Nurses and nursing in primary medical care in England.
(1/16)
In 1974 we sent questionnaires on attachment and employment of nurses to 9214 general practices in England. There were 7863 replies (85%), of which 551 were excluded from the study. A total of 2654 nurses were directly employed by 24% (1774) of the practices, and 68% (4972) had attached nurses. Practices in health centres were larger and had greater nursing resources than those in other premises. We suggest that practices may employ nurses to compensate for ineffective nursing attachments, and we conclude that general-practice-employed nurses are becoming "professionalised". (+info)
Moving to a health centre--the effect on workload and patients.
(2/16)
A detailed study of the workload of an urban practice was made during a six-month period before and after moving into a health centre to see if the pattern changed after the move. It was found that the services provided enabled a much greater proportion of routine work to be done by the practice nurse so that the doctor could spend more time with the patients seen by him.A survey of the opinion of patients showed that the great majority was pleased with the services offered in the new premises and did not feel that they had lost contact with their own doctor. (+info)
Multidisciplinary chronic pain management in a rural Canadian setting.
(3/16)
INTRODUCTION: Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. METHODS: The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. RESULTS: Patients achieved clinically and statistically significant improvements in pain and disability. CONCLUSION: Successful multidisciplinary chronic pain management services can be provided in a rural setting. (+info)
A joint course for general practitioner and practice nurse trainers.
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An experimental multidisciplinary course for prospective general practitioner and practice nurse trainers is described. Factual knowledge and attitudes were measured before and after the course and some of the changes measured emphasized the importance of multidisciplinary training. The ideas generated by the group of nurse trainers in terms of their future professional development were identified. (+info)
Novel role for specialist nurses in managing diabetes in the community.
(5/16)
To develop care of diabetes further a specialist nurse established contact with general practices in Sheffield Health District and identified difficulties in providing a service for diabetics. One hundred and thirty practices were visited, and full data were collected from 104. Each practice agreed to establish a register of diabetics, and information and support were subsequently provided to help in developing services. In collecting information from each practice the nurse covered specific points on staff, facilities, and organisation. Over two years the service offered in 60 practices considerably improved, allowing a minimum standard of diabetic care to be achieved. This allowed coordinated and effective referral of certain patients from hospital diabetic clinics and improved services to those not attending any clinics. (+info)
Use of a contraindications checklist by practice nurses performing immunizations at a well child clinic.
(6/16)
At the inception of a general practice well child clinic, a checklist card was introduced into the clinic notes to summarize specific and relative contraindications to immunizations. This card was used by the practice nurses as they ran the immunization procedures during the clinic. A failure on the checklist led to a consultation with the clinic doctor who decided whether to proceed with the immunization. Of 155 immunizations given during the six-month period, only 23 (15%) failed the checklist and required the child to be assessed by the clinic doctor. Of these, nine (39%) were for simple upper respiratory tract infection. All the children were deemed fit to receive immunization. Only one child was found to have a specific contraindication to pertussis. The checklist cards allowed the smooth operation of the immunization procedures by practice nurses who were able to check comprehensively whether there were any contraindications and whether immunizations were being inappropriately refused. (+info)
Practice nurses: social and occupational characteristics.
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Three hundred practice nurses in the West Midlands responded to a questionnaire survey about their social and occupational characteristics. The nurses were mainly married women with children and had had considerable hospital experience. They were largely satisfied with their job and felt that their own general practitioner colleagues were supportive, though doctors in general might not be so. Large variations in patterns of work were revealed and in some cases there was a considerable extension of the traditional nursing role. Almost two-thirds of practice nurses were undertaking breast and vaginal examinations, 70% were carrying out cervical smears and a number of nurses were diagnosing, investigating and managing common ailments. Nurses expressed a desire for further extension of their role to allow them to undertake broader aspects of patient care and to be less task-centred, but felt that they would require further training to do so. There was evidence of a need for better definition of the practice nurse's role and for more support from health authorities and the nurses' own professional body. (+info)
Nurse practitioners in primary care. 3. The southern Ontario randomized trial.
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A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method. (+info)