Papers by Esther Sangster-gormley
International Journal of Palliative Nursing, 2013
The purpose of this study, which was part of a large national case study of nurse practitioner (N... more The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC. Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis. NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits. NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
Nursing Research and Practice, 2014
Background. Improved quality of care and control of healthcare costs are important factors influe... more Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n = 11), NP-transition (n = 5), NP-inpatient (n = 2), Nursing Research and Practice CNS-outpatient (n = 11), CNS-transition (n = 13), and CNS-inpatient (n = 1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
Nurse Researcher, 2013
Background: At the time of this study (2009) the role of the nurse practitioner was new to the pr... more Background: At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members' acceptance for the new role. Method: The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents.
Journal of Clinical Nursing, 2014
The aim of this study was to explore the integration of the nurse practitioner role in Canadian n... more The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. The study used a sequential mixed methods design using a national survey followed by case studies. A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care.
Nursing Leadership, 2013
The number of people living longer is increasing, and those with physical or cognitive impairment... more The number of people living longer is increasing, and those with physical or cognitive impairments may need admission into long-term care settings. In long-term care there is a need to increase nursing staff's capacity to meet the care needs of residents, develop a team approach to providing care and provide opportunities for staff to improve their knowledge and skills. One approach to meet these needs has been to employ a nurse practitioner (NP). The purpose of this paper is to examine nursing staff's perceptions of how working with an NP affected their ability to provide care, function as a team and increase their knowledge and skill. Data used in this paper were obtained from nursing staff and managers who participated in focus groups that were part of case studies conducted in the second phase of a larger sequential, two-phase mixed-methods study. NPs used multiple approaches to increase staff knowledge and skills and improve quality of care. These findings describe the benefits of employing NPs in long-term care settings.
Nursing Management, 2015
In 2005, legislation was enacted allowing nurse practitioners (NPs) to practise in British Columb... more In 2005, legislation was enacted allowing nurse practitioners (NPs) to practise in British Columbia, Canada. Although substantial human and financial resources had been dedicated to the implementation of the role, no evaluation has been conducted to date. As part of a larger multiphase, mixed-methods study design, which evaluated the integration of NPs into the British Columbia healthcare system, this article describes findings related to changes that result for patients and the implications for the healthcare system when NPs become part of the care process. Using survey and interview data, themes that emerged were patient satisfaction, access to care, and behavioural changes. Findings suggest that patients are satisfied with the care they receive from NPs and that NPs make positive changes to health behaviour.
Studies in health technology and informatics, 2015
A survey was conducted in the province of British Columba, Canada with nurse practitioners (NP). ... more A survey was conducted in the province of British Columba, Canada with nurse practitioners (NP). This paper reports on the quantitative and qualitative findings of the survey questions specifically focused on NP perceptions of the clinical impacts associated with using electronic medical records (EMRs) in a primary care setting. Findings suggest that although NPs perceived EMRs to improve the overall quality of clinical decisions, challenges remain in terms of tailoring the design of EMRs to address NP needs.
Nurse Researcher, 2015
To discuss and provide examples of how mixed-methods research was used to evaluate the integratio... more To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. Data were collected using surveys, focus groups, participant interviews and case studies over three years. Data sources and methods were triangulated to determine how the findings addressed the research questions. The challenges and benefits of using the multiphase design are highlighted in the paper. The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières
There has been a research focus on physician adoption of electronic medical records (EMRs). Howev... more There has been a research focus on physician adoption of electronic medical records (EMRs). However, there has been less research into nurse practitioner (NP) use of EMRs. The authors present findings on the adoption and use of EMRs by NPs arising from a survey of the patterns of NP practices in the Canadian province of British Columbia. The research reveals a high rate of NP adoption of EMRs, with 82% of respondents indicating that they were using the technology. However, only 19% of NPs were using fully electronic records while 63% were using hybrid records, with only components of the electronic record being available. Respondents were found to be using several EMR features and functions, namely patient demographics, clinical notes, medication lists, laboratory results, and patient problems. NPs' high rate of EMR adoption suggests that there is much to be learned regarding the effect of eHealth strategies on EMR adoption. French L'adoption par les médecins de la tenue de ...
Studies in health technology and informatics
Integrating the Nurse Practitioner (NP) role into clinical practice settings is new in British Co... more Integrating the Nurse Practitioner (NP) role into clinical practice settings is new in British Columbia (BC), Canada. Encounter codes are unique numeric codes assigned to specific types of patient care services performed by NPs. In this study we apply knowledge discovery techniques to analyze the encounter codes extracted from the BC Ministry of Health database to understand the most common practice activities carried out by NPs and what diseases patients sought care for from NPs. The analysis produced important information about NPs' practice patterns. This work leads to a better understanding of NP practice patterns in BC.
Studies in health technology and informatics
In this paper we describe how nurse practitioners (NPs) use electronic medical records (EMR) feat... more In this paper we describe how nurse practitioners (NPs) use electronic medical records (EMR) features and functions at: (1) an individual and (2) a clinic level to support patient wellness and chronic disease management activities. Fifteen NPs from British Columbia (BC), Canada participated in a qualitative, semi-structured interview study. NPs used EMRs with individual patients and at a clinic level to support wellness and chronic disease management activities. NP's used clinic notes, reminders, tasks and careplans to support wellness and disease management activities in individual patients while reports were used to manage patients at a clinic level.
Studies in health technology and informatics, 2013
The objective of this study is to assess the feasibility of applying knowledge discovery techniqu... more The objective of this study is to assess the feasibility of applying knowledge discovery techniques to identifying nurse practitioner practice patterns and enacted scope of practice. For the research, we plan to use data extracted from a Ministry of Health database. The data items are focused around: nurse practitioner demographics, health authorities, and encounter types. This analysis produces patterns that indicate relationships between the demographics, scope of practice and practice settings of nurse practitioners working in British Columbia.
Studies in health technology and informatics, 2014
Integrating the Nurse Practitioner (NP) role into clinical practice settings is new in British Co... more Integrating the Nurse Practitioner (NP) role into clinical practice settings is new in British Columbia (BC), Canada. Encounter codes are unique numeric codes assigned to specific types of patient care services performed by NPs. In this study we apply knowledge discovery techniques to analyze the encounter codes extracted from the BC Ministry of Health database to understand the most common practice activities carried out by NPs and what diseases patients sought care for from NPs. The analysis produced important information about NPs' practice patterns. This work leads to a better understanding of NP practice patterns in BC.
Journal of the American Association of Nurse Practitioners, 2013
The purpose of this article is to describe how two mid-range theories, Kolkaba's Comfort Theo... more The purpose of this article is to describe how two mid-range theories, Kolkaba's Comfort Theory and Antonovsky's Sense of Coherence can be used to illuminate the holistic nature of nurse practitioner (NP) practice. Original research and theoretical papers related to both theories described. The NP role has been in existence for more than 40 years and can be found in healthcare systems in more than 60 countries around the world. Increasingly, NPs are assuming responsibility for providing primary health care to people with complex care needs. Although researchers have consistently demonstrated the NPs provide safe, effective care, and patients are satisfied with that care, theories demonstrating the holistic nature of NP practice are less evident. Comfort Theory and Sense of Coherence can be used to demonstrate how the holistic nature of NP care results in patient-centered outcomes.
Studies in health technology and informatics, 2014
In this paper we describe how nurse practitioners (NPs) use electronic medical records (EMR) feat... more In this paper we describe how nurse practitioners (NPs) use electronic medical records (EMR) features and functions at: (1) an individual and (2) a clinic level to support patient wellness and chronic disease management activities. Fifteen NPs from British Columbia (BC), Canada participated in a qualitative, semi-structured interview study. NPs used EMRs with individual patients and at a clinic level to support wellness and chronic disease management activities. NP's used clinic notes, reminders, tasks and careplans to support wellness and disease management activities in individual patients while reports were used to manage patients at a clinic level.
Nursing Leadership, 2013
The number of people living longer is increasing, and those with physical or cognitive impairment... more The number of people living longer is increasing, and those with physical or cognitive impairments may need admission into long-term care settings. In long-term care there is a need to increase nursing staff's capacity to meet the care needs of residents, develop a team approach to providing care and provide opportunities for staff to improve their knowledge and skills. One approach to meet these needs has been to employ a nurse practitioner (NP). The purpose of this paper is to examine nursing staff's perceptions of how working with an NP affected their ability to provide care, function as a team and increase their knowledge and skill. Data used in this paper were obtained from nursing staff and managers who participated in focus groups that were part of case studies conducted in the second phase of a larger sequential, two-phase mixed-methods study. NPs used multiple approaches to increase staff knowledge and skills and improve quality of care. These findings describe the benefits of employing NPs in long-term care settings.
BMC Nursing, 2013
At the time of this study (2009) the role of the nurse practitioner was new to the province of Br... more At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members' acceptance for the new role. The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members' prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.
BMC Health Services Research, 2015
Background: Integrating Nurse Practitioners into primary care teams is a process that involves si... more Background: Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter-and intra-professional collaboration, and team-based work processes that make the best use of the subsidiarity principle.
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Papers by Esther Sangster-gormley