An exemplar of naturalistic inquiry in general practice research (original) (raw)
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Journal of Clinical Nursing, 2016
Aims and objectives: To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. Background: There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. Design: A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Methods: Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Results: Data revealed three overarching themes. This paper presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Conclusion: Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity.
Understanding collaboration in general practice: a qualitative study
Family Practice, 2017
Background. An increased incidence of chronic and complex conditions in the community is placing pressure on human resources in general practice. Improving collaboration between GPs and registered nurses may help alleviate workforce stressors and enhance health outcomes. Objective. To explore the facilitators and challenges of collaboration between GPs and registered nurses in Australian general practice. Methods. Eight GPs and 14 registered nurses from general practices in New South Wales, Australia, participated in semi-structured face-to-face interviews. Recordings were transcribed verbatim and underwent thematic analysis. Results. The overarching theme 'Understanding collaboration in general practice' comprises four sub-themes, namely (i) interpreting collaboration in general practice, (ii) modes of communication, (iii) facilitators of collaboration and (iv) collaboration in practice. Conclusion. Our findings suggest that regular, formal avenues of communication, professional development and non-hierarchical environments facilitated collaboration between nurses and GPs. Implementing strategies to promote these features has the potential to improve inter-professional collaboration and quality of care within primary care.
BMC family practice, 2016
Background: In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. Methods: A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Results: Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners’ and medical practitioners’ adjustment to new routines and facilitating the collaborative work relied on the willingness and personal commitment of individuals. Conclusions: Findings of this study suggest that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, strategic support from healthcare reform decision-makers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice models in primary healthcare.
BMC health services research, 2007
Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. 'Developing person...
Doing qualitative research - The craft of naturalistic inquiry (Beuving & De Vries) 2015
Naturalistic inquiry is about studying people in everyday circumstances by ordinary means. It strives to blend in, to respect people in their daily lives, to take their actions and experiences seriously, and to build on these carefully. The book offers guidance, combining thoughtful reflection with practical advice. It is written for undergraduate and graduate students in social science; for practicioners in social work, health care, policy advice, and organizatinal consultancy; for all who have a genuine interest in society and its members.
A reflection on ten years experience of providing qualitative research training in primary care
Primary Health Care Research and Development, 2007
Aims: To gain structured feedback on a qualitative research methods training programme delivered to primary care researchers over a period of ten years. To examine dilemmas and challenges and how these had been resolved. To examine how the programme could be further developed. Background: The Wolds Primary Care Research Network's (WoReN) qualitative research methods training programme was developed and evolved in response to the needs of primary care practitioners and researchers and the NHS Research Agenda. Methods: Information on participants' professional backgrounds: which workshops they attended; their evaluation sheets, comments; and personal appraisals were collected from 1996 to 2006. Structured telephone conversations with a number of participants and ongoing informal feedback from participants added to this information. Numbers and ranges of professionals attending workshops were ascertained, how far they travelled to workshops and further degrees obtained by them, within the decade, were also noted. Findings: We found a lack of similar training elsewhere. A wide range of people attended workshops, especially general practitioners (GP) and academic researchers. Other practitioners were a significant presence however, and included nurses, pharmacists, health visitors and professions allied to medicine. Participants were prepared to attend extended workshops and to travel significant distances to them. Participants preferred a continuous cycle of workshops rather than discreet sessions, in order for them to consolidate their learning and to develop at their own pace. Practical exercises reflecting the qualitative research process were considered very conducive to learning and participants also appreciated one-to-one consultations about their work and longer-term, ongoing support as they progressed through their projects. Workshop design needed to continually reflect the changing requirements of participants, employers, funders, potential trainers and national NHS requirements. A new audience for training was identified in supervisors not versed in the qualitative paradigm.
Collaboration with general practitioners: preferences of medical specialists--a qualitative study
BMC health services research, 2006
Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. 'Teaching GPs' and 'regulating patient flow' (referrals) appeared to domina...
2017
In 2012, I conducted my first PhD study exploring general practitioners' attitudes toward online patient feedback. After designing the research questions and topic guide to conduct the interviews, I reviewed existing literature where authors described recruiting general practitioners to take part in research. I found there was some focus in the literature on the challenges associated with low general practitioner participation in survey-based and intervention studies, but little that described the process, experience, and challenges associated with recruiting general practitioners to take part in qualitative research. Although general practitioners are known to be a difficult group to recruit to take part in research, the recruitment process I experienced was much more challenging than I had anticipated. This case study sheds light on my experience of recruiting 20 general practitioners in England to an interview-based study, and outlines a critical reflection on the eight strategies used for recruitment. I started by using traditional methods such as postal invitations and faxes to recruit general practitioners. Due to the very low success rate, I resorted to using more inexpensive and creative methods, such as sending an invitation letter through email, advertising in general practitioner Email Newsletters, seeking help from existing research networks, recruiting through friends and acquaintances, and using social media. In this case study, I also describe the participants' (general practitioners') motivations for taking part in the study, and I conclude with offering suggestions on how to maximize response rates to general practitioner-based qualitative studies in England. Learning Outcomes By the end of the case, students should be able to Have a better understanding of the potential challenges faced when recruiting general practitioners (GPs) to take part in research Understand that sometimes probability sampling cannot be used due to difficulties with recruiting Learn to be creative and flexible when recruiting participants to research Understand the strategies and approaches that could be used to increase GP participation in research Project Overview and Context In 2012, I embarked on conducting a qualitative interview study with general practitioners (GPs), exploring their attitudes toward online patient feedback. GPs are the first point of call for patients in the United Kingdom. They treat all common medical conditions and refer patients to hospitals or other medical services for specialist or urgent care. Once my research questions and interview topic guide was designed, I focused my energies on exploring what strategies I should use for recruiting GPs to the study and what type of response rate I should expect.