282 lines
8.9 KiB
YAML
282 lines
8.9 KiB
YAML
abstract: 'Background
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Having nurses take on tasks that are typically conducted by doctors
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(doctor-nurse substitution, a form of `task-shifting'') may help to
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address doctor shortages and reduce doctors'' workload and human resource
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costs. A Cochrane Review of effectiveness studies suggested that
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nurse-led care probably leads to similar healthcare outcomes as care
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delivered by doctors. This finding highlights the need to explore the
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factors that affect the implementation of strategies to substitute
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doctors with nurses in primary care. In our qualitative evidence
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synthesis (QES), we focused on studies of nurses taking on tasks that
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are typically conducted by doctors working in primary care, including
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substituting doctors with nurses or expanding nurses'' roles.
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Objectives
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(1) To identify factors influencing implementation of interventions to
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substitute doctors with nurses in primary care. (2) To explore how our
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synthesis findings related to, and helped to explain, the findings of
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the Cochrane intervention review of the effectiveness of substituting
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doctors with nurses. (3) To identify hypotheses for subgroup analyses
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for future updates of the Cochrane intervention review.
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Search methods
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We searchedCINAHL and PubMed, contacted experts in the field, scanned
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the reference lists of relevant studies and conducted forward citation
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searches for key articles in the Social Science Citation Index and
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Science Citation Index databases, and `related article'' searches in
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PubMed.
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Selection criteria
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We constructed a maximum variation sample (exploring variables such as
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country level of development, aspects of care covered and the types of
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participants) from studies that had collected and analysed qualitative
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data related to the factors influencing implementation of doctor-nurse
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substitution and the expansion of nurses'' tasks in community or primary
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care worldwide. We included perspectives of doctors, nurses, patients
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and their families/carers, policymakers, programme managers, other
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health workers and any others directly involved in or affected by the
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substitution. We excluded studies that collected data using qualitative
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methods but did not analyse the data qualitatively.
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Data collection and analysis
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We identified factors influencing implementation of doctor-nurse
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substitution strategies using a framework thematic synthesis approach.
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Two review authors independently assessed the methodological strengths
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and limitations of included studies using a modified Critical Appraisal
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Skills Programme (CASP) tool. We assessed confidence in the evidence for
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the QES findings using the GRADE-CERQual approach. We integrated our
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findings with the evidence fromthe effectiveness review of doctor-nurse
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substitution using amatrixmodel. Finally, we identified hypotheses for
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subgroup analyses for updates of the review of effectiveness.
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Main results
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We included 66 studies (69 papers), 11 from low-or middle-income
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countries and 55 from high-income countries. These studies found several
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factors that appeared to influence the implementation of doctor-nurse
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substitution strategies. The following factors were based on findings
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that we assessed as moderate or high confidence. Patients in many
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studies knew little about nurses'' roles and the difference between
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nurse-led and doctor-led care. They also had mixed views about the type
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of tasks that nurses should deliver. They preferred doctors when the
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tasks were more ` medical'' but accepted nurses for preventive care and
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follow-ups. Doctors in most studies also preferred that nurses performed
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only ` non-medical'' tasks. Nurses were comfortable with, and believed
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they were competent to deliver a wide range of tasks, but particularly
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emphasised tasks that were more health promotive/ preventive in nature.
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Patients in most studies thought that nurses were more easily accessible
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than doctors. Doctors and nurses also saw nurse-doctor substitution and
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collaboration as a way of increasing people''s access to care, and
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improving the quality and continuity of care. Nurses thought that close
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doctor-nurse relationships and doctor''s trust in and acceptance of
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nurses was important for shaping their roles. But nurses working alone
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sometimes found it difficult to communicate with doctors. Nurses felt
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they had gained new skills when taking on new tasks. But nurses wanted
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more and better training. They thought this would increase their skills,
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job satisfaction and motivation, and would make them more independent.
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Nurses taking on doctors'' tasks saw this as an opportunity to develop
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personally, to gain more respect and to improve the quality of care they
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could offer to patients. Better working conditions and financial
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incentives also motivated nurses to take on new tasks. Doctors valued
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collaborating with nurses when this reduced their own workload. Doctors
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and nurses pointed to the importance of having access to resources, such
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as enough staff, equipment and supplies; good referral systems;
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experienced leaders; clear roles; and adequate training and supervision.
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But they often had problems with these issues. They also pointed to the
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huge number of documents they needed to complete when tasks were moved
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from doctors to nurses.
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Authors'' conclusions
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Patients, doctors and nurses may accept the use of nurses to deliver
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services that are usually delivered by doctors. But this is likely to
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depend on the type of services. Nurses taking on extra tasks want
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respect and collaboration from doctors; as well as proper resources;
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good referral systems; experienced leaders; clear roles; and adequate
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incentives, training and supervision. However, these needs are not
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always met.'
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affiliation: 'Shakibazadeh, E (Corresponding Author), Univ Tehran Med Sci, Dept Hlth
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Educ \& Hlth Promot, Tehran, Iran.
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Karimi-Shahanjarini, Akram, Hamadan Univ Med Sci, Dept Publ Hlth, Hamadan, Iran.
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Karimi-Shahanjarini, Akram, Hamadan Univ Med Sci, Social Determinants Hlth Res Ctr,
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Hamadan, Iran.
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Shakibazadeh, Elham, Univ Tehran Med Sci, Dept Hlth Educ \& Hlth Promot, Tehran,
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Iran.
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Rashidian, Arash, Univ Tehran Med Sci, Sch Publ Hlth, Dept Hlth Management \& Econ,
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Tehran, Iran.
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Hajimiri, Khadijeh, Zanjan Univ Med Sci, Sch Publ Hlth, Dept Hlth Educ \& Hlth Promot,
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Zanjan, Iran.
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Glenton, Claire; Lewin, Simon, Norwegian Inst Publ Hlth, Oslo, Norway.
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Noyes, Jane, Bangor Univ, Ctr Hlth Related Res, Bangor, Gwynedd, Wales.
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Lewin, Simon, South African Med Res Council, Hlth Syst Res Unit, Tygerberg, South
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Africa.
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Laurant, Miranda, Radboud Univ Nijmegen, Med Ctr, IQ Healthcare, Radboud Inst Hlth
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Sci, Nijmegen, Netherlands.
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Laurant, Miranda, HAN Univ Appl Sci, Inst Nursing Studies, Nijmegen, Netherlands.
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Colvin, Christopher J., Univ Cape Town, Sch Publ Hlth \& Family Med, Div Social
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\& Behav Sci, Cape Town, South Africa.'
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article-number: CD010412
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author: Karimi-Shahanjarini, Akram and Shakibazadeh, Elham and Rashidian, Arash and
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Hajimiri, Khadijeh and Glenton, Claire and Noyes, Jane and Lewin, Simon and Laurant,
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Miranda and Colvin, Christopher J.
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author-email: shakibazadeh@tums.ac.ir
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author_list:
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- family: Karimi-Shahanjarini
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given: Akram
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- family: Shakibazadeh
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given: Elham
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- family: Rashidian
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given: Arash
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- family: Hajimiri
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given: Khadijeh
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- family: Glenton
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given: Claire
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- family: Noyes
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given: Jane
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- family: Lewin
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given: Simon
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- family: Laurant
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given: Miranda
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- family: Colvin
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given: Christopher J.
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da: '2023-09-28'
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doi: 10.1002/14651858.CD010412.pub2
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eissn: 1361-6137
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files: []
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issn: 1469-493X
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journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
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keywords-plus: 'PRIMARY-HEALTH-CARE; RANDOMIZED CONTROLLED-TRIAL; ADVANCED PRACTICE
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NURSES; MENTAL-HEALTH; GENERAL-PRACTICE; PATIENTS EXPERIENCES;
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SELF-MANAGEMENT; DIABETES CARE; NURSING ROLES; TELEPHONE CONSULTATION'
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language: English
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number: '4'
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number-of-cited-references: '231'
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orcid-numbers: 'Colvin, Christopher/0000-0002-8930-7863
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Glenton, Claire/0000-0002-7558-7737
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Karimi, Akram/0000-0002-2453-1389
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Shakibazadeh, Elham/0000-0002-1320-2133
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Laurant, Miranda/0000-0002-8826-3352'
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papis_id: ba970c8fdbfb4b734ff25635f4fdbc04
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ref: Karimishahanjarini2019barriersfacilitators
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researcherid-numbers: 'Colvin, Christopher/AAB-8276-2019
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Colvin, Christopher/AAQ-1607-2021
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Glenton, Claire/GSE-3606-2022
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Karimi, Akram/AAA-5080-2021
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Shakibazadeh, Elham/X-6430-2018
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Rashidian, Arash/E-5061-2011
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Laurant, Miranda/H-6488-2015'
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tags:
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- review
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times-cited: '54'
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title: 'Barriers and facilitators to the implementation of doctornurse substitution
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strategies in primary care: a qualitative evidence synthesis'
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type: Review
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unique-id: WOS:000466276500002
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usage-count-last-180-days: '3'
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usage-count-since-2013: '35'
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web-of-science-categories: Medicine, General \& Internal
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year: '2019'
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