Optimizing nursing talent in primary health care

Canadian researchers use Knowledge Translation to study nursing practices and engage nurses in population health approaches in patient care.

Dr. Jeanne Besner (Order of Canada)

• Former Director, Health Systems and Workforce Research Unit, Alberta Health Services

Associates and Partners

• Dr. Jane Drummond, Nursing, University of Alberta
• Dr. Nelly D. Oelke, Alberta Health Services
• Mr. Robert McKim, Public Health, University of Alberta & Alberta Health Services
• Ms. Rebecca Carter, Alberta Health Services
• Alberta Innovates (formerly Alberta Heritage Foundation for Medical Research)

Issue

Are nurses achieving their full scope of practice when it comes to helping Canadians manage their everyday health needs?

“Helping individuals adopt healthy lifestyles that can prevent chronic illness or injuries is part of what health specialists call population health,” says Dr. Jeanne Besner, the leader of an innovative study for Alberta Health Services that used Knowledge Translation techniques to help examine the role of nurses in front-line health care in Alberta.

In 2003, Alberta Health Services (AHS)—the agency responsible for health care delivery in Alberta—added the option of Primary Care Networks to local health care systems in the province. Consumers could go to a Primary Care Network as their “first point of access” to the health care system and receive integrated care from physicians, nurses, pharmacists, physiotherapists, mental health workers and other health care professionals. The goal was to use inter-professional teams to provide consumers with better-coordinated care. Population health approaches such as health education, screening programs and other community supports would help improve the health of individuals and families associated with the Primary Care Network.

“We wanted to know whether nurses in these Primary Care Networks had been able to fully enact their scope of practice,” says Dr. Besner. “Had they been able to use the full range of their knowledge and skills in order to influence consumer health?”

Research

With the help of a CIHR Partnerships for Health Systems Improvement grant, Dr. Besner and her team brought together health care practitioners and administrators to design an interactive research program for three different Primary Care Networks.

Using a Knowledge Translation model, Dr. Besner and her colleagues asked nurses (Nurse Practitioners, Registered Nurses, Licensed Practical Nurses), other professionals and decision makers responsible for program development to participate directly in their research team. The result was a study that provided an inside view of the daily practice of professional team members in each network studied.

“It’s quite complex, this kind of research. One of our goals was to form partnerships among the decision makers and participants. This influenced what to study, the sites we chose, and how to go about it. Also when you bring people together with a clinical background, an administrative background and a research background, they don’t always understand each other. We had to talk about research objectivity, for example, and bring together a lot of viewpoints to ensure the integrity of the research.”

A variety of assessment tools—from surveys to in-depth interviews—helped the researchers understand the nurses’ own perception of their roles within the networks and their sense of the potential for innovation and change. Consumer viewpoints were also gathered to understand whether individuals and families felt included in this team approach to health care decision making.

The interactive research process allowed the researchers both to gather information and to reflect back the views of participants to the decision makers as the study progressed. Being located directly in a clinical practice setting allowed the researchers to link what they were hearing with the actual context and culture of each workplace. This also made it possible to observe how the feedback was received and used, and to follow the evolution of each network’s service delivery during the study.

“With some luck, we hoped this might lead to more rapid uptake of the findings, since the decision makers were invested in the whole process,” says Dr. Besner.

Results

“What stood out from our interviews with participants is the importance of having a clear vision,” says Dr. Besner. “It’s important to identify where you are going and what you are expecting of every member of the team. It’s hard as a nurse or other practitioner to move your practice forward into new areas that would benefit consumers, if your role hasn’t been clearly defined in the first place.”

While the study did point to ways in which the role of nurses could be further optimized, Dr. Besner and her team did observe change in the networks they studied. Based on the feedback generated by the research process, decision makers in these networks began involving more patients in the design of their programs. Consumers also reported that the nurses in these Networks were taking more time to listen to their individual stories and challenges, and to provide education on drugs, nutrition and other matters.

The research team have presented their findings broadly and international interest in the study is strong. The final report was presented to Alberta Health Services and the Alberta Medical Association in 2010. Alberta Health Services has begun the process of refining the goals of Primary Care Networks.

“Systems research like this opens a window on the dynamics of the health care system,” says Dr. Besner. “It’s wonderful that CIHR supports research that helps researchers and practitioners collaborate who would not traditionally exchange their expertise.”