A qualitative evaluation of New Zealand consumers perception of general practice nurses

BMC Family Practice (Impact Factor: 1.67). 02/2013; 14(1):26. DOI: 10.1186/1471-2296-14-26
Source: PubMed
ABSTRACT
Background
An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice.

Methods
A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis.

Results
Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses.

Conclusions
Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting.

Full-text

Available from: Elizabeth Halcomb
RES E A R C H A R T I C L E Open Access
A qualitative evaluation of New Zealand
consumers perceptions of general practice nurses
Elizabeth J Halcomb
1*
, Kath Peters
1
and Deborah Davies
2
Abstract
Background: An important consideration in health service delivery is ensuring that services meet consumer needs
and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with
suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored
consumer satisfaction with nurses in general practice.
Methods: A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New
Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed
using thematic analysis.
Results: Four major themes emerged from the data. These themes highlighted that, despite confusion experienced
by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by
them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable.
Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of
practice nurses.
Conclusions: Consumers are highly satisfied with practice nurse service delivery and value their relationships with
these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of
practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver
care, within their scope of practice, at the right time may have the potential to provide more timely care within the
primary care setting.
Keywords: Primary health care, Patient satisfaction, Practice Nursing, Qualitative research
Background
The growing burden of chronic and complex disease,
and population aging have driven a signi ficant growth in
primary health care services internationally [1]. In New
Zealand some 80% of the population will visit their gen-
eral practice annually [2]. To meet this growing demand
there has been significant evolution of the primary
health care workforce. In particular, there has been sub-
stantial growth and development in nursing services
provided within general practice [3]. Indeed, many
patients will visit their general practice and see only the
practice nurse to receive health care services [4].
Given the rapidly changing nature of the primary care
workforce it is important that the views of the commu-
nity and the recipients of the growing general practice
nursing services are explored. The importance of involv-
ing the community in health service development and
evaluation has long been recognised [5]. Indeed, patient
satisfaction has been identified by the World Health Or-
ganisation as one of the five criteria for good health care
quality [6]. As higher levels of patient satisfaction have
been linked to improved compliance with therapeutic
regimes and better clinical outcomes it behoves
researchers and policy makers to explore these issues in
a timely manner [7,8].
Despite the growing attention paid to satisfaction with
general practice, internationally, limited research has
been undertaken to explore consumer perceptions of
general practice nursing [9-12]. Whilst some general
* Correspondence: e.halcomb@uws.edu.au
Equal contributors
1
School of Nursing and Midwifery, University of Western Sydney, Penrith,
Australia
Full list of author information is available at the end of the article
© 2013 Halcomb et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Halcomb et al. BMC Family Practice 2013, 14:26
http://www.biomedcentral.com/1471-2296/14/26
Page 1
practice satisfaction scales include a small number of
items about nursing services, few collect sufficient infor-
mation to provide a detailed insight into consumer
perceptions of general practice nurses [12]. With the
shifting focus to team-based models of care in general
practice, it is timely to increase the focus on consumers
perceptions of nurses as health professionals in the ir
own right.
A small number of Australian studies have identified
broad consumer support for the general practice nurse
role [13,14]. A limitation of these investigations, how-
ever, is that many participants had not actually received
services from a practice nurse, but rather were providing
their opinion about how they thought they would feel
about receiving services from a nurse in that setting.
A number of studies have investigated patient satisfac-
tion with nurse-led clinic interventions [15,16]. In their
Australian paper, Mahomed et al. [15] reported the de-
velopment of a grounded theory of patients satisfaction
from a larger study exploring a practice nurse-led model
of chronic disea se management. This study described
how patients undergo a cyclical process of what they
described as navigating care. This cycle incorporated
the three stages of determining care needs, forming
relationships and having confidence [15]. Failure to ad-
equately develop any of these stages increased the
chance that the participants would opt out of the nurse-
led care intervention.
In New Zealand, Marshall et al. [16] reported data
from an 8-item survey on consultation satisfaction
related to healthy lifestyle clinics. These items focussed
broadly on satisfaction with the consultation, exploring
factors such as adequacy of the consultation room and
impact of the education provided on confidence and
health. Despite a relatively low response rate,
respondents provided over 85% agreement with all
items , except the ability to book an appointment easily.
This highlig hts the challenge of the ceiling effect found
in many quantitative measures of patient satisfaction
[17].
Given that these studies focus on patients who are par-
ticipating in a trial of nurse-led care, participants may
not refle ct the broader general practice population. It is
timely, to explore consumers experiences of receiving
services from general practice nurses in the naturalistic
setting.
Methods
Sampling and recruitment
Ninety-one practice nurses from 20 general practices in
New Zealand participated in a study to evaluate con-
sumer satisfaction with general practice nurses. 1505
consumers completed a survey about their levels of sat-
isfaction. These survey data have been reported
elsewhere. All survey participants were asked to provide
their contact details to the research team if they were
interested in participating in follow-up interviews. In
total 34 individuals provided their contact details to the
research team. The research assistant contacted these
individuals via telephone randomly to confirm their con-
sent to participate and arrange a mutually convenient
time for an interview. Individuals who were not able to
be contacted on the first attempt went to the bottom of
the list and further attempts to contact were made if
other participants were not re cruited.
Informed consent was provided by each consumer be-
fore data were collected. Interviews were conducted via
telephone and used a semi-structured interview guide to
allow the interviewer to probe into issues that arose
(Table 1). These questions were drawn from a review of
the literature, the project teams previous experience and
the preliminary survey findings [12]. Interviews were
digitally recorded and transcribed by an independent
transcription company. Data collection continued until
data saturation was achieved, that is, that no new data
emerged from subsequent interviews. Saturation was
achieved after 18 inte rviews.
Ethical considerations
This study was approved by the Human Ethics Commit-
tee of the University of Western Sydney. To preserve
anonymity, all participants mentioned in this paper and
any reports stemming from the data have been allocated
a pseudonym. Where names of health professionals have
Table 1 Question route
1. Thinking about the time when you receive health services from the
practice nurse:
a) What was the nature of this care that you received from the
practice nurse (prompt vaccination, managing wounds,
counseling, lifestyle advice, checking medications, ECG, taking
blood)?
b) How did you come to see the practice nurse for these services?
c) How often do you see the practice nurse?
2. What do you think about the care you get from the practice nurse?
a) What does the nurse do well (prompt willing and able to
answer your questions, show respect and concern, treat your
problem)?
b) What could the nurse do better? How could the nurse improve
the care that they provide?
3. If you had a choice would you continue to receive these services
from the practice nurse in the future? Why/Why not?
4. What do you see as the GPs role in your practice?
5. What do you see as the practice nurses role in the practice?
6. What do you think the nurses should do more of?
7. What do you think the nurses should do less of? Any other
comments?
Halcomb et al. BMC Family Practice 2013, 14:26 Page 2 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 2
been provided by the participants these have also been
allocated a pseudonym in the reports and publications.
Data analysis
Thematic analysis was undertaken by two researchers in
order to ensure findings portrayed a collective represen-
tation of participants. Using the process described by
Braun & Clarke [18], narratives in participants
transcripts that represented similar experience s were
grouped into codes and then categorised into themes.
These themes were discussed at length until consensus
was reached that the interpretation of the data was an
accurate interpretation of participants spoken word.
Rigour
The principles of credibility and confirmability were
used to demonstrate rigour in this study. The involve-
ment of two researchers in the process of independently
analysing the interview transcripts and developing
themes provides credibility [19]. Confirmability is
demonstrated via the use of verbatim quotes to provide
the participants voice, rather than purely the researchers
interpretations of the data [19].
Results
Of the 18 consumers who participated, there were 13
women (72.2%) and 5 men (27.8%). Participants were
from across the adult lifespan. From the information
disclosed, approximately half of the participants visited
the practice nurse for issues related to a chronic health
condition. Three participants (16.7%) had regularly
attended the practice nurse for assistance with weight
management. Four of the female participants (22.2%)
described attending the practice with their children. The
interview data revealed four themes. These themes and
their sub-themes are described in Table 2.
Satisfaction with practice nurses: they are first class
Overall, participants were extremely happy with the care
delivered by Practice Nurses and this is illustrated in the
following excerpts from their transcripts: I just think
theyre [PNs] marvellous (Melanie), they are first class
(James), She [PN] is the best thing that ever happened
in my life (Chrissy). This was characterised by two sub-
themes; the way in which the PNs valued the consumers
and listened to them and the development of ongoing
rapport between consumers.
a) Being valued: She listened to me and treated me like
a person
Several participants described how the practice nurses
listened to me and she treated me like a person
(Chrissy). Another participant conveyed They didn't
talk down to me because of my nationality which is good
because some doctors take one look at me and then they
talk so slow that I did start to get a bit angr y (Jacqui).
In contrast to their experiences with doctors, some
participants expressed how they felt valued by Practice
Nurses
I see the doctors as in a hurry and they get to the
point of it and they make you feel - if it's something
more serious - they make you feel like you've got to the
cause of the problem. Whereas nurses , in my
experience, just being that little bit more slower,
calmer and they're a bit more personalised. They talk
to you; they know your children, especially if you've
been going somewhere for a long time like I have - I've
just been very lucky (Natalie).
b) Developing relationships: You build up a rapport
with them
Participants also described the benefits of developing
an ongoing relationship with the practice nurse. You
build up a rapport with them and you feel confident with
them (Millicent). They dont sort of abandon you after
the visit. You go back, they contact you (Melanie).
The willingness of practice nurses to establish and
build a rapport with the consumer and their family was
highly valued. They always remember who you are. They
remember the childrens name which I always thinks
great (Natalie).
Table 2 Themes & sub-themes
Theme Sub-themes
Satisfaction with practice nurses: they are first class a) Being valued: She listened to me and treated me like a person
b) Developing relationships: You build up a rapport with them
Confidence with practice nurses: she knows what shes doing a) Appreciating practice nurses knowledge: They explain things and that sort of
puts me at ease
b) Appropriate referral : I know shed get the doctor
Confusion with the practice nurse role: when you say a practice nurse, Im a little bit unsure what you mean
Appreciation of Practice Nurse accessibility: It makes it a lot
easier for me
a) Being readily available "I don't have to wait around"
b) Affordable care: So easy on my funds
Halcomb et al. BMC Family Practice 2013, 14:26 Page 3 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 3
In contrast to the benefits of an ongoing relationship,
some participants described the negative impact of not
having an established relationship with the practice
nurse;
I had somebody that filled in for someone. Im really
quite a private person. I really find it quite hard going
to, you know - I ... know that nurse and thatswhoI
go to. She gets to know me (Eliza).
Confidence with practice nurses: she knows what shes
doing
a) Appreciating practice nurses knowledge: They
explain things and that sort of pu ts me at ease
Practice nurses were perceived by consumers as being
knowledgeable and competent.
in the fact that her manner, her speaking and also her
professionalism, the way she goes about her job, gives
the customer, the patient, the conf idence that, hey, she
knows what shes doing. I feel comfortable about it
(James).
Consumers very much appreciated the detailed
explanations given by Practice Nurses about their
chronic conditions, the need for particular treatments or
lifestyle changes.
They [Practice Nurses] explain things. They actually
explain why they're doing what the y're doing and that
sort of thing so it puts me at ease. Even though I've
had them [tests] all before but it's a different way of
them explainin g it all to me. I could understand it
(Jacqui).
And often when I havent been able to take much pain
relief, and theyre very good at explaining why.... I
mean the doctors just havent got time have they? Well
thats how I feel anyhow. The doctors good too and
often hes not there so I would say they are very good
at that sort of thing (Melanie).
Oh she's - how would you describe her - she's - she tells
you what you need to know directly but indirectly.
She's able to - she's tactful in how she tells you. There's
some things you don't want to hear - sort of stuff - or
you know but she just confirms it and that. I think I
[unclear] want to know and I have learnt things that I
need to be doing and that is all about, sometimes,
you've got to pull your head in and do that (Violet).
b) Appropriate referral: I know shed get the doctor
Underpinning this was the consumers confidence that
as soon as they see somethings not quite right, the doc-
tor come s in (Melanie). Whilst there was some indica-
tion that consumers wanted to retain the choice to see
the GP if they chose to, the confidence that the PN
would seek the advice of the GP was seen as comforting.
I would probably go to the doctor first if I could get in,
which is a little bit of an issue up at this clinic at the
moment, Id probably go to the doctor, but having said
that, if there wa s an issue Id be perfectly happy to go
to the practice nurse because I know shed get the
doctor (Melanie).
If I had a really serious incident, as you would call it,
I would prefer a doctor to be available rather than a
nurse.... Im assuming, incorrectly or what, that a
doctor would have a little bit more in-depth knowledge
of determining or diagnosing whats wrong than a
nurse (James).
Participants spoke positively of the PN role in triaging
when they needed medical attention.
Shes my first port of call and if I feel I have an
emergency which is not a hospital emergency, then I
will talk to a practice nurse (Ben).
The other time when I see my practice nurse is when I
need something urgently. Now Ive had occasion when
Ive had diarrhoea, that type of thing, or when Ive felt
really crook and I speak first of all to a practice nurse
who then decides whether, well, usually I have to
admit, usually decides then I ll see a doctor (Ben).
Confusion around the practice nurse role: when you say
a practice nurse, Im a little bit unsure what you mean
For a coup le of participants it was unclear who was a
PN within their practice or what a PN is. Well even the
nurse that gave me the injection, ...she was wonderful
and she, I suppose shes a practice nurse too really isnt
she (Miriam). In referring to pathology blood colle ctors
one participant commented. Whether you would call
those practice nurses or not I dont know. (Ben).
A few participants described how the role of the PN
had changed. I think years ago they were just there.
They came in when you were with the doctor and stood
while you had a smear or whatever, but now theyre far
more up front with what they do (Melanie). Melanie
went on to explain Im lucky Ive been round the health
system for yonks, and I wonder like sometimes if people
ring up and make an appointment and theresno
Halcomb et al. BMC Family Practice 2013, 14:26 Page 4 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 4
appointments, do they understand that the practice
nurses are available. Maybe they could be a little bit
more prominent.
Several participants did indeed express a lack of
clarityaboutthePNroleandthescopeoftheir
practice.
Thats where its quite grey to me because I dont think
its ever been made clear all the things that you could
use the nur se for. So my usual port of call is usually
the GP. Its just been like the vaccinations and smear
test s that Ive ended up seeing the nurse instead
(Sharon).
When you say a practice nurse, Im a little bit unsure
what you mean because, you see, now there is a nurse
there that does nurse-type things for the doctor, you
know, like bandages and looking after your wound,
stuff like that...Then theres the nurse ... went
through your notes, checked on your medication and
make sure youre doing it right (Barry).
Participants tended to base their perception of the
PNs s cope of practice around their experience of
nursing ser vices. Yeah, definitely the vaccinations
and sme ar te sts I go to the nurse. Theresbeenafew
things. Like my d aughter sprained her ankle re ally
bad a year ago. I ended up seeing the GP. I mean, if
I could have gone to the n urse I would have done
that if IdknownIcould(Sharon).
Once participants had gained an appre ciation of
the practice nurse and their role they indicated that
they returned to the nurse. Ive probably only really
started to see them in the la st two to three years be-
cause up until then I wasnt really aware t hat they
were there and available to me (Sharon).
A key PN role identified by consumers wa s that of
substitution for the GP in simple ta sks. Having the
PN take on these tasks was seen a s time saving for
GPs, particularly in a context of workforce shortage.
There are t hings , those superficial thing s that its
much better to go to a practice nurse because itsnot
wasting his time (Melanie).
Imveryhappyforthemtostitchmeuportape
up whatever s hap pening any of those sorts of
things any body whos trained can do those sorts
of jobs. Im not saying the jobs are too ea sy, but a
nurse can strap up a sprained wrist with a s much
skill as a doctor can (Michelle).
Appreciation of Practice Nurse accessibility
a) Being readily available: "I don't have to wait around"
A common complaint among participants was the dif-
ficulty that they encountered in making appointments
and receiving treatment from a GP.
Once upon a time we could just make an appointment
there and then get in today and see our doctor. Its not
like that anymore. Youve got to make appointment
perhaps for make an appointment today for next
week perhaps or even, you know, two or three days
time when theyre on duty (Miriam).
Contrary to this experience of having to wait for
extended periods for a GP appointment, Practice Nurses
were seen as being readily available for consultations.
Consumers valued not having to wait to see the Practice
Nurses and appreciated them being contactable by tele-
phone if support or advice is required.
Im waiting for this hip replacement , theyve been
marvellous. When things have gone wrong, Ive been
able to see them straight away (Melanie).
I dont normally I certainly dont to have to wait
round very much to get to see a practice nurse and if I
do, I simply leave a message and theyll call me back,
probably within a half hour, but certainly within the
hour. It is what Id call virtually immediate access
(Ben).
Its usually pretty good. It can be a lot quicker than
waiting to see the doctor. You can guarantee if you
want to see a nurse you can get in today (Sharon).
b) Affordable care: So easy on my funds
Accessibility of practice nurses was also enhanced due
to the lower financial cost for consumers. This was par-
ticularly important for consumers who were low income
earners and pensioners.
Yeah, because - and not only that - I suppose it
actually - it takes the pressure of the doctors for, you
know, some of the things. Not only that, it makes it a
lot easier for me. It doesnt become so costly because,
you know, some of the things I see the practice nurse
for it doesnt sort of tie up the doctor really, you know,
makes it so easy on my funds too (Bill).
We pay $20 when we go to see the care nurse but we
pay about $39.90, I think it is, to see the doctor. That
for us really is very helpful (Abbey).
Participants also reflected on the value for money in
seeing the GP rather than the PN. Sometimes I think
Halcomb et al. BMC Family Practice 2013, 14:26 Page 5 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 5
god, that was a useless visit. I paid $51 for nothing. I
could have got that off [the PN] (Violet).
Discussion
Similar to previous literature that explored consumer
satisfaction with PN performance [12], participants of
this study regarded the care delivered to them by PNs as
positively contributing to their health care experiences.
Such high consumer satisfaction with PNs may assist in
increasing patients compliance with recommended
treatment and health promotion strategies [7,8]. This
finding provides further evidence to support the import-
ance of the PN role in health promotion and chronic
disease management.
Contrary to concerns highlighted by participants in
previous research that PNs may act as gatekeepers and
impede consumer access to the GP [20], participants in
this study expressed confidence that PNs would refer
them to the GP if their condition warranted it. However,
despite considering the PNs level of knowledge to be ex-
ceptional and trus ting them to appropriately refer,
consumers still expressed a preference to see the GP if
they choos e. This resonates with findings from existing
literature which highlights that although participants
perceived PNs showed more compassion and allocated
more time to their consultations, the GPs opinion was
more highly valued and therefo re appointments with
them favoured [10,11,21].
Participants preference to see their GP instead of a
PN may stem from a lack of understanding related to
the role and scope of practice of the nurse. Indeed,
consumers in this study expressed confusion about what
tasks the PNs could do. This is consistent with the lit-
erature which describes a level of confusion amongst
New Zealand consumers about the PNs scope of practice
and clinical skills [22-24]. Similarly, GPs have expressed
confusion and uncertainty regarding the scope and
expectations of the PN role [3,25]. Reasons for this un-
certainty may be in part blamed on the disparate
qualifications and variable skill mix of nurses employed
in general practice. General practices may employ a mix
of enrolled, registered and advanced practice nurses, as
well as nurse practitioners under the Practice Nurse title
[26]. These varying qualifications not only impact on the
PNs scope of practice but also the level of further educa-
tion that they can undertake to increase their skill base.
With the introduction of New Zealands Care-Plus
model that promotes a team-based model of care,
understanding the roles and scope of practice of various
health professionals is becoming increasingly important
[22]. To facilita te consumers effectively navigating the
maze of team-based care it is impo rtant that they have a
clear understanding of which health professional to con-
sult for what issues. Given the continuing evolution of
primary care to meet the growing demands of chronic
and complex disease, there is a need for ongoing dia-
logue between health professionals and consumers about
the various scopes of practice and changing role bound-
aries as tasks are delegated and health professionals
substituted.
Limitations
Qualitative interviews are useful to provide insight to
the experience of individuals where little is previously
known. These interviews provided a new insight into the
experience of general practice consume rs across New
Zealand following consultation with a practice nurse.
One of the major limitations of this study is that the
convenience sample who participated in this study are
not necessarily representative of the wider population of
general practice consumers. The design of the study did
not allow us to identify demographic differences be-
tween those who agreed to participate and those who
declined to be involved.
Telephone interviews were used to collect data in this
study as a means of overcoming the geographical
distances between participants and the interviewer. Add-
itionally, this strategy allowed data to be collected at a
time convenient to the participant. Whilst use of the
telephone provided participants with a degree of ano-
nymity, the separation between the participant and the
interviewer may have hindered the development of rap-
port [27].
Conclusions
In a country where practice nursing has been well
established for many years, we sought qualitative
responses from consumers regarding their satisfaction
with service delivery by practice nurses. We confirmed
findings of previou s studies in which patients highly
valued the role of the PN but wanted to retain the
choice to see a GP when they felt it was necessary.
The findings of this study suggest that, if exposed to
practice nurse led care, patient s view this positive ly and
continue to seek it out. How ever, we demonstrated that,
although PNs have been an important part of primary
care for many years , there is a need for better communi-
cation with consumers about the roles and scope of
practice of PNs. The findings from this study may lead
to further investigations about the acceptability and sat-
isfaction with specific PN interventions.
Competing interests
The authors declare that they have no competing interests.
Authors contributions
DD and EH were responsible for the study conception and design. EH
oversaw the data collection. KP and EH performed the qualitative analysis.
EH and KP were responsible for drafting of the manuscript. DD made critical
Halcomb et al. BMC Family Practice 2013, 14:26 Page 6 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 6
revisions to the paper for important intellectual content. All authors read and
approved the final manuscript.
Acknowledgements
The project team wishes to thank the practice nurses and consumers who
so willingly gave their time to provide an insight into their experiences and
participate in this project. We thank Larni Kelleher for conducting the
interviews.
This study was funded by the New Zealand College of Primary Health Care
Nurses (formerly College of Practice Nurses), NZNO. The funding body,
through its members, assisted in participant recruitment, however, they had
no involvement in the analysis and interpretation of data.
Author details
1
School of Nursing and Midwifery, University of Western Sydney, Penrith,
Australia.
2
Clinical Nurse Specialist (Lead) Primary Health Care, Health Care
Development, MidCentral District Health Board, Palmerston North, New
Zealand.
Received: 18 September 2012 Accepted: 12 February 2013
Published: 22 February 2013
References
1. Bodenheimer T, Chen E, Bennett HD: Confronting The Growing Burden Of
Chronic Disease: Can The U.S. Health Care Workforce Do The Job? Health
Aff 2009, 28(1):6474.
2. Prince A, Nelson K: Educational needs of practice nurses in mental health.
J Prim Health Care 2011, 3(2):142149.
3. Halcomb EJ, Salamonson Y, Cooper MK, Clausen JL, Lombardo L: Culturally
and linguistically diverse general practitioners utilisation of practice
nurses. Collegian, http://www.collegianjournal.com/article/S1322-7696(12)
00052-2/abstract. in press.
4. Ministry of Health: A portrait of health: Key results from the 2006/7 New
Zealand health survey. Wellington, New Zealand: Ministry of Health; 2008.
5. World Health Organization: The Alma-Ata conference on primary health
care. WHO Chron 1978, 32:409430.
6. Shaw CD, Kalo I: A background for national health policies in health systems.
Copenhagen: WHO; 2002.
7. Potiriadis M, Chondros P, Gilchrist G, Hegarty K, Blashki G, Gunn JM: How do
Australian patients rate their general practitioner? A descriptive study
using the General Practice Assessment Questionnaire. Med J Aust 2008,
189(4):215219.
8. Donovan JL: Patient decision making. The missing ingredient in
compliance research. Int J Technol Assess Health Care 1995, 11(3):443455.
9. Hegney D, Buikstra E, Fallon T, Martin-McDonald K, Patterson E, Rees S:
Consumer Perceptions of Practice Nurses. Toowoomba, Queensland,
Australia: Centre for Rural and Remote Area Health, University of Southern
Queensland; 2004.
10. Hegney D, Price K, Patterson E, Martin-McDonald K, Rees S: Australian
consumers expectations for expanded nursing roles in general practice:
choice not gatekeeping. Aust Fam Physician 2004, 33(10):845848.
11. Redsell S, Stokes T, Jackson C, Hastings A, Baker R: Patients' accounts of the
differences in nurses' and general practitioners' roles in primary care.
J Adv Nurs 2007, 57(2):172180.
12. Halcomb EJ, Caldwell B, Davidson PM, Salamonson Y: Development and
psychometric validation of the general practice nurse satisfaction scale.
J Nurs Scholarsh 2011, 43(3):318327.
13. Cheek J, Price K, Dawson A, Mott K, Beilby J, Wilkinson D: Consumer
perceptions of nursing and nurses in general practice. Adelaide, South
Australia: Centre for Research into Nursing and Health Care, University of
South Australia; 2002.
14. Hegney D, Buikstra E, Fallon T, Martin-McDonald K, Patterson E, Rees S:
Consumer perceptions of practice nursing. Toowoomba, Queensland:
University of Southern Queensland; 2004.
15. Mahomed R, St John W, Patterson E: Understanding the process of patient
satisfaction with nurse-led chronic disease management in general
practice. J Adv Nurs 2012, 68(11):25382549.
16. Marshall B, Floyd S, Forrest R: Clinical outcomes and patients perceptions
of nurse-led healthy lifestyle clinics. J Prim Health Care 2001, 3(1):4852.
17. Andrew S, Salamonson Y, Everrett B, Halcomb EJ, Davidson PM: Beyond the
ceiling effect: using a mixed methods approach to measure patient
satisfaction. Int J Mult Res Approaches 2011, 5(2):5263.
18. Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol
2006, 3:77101.
19. Polit DF, Beck CT: Essentials of Nursing Research: Appraising Evidence for
Nursing Practice. 7th edition. Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins; 2010.
20. Hegney D, Price K, Patterson EA, Martin-McDonald K, Rees S: Australian
consumers expectations for expanded nursing roles in general practice.
Aust Fam Physician 2004, 33(10):845848.
21. Watts I, Foley E, Hutchinson R, Pascoe T, Whitecross L, Snowdon T: General
practice nursing in Australia. Canberra, ACT: Royal Australian College of
General Practitioners and Royal College of Nursing, Australia; 2004.
22. Pullon S, McKinlay E, Stubbs M, Todd L, Badenhorst C: Patients and health
professionals perceptions of teamwork in primary care. J Prim Health
Care 2011, 3(2):128135.
23. Carryer J, Snell H, Perry V, Hunt B, Blakey J: Long-term conditions care in
general practice settings: Patient perspectives. New Zeal Fam Physician
2008, 35(5):319323.
24. Kenealy T, Docherty B, Sheridan N, Gao R: Seeing patients first: creating an
opportunity for practice nurse care? J Prim Health Care 2010, 2(2):136141.
25. McCarthy G, Cornally N, Moran J, Courtney M: Practice nurses and general
practitioners: perspectives on the role and future development of
practice nursing in Ireland. J Clin Nurs 2012, 21:
22862295.
26. Halcomb EJ, Patterson E, Davidson PM: Evolution of practice nursing in
Australia. J Adv Nurs 2006, 53(3):376390.
27. Novick G: Is there a bias against telephone interviews in qualitative
research? Res Nurs Health 2008, 31(4):391398.
doi:10.1186/1471-2296-14-26
Cite this article as: Halcomb et al.: A qualitat ive evaluation of New
Zealand consumers perceptions of general practice nurses. BMC Family
Practice 2013 14:26.
Submit your next manuscript to BioMed Central
and take full advantage of:
Convenient online submission
Thorough peer review
No space constraints or color figure charges
Immediate publication on acceptance
Inclusion in PubMed, CAS, Scopus and Google Scholar
Research which is freely available for redistribution
Submit your manuscript at
www.biomedcentral.com/submit
Halcomb et al. BMC Family Practice 2013, 14:26 Page 7 of 7
http://www.biomedcentral.com/1471-2296/14/26
Page 7
  • Source
    • "Rigour. Credibility was achieved through the involvement of two researchers who analyzed one written interview independently and developed a codebook in consensus and the use of verbatim quotes to provide the study participants voice along with researchers' data interpretations , respectively3435. In case of disagreement on the coding there was an additional discussion in a larger team of researchers. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the study reported in this article was to investigate staff nurses' perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses' involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.
    Full-text · Article · Apr 2016 · PLoS ONE
    • "Role confusion and role ambiguity have both been identified as key barriers to interprofessional collaboration (Moaveni et al. 2010, Oandasan et al. 2010, McInnes et al. 2015). In addition, it is important that information about the roles of health providers is clearly conveyed to the consumers of health services to improve their access to and interactions with the service (Witt & Almeida 2008, Halcomb et al. 2013). A key member of the multidisciplinary PHC team is the nurse (Billingham 2003, Australian Nursing Federation 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: 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.
    No preview · Article · Mar 2016 · Journal of Clinical Nursing
    • "rnational ) . Rigor Credibility and confirmability were achieved by the coding procedure outlined above , in which two researchers analyzed a written interview independently and subsequently developed a codebook together . The use of verbatim quotations also ensured that the participants ' voices can be heard in the study ( Polit and Beck , 2010 ; Halcomb et al . , 2013"
    No preview · Article · Oct 2015 · Evidence-based nursing
Show more