Changing nursing practice within primary health care innovations: the case of advanced access model
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RESEARCH ARTICLE
Open Access
Changing nursing practice within primary health care innovations: the case of advanced access model Sabina Abou Malham 1,2* , Mylaine Breton3,4,2, Nassera Touati5,2, Lara Maillet5,2, Arnaud Duhoux6,2 and Isabelle Gaboury7,2
Abstract 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) knowledge and capabilities; and 5) patient perceptions. (Continued on next page)
* Correspondence: [email protected] 1 School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada 2 Charles Lemoyne– Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS) Research Centre, Campus Longueuil, 150 Place Charles-Lemoyne, Room 200, Longueuil, Québec J4K 0A8, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link
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