitioner (NP-PHC) has a long history in Ontario. In this paper, we describe the evolution of the role with a focus on geographic distribution, a profile of client populations and the services provided by NP-PHCs. Comparisons will be made to findings from previous studies and reports on the NP-PHC role in Ontario.

The acute care nurse practitioner in Ontario: a workforce study.

In spite of the long history of nurse practitioner practice in primary healthcare, less is known about nurse practitioners in hospital-based environments because until very recently, they have not been included in the extended class registration (nurse practitioner equivalent) with the College of Nurses of Ontario. Recent changes in the regulation of nurse practitioners in Ontario to include adult, paediatric and anaesthesia, indicates that a workforce review of practice profiles is needed to fully understand the depth and breadth of the role within hospital settings. Here, we present information obtained through a descriptive, self-reported survey of all nurse practitioners working in acute care settings who are not currently regulated in the extended class in Ontario.

Primary healthcare renewal in Canada: a glass half empty?

Primary healthcare renewal was an important government initiative arising in the early 21st century. This sector of the healthcare system in Canada had been under-resourced and ignored for decades. Recent changes include the development of salaried models for physician care, the use of other professionals in primary care, the integration of inter-professional teams, funding for information management systems and some incentives to provide directed primary care services.

Impact of the opening of a specialized cardiac surgery recovery unit on postoperative outcomes in an academic health sciences centre.

Purpose: It is controversial as to whether cardiac surgery patients are optimally managed in a mixed medical-surgical intensive care unit (ICU) or in a specialized postoperative unit. We conducted a prospective cohort study in an academic health sciences centre to compare outcomes before and following the opening of a specialized cardiac surgery recovery unit (CSRU) in April 2005.

Methods: The study cohort included 2,599 consecutive patients undergoing coronary artery bypass grafting (CABG), valve and combined CABG-valve procedures from April 2004 to March 2006.

Knot-So-Fast: a learning plan to minimize patient restraint in critical care.

In 2001, new legislation in Ontario, the Patient Restraint Minimization Act, mandated that all hospitals develop a policy to minimize the use of restraints. Since restraining patients was a common practice in our intensive care unit (ICU), a practice change was necessary. To do this, a learning plan was created to share key information pertaining to the Act that would support humane and dignified care for our critically ill patients.

Can minimal patient restraint be safely implemented in the intensive care unit?

The introduction of a corporate policy on the minimal use of restraints created concern within our intensive care unit. It was thought that corporate leaders did not understand the necessity of patient restraints within critical care. In an effort to make a stand against the developing policy, a group of critical care nurses reviewed the literature for evidence to support the use of restraints\with this patient population.

Managing diabetic ketoacidosis: the role of the ICU nurse in an endocrine emergency.

Diabetic ketoacidosis is an endocrine emergency that requires intensive management and monitoring. Eight per cent of diabetic-related admissions are for the management of diabetic ketoacidosis and, prior to the discovery of insulin, all of these patients died (Delaney, Zisman & Kettyle, 2000). In this article, the author reviews the pathophysiology of the classic presentation of diabetic ketoacidosis: hyperglycemia and ketoacidosis.

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

Despite extensive knowledge of pain and pain management, critical-care nurses commonly withhold analgesia from patients for extended periods prior to and during weaning from mechanical ventilation. Nurses working in critical care were interviewed (n = 10) to gain insight into the importance of pain management during weaning and the nature of decision-making in pain management. Using the research method of grounded theory, the author found decision-making to be a dynamic and continuous process of knowledge gathering, knowledge interpretation, and action, influenced by nurses' beliefs concerning (1) the existence of and importance of managing pain, and (2) the role of the nurse.