Primary health care

PURPOSE
To determine the effect of hospital work environments on hospital outcomes across multiple countries.


DESIGN
Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009.


MAIN OUTCOME MEASURES
Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care.


RESULTS
High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes.


CONCLUSIONS
Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/95019/1/T201105164.pdf

Importance of work environments on hospital outcomes in nine countries

在Microsoft Excel中标记某个单元格或区域时，我们通常会看到在该单元格或区域的右下角有一个小黑方块，此小黑方块就是“填充柄”(如图1)。“填充柄”有什么作用?如何使用“填充柄”实现自动填充?下面就作以简单介绍。

活用Microsoft Excel中的“填充柄”功能

The coronavirus disease (COVID-19) pandemic has exposed nurses to conditions that threaten their health, well-being, and ability to work. It is therefore critical to study nurses’ experiences and well-being during the current crisis in order to identify risk groups for ill health and potential sources of organizational intervention. The aim of this study was to explore perceptions of the most salient sources of stress in the early stages of the coronavirus pandemic in a sample of U.S. nurses. A cross-sectional online survey was conducted among a sample of 695 U.S. nurses in May 2020. Content analysis was conducted on nurses’ responses (n = 455) to an open-ended question on the most stressful situations they had experienced during the pandemic. Six distinct themes emerged from the analysis: exposure/infection-self; illness/death-others; workplace; personal protective equipment/supplies; unknowns; opinions/politics. Two sub-themes concerned restrictions associated with the pandemic and feelings of inadequacy/helplessness regarding patients and their treatment. More than half of all comments concerned stress related to problems in workplace response to the pandemic. Healthcare institutions should provide opportunities for nurses to discuss the stress they are experiencing, support one another, and make suggestions for workplace adaptations during this pandemic.

Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses

PURPOSE: The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. DESIGN AND METHODS: Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses' employment, work role, and access to personal protective equipment. FINDINGS: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. CONCLUSIONS: This is the first study of primary healthcare nurses' experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. CLINICAL RELEVANCE: Understanding the implications of COVID-19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.

https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/jnu.12589

The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia.

Aims and objectives
This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice.

Background
Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting.

Design
Integrative review.

Methods
A comprehensive search of relevant electronic databases using keywords (e.g. ‘competencies’, ‘competen*’ and ‘primary health care’, ‘general practice’ and ‘nurs*’) was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000.

Results
Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment.

Conclusion
Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers.

Relevance to clinical practice
Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce.

/pdf/nursing-competency-standards-in-primary-health-care-an-1x2z3n0yz1.pdf

Nursing competency standards in primary health care: an integrative review

Aim To identify Australian primary health care nurses' immediate support needs during the COVID-19 pandemic. Background COVID-19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. Methods Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. Results Six-hundred and thirty-seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. Conclusion A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. Implications for nursing management Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community-based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service.

/pdf/the-support-needs-of-australian-primary-health-care-nurses-iebg7s4ru8.pdf

The support needs of Australian primary health care nurses during the COVID-19 pandemic.

Aims
To explore the current role of general practice nurses and the scope of Australian nursing practice to inform the development of national professional practice standards for Australian general practice nurses.

Background
Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting.

Design
Concurrent mixed methods design.

Methods
Data collection was conducted during 2013-2014 and involved two online surveys of registered and enrolled nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts.

Findings
Data collection enabled the development of 22 Practice Standards separated into four domains: 1) Professional Practice; 2) Nursing Care; 3) General Practice Environment; and 4) Collaborative Practice. To differentiate the variations in enacting these standards, performance indicators for the enrolled nurse, registered nurse and registered nurse advanced practice are provided under each standard.

Conclusion
The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These standards are also an important means of articulating the role and scope of the nurses’ practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance.

This article is protected by copyright. All rights reserved.

/pdf/the-development-of-professional-practice-standards-for-1uicti6wgt.pdf

The development of professional practice standards for Australian general practice nurses

Aims and objectives
To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying.

Background
The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention.

Design
A cross-sectional online survey.

Method
Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work.

Results
Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work–life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice.

Conclusions
This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce.

Relevance to clinical practice
Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care.

/pdf/australian-primary-health-care-nurses-most-and-least-16o6ydh9vo.pdf

Christine Ashley

Papers

The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia.

Nursing competency standards in primary health care: an integrative review

The support needs of Australian primary health care nurses during the COVID-19 pandemic.

The development of professional practice standards for Australian general practice nurses

Australian primary health care nurses most and least satisfying aspects of work.