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Changing nursing practice within primary health care innovations: the case of advanced access model

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Abou Malham, Sabina et Breton, Mylaine et Touati, Nassera et Maillet, Lara et Duhoux, Arnaud et Gaboury, Isabelle (2020). Changing nursing practice within primary health care innovations: the case of advanced access model. BMC Nursing, 19 (115). p. 1-17. ISSN 1472-6955

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Résumé

Background: The advanced access (AA) model has attracted much interest across Canada and worldwide as a
means of ensuring timely access to health care. While nurses contribute significantly to improving access in primary
healthcare, little is known about the practice changes involved in this innovative model. This study explores the
experience of nurse practitioners and registered nurses with implementation of the AA model, and identifies factors
that facilitate or impede change.

Methods: We used a longitudinal qualitative approach, nested within a multiple case study conducted in four
university family medicine groups in Quebec that were early adopters of AA. We conducted semi-structured interviews with two types of purposively selected nurses: nurse practitioners (NPs) (n = 6) and registered nurses (RNs) (n = 5). Each nurse was interviewed twice over a 14-month period. One NP was replaced by another during the second interviews. Data were analyzed using thematic analysis based on two principles of AA and the Niezen & Mathijssen Network Model 2014).

Results: Over time, RNs were not able to review the appointment system according to the AA philosophy. Half of
NPs managed to operate according to AA. Regarding collaborative practice, RNs were still struggling to participate in team-based care. NPs were providing independent and collaborative patient care in both consultative and joint practice, and were assuming leadership in managing patients with acute and chronic diseases. Thematic analysis revealed influential factors at the institutional, organizational, professional, individual and patient level, which acted mainly as facilitators for NPs and barriers for RNs. These factors were: 1) policy and legislation; 2) organizational policy support (leadership and strategies to support nurses’ practice change); facility and employment arrangements(supply and availability of human resources); Inter-professional collegiality; 3) professional boundaries; 4) knowledgeand capabilities; and 5) patient perceptions.

Conclusions: Our findings suggest that healthcare decision-makers and organizations need to redefine the boundaries of each category of nursing practice within AA, and create an optimal professional and organizational context that supports practice transformation. They highlight the need to structure teamwork efficiently, and integrate and maximize nurses’ capacities within the team throughout AA implementation in order to reduce waiting times.

Type de document: Article
Mots-clés libres: Soins de santé primaires, Modèles de pratique infirmière, Personnel évaluation, Advanced access, Primary health care, Nurses practice change, Nurse optimization.
Déposé par: Yves Brillon
Date de dépôt: 08 déc. 2020 16:41
Dernière modification: 08 déc. 2020 16:41
URI: http://espace.enap.ca/id/eprint/208

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