Jurnal 8
Jurnal 8
Jurnal 8
ABSTRACT
The main aim of this survey was to explore patients’ satisfaction and evaluate the quality of care provided
by an advanced nurse practitioner (ANP) service in an emergency department. ANPs increasingly
assume the role of providing care for patients in Irish emergency departments. Measuring the impact
of ANP services on patient outcomes has become a necessary component of performance evaluation.
A prospective survey design was used for this study, which incorporated a self-complete questionnaire.
The majority of respondents perceived the ANP service positively. There was a high level of patient
satisfaction associated with waiting times, pain management, advice given, and communication. This
survey demonstrated the provision of quality of care by the ANP service and correspondingly high levels
of patient satisfaction.
554 The Journal for Nurse Practitioners - JNP Volume 12, Issue 8, September 2016
complete the questionnaire on the child’s behalf. respondent was 4 years old. Of all of the participants
Older children were advised that they could com- who took part in this survey, 32.5% (n ¼ 37) were
plete the questionnaire unaided if they felt they children (aged 2-16 years). Therefore, children
could. It was left to both the child and the parents’ account for one third of the ANP caseload in this
discretion as to who actually completed the ques- particular ED. The oldest respondent was 78 years
tionnaire. However, they were all advised that old, and the median age was 25.5 years.
completion of the questionnaire could also be a
combined child/parent effort. Responses to Questionnaire
It is possible that patients may have felt obliged to Question 1: “The ANP Understood Why I Had
participate; however, this would have been mini- Come to See Them.” Of all the responses given to
mized because patients were only invited to partici- this question, 83.3% (n ¼ 95) of participants strongly
pate after completion of their care and by assuring agreed that the ANP understood why they had come
anonymity. All participants gave informed consent, to the ED. Furthermore, 16.7% (n ¼ 19) of partici-
and all data were kept confidential and anonymous. pants agreed with this question. This meant that all
Patients were given an information sheet giving participants (100%, N ¼ 114) either strongly agreed
assurance of confidentiality, informed consent, and or agreed that the ANP understood why they had
voluntary participation. come to the ED.
Question 2: “The ANP Seemed to Be Very
Recording Waiting Times and Other Relevant Data Thorough.” Of the responses given to this ques-
Unique identification codes were used on the ques- tion, 88.6% (n ¼ 101) of participants strongly agreed
tionnaires in order to correlate the responses to other that the ANP seemed to be very thorough. Some
relevant data. An activity schedule was developed and participants (11.4%, n ¼ 13) agreed that the ANP
completed by the ANPs to capture information seemed to be very thorough. In total, 100%
regarding patient presentations. Such information (N ¼ 114) of all participants agreed that the ANP
included the time from registration until the initial seemed to be very thorough to some extent.
assessment by the ANP, the time from the initial Question 3: “I Was Less Worried About My
assessment to referral or discharge, type of investigations, Injury/Problem After Seeing the ANP.” Of
presentation type, and any unplanned reattendance. the responses given to this question, 73.7% (n ¼ 84)
of participants strongly agreed that they were less
Analysis worried about their injury after seeing the ANP.
Statistical analysis was performed using SPSS (Version Some 24.5% (n ¼ 28) of the participants of this
22) for Windows (SPSS Inc, Chicago, IL). Qualita- survey agreed that they were less worried about
tive data from the open-ended question were their injury/problem after seeing the ANP. Just 1.8%
content analyzed. (n ¼ 2) of the participants disagreed that they were
less worried about their injury after seeing the ANP.
RESULTS Question 4: “I Will Follow the Advice of
Response Rate the ANP Because I Believe It Is Good
During the allocated study period, a total of 162 new Advice.” Many participants strongly agreed (86.8%,
patients were treated by the ANPs. A total of 5 n ¼ 99) or agreed (13.2%, n ¼ 15) that they would
patients did not meet the inclusion criteria. Of the follow the advice of the ANP. Therefore, all partic-
157 eligible patients, a total of 114 chose to partici- ipants (100%, N ¼ 114) agreed that they would
pate, giving a 72.6% response rate. follow the advice given to them by the ANP because
they believed it to be good advice.
Age and Sex of Participants Question 5: “Did You Have Enough Time
Males accounted for 61.3% of the response rate, and to Discuss Things With the ANP?” Of the
females accounted for 38.7%. The youngest valid responses returned, many of the participants
556 The Journal for Nurse Practitioners - JNP Volume 12, Issue 8, September 2016
Table 2. Categories of Response From the Open-ended Question
ANP thoroughness “Very thorough and helpful”
“Very thorough”
“The nurse practitioner did all they could have done.”
Professional service “This service was excellent and the nurse practitioner was very professional and related well to
patient.”
“My experience was of great staff and professional service.”
Satisfaction with “The nurse practitioner was excellent.”
ANP service “I was very happy with the nurse practitioner.”
“. . . was very pleased with the care he got from the nurse practitioner.”
“Happy with the service. Nurse practitioner was very efficient.”
”Great service”
Reduced waiting “Was impressed with short waiting time to be seen”
time “Very happy with reduced waiting time and received excellent care and advice from ANP”
ANP ¼ advance nurse practitioner.
between the 2 variables found no significant corre- survey, one quarter of them (25.4%, n ¼ 29) had
lation (q ¼ .085). The percentage of variance incurred a fracture of some type. The radiologists’
(0.72%) revealed minimal overlap between the 2 x-ray report was used as the gold standard to check that
variables. Therefore, waiting times did not influence these fractures had been correctly identified. All
total patient satisfaction with the ANP service. patients (100%, n ¼ 29) with confirmed fractures had
A Kruskal-Wallis test was undertaken to deter- been correctly identified and appropriately managed
mine if there was any statistical significance between by the ANPs. Those patients with confirmed frac-
the age of patients and a global question regarding the tures were either referred to the fracture clinic
overall quality of the ANP service. The ages of the (n ¼ 20, 17.5%) or referred directly to the orthopedic
participants were collapsed into 3 equal age groups. team (n ¼ 9, 7.9%) as appropriate. A further 10
The test proved to hold no statistical significance patients (8.8%) were referred to the fracture clinic for
(.753 > 0.05), and, therefore, it can be stated that clinical reasons other than having incurred a fracture.
there was no difference in the age groups and global Of all the participants (N ¼ 114) who took part in
satisfaction with the ANP service. A Mann-Whitney this survey, there were 22 (19.3%) referrals made to
U test revealed no statistically significant difference specialties. Orthopedics accounted for 19 (16.7%) of
(P ¼ .68, >0.05) between total patient satisfaction referrals, and ophthalmology referrals accounted for 3
between male and female participants. (2.6%) of all referrals made to specialties. A total of 5
Many (93%, n ¼ 106) of the participants in this (4.4%) of the patients were referred to a trauma clinic
survey had an x-ray as part of their investigation. Of for review by the ED consultant at a later date. The
all the participants (N ¼ 114) who completed this remaining patients (n ¼ 67, 58.8%) were either dis-
charged or advised to see their own general practi-
Table 3. Time of the Initial Assessment to the Time of tioner for follow-up if required (Table 4).
Referral or Discharge by the Advanced Nurse Of all the participants in this study, there were 2
Practitioner (1.75 %) unplanned reattendances to the ED. One
patient reattended with a cast problem. A second
Groups Frequency Percent
patient reattended with continued pain after a period
Group 1 90 78.6
of immobilization in a cast for fracture.
0-60 min
Group 2 23 20.4
Types of Minor Injuries Seen During the Study Period
61-120 min
The participants in this study presented with multiple
Group 3 1 1.0
various types of injuries. These injuries were classified
121-180 min
under 8 main subheadings (Table 1).
558 The Journal for Nurse Practitioners - JNP Volume 12, Issue 8, September 2016
informed of who to contact if they needed more help EDs in Ireland currently face, ANPs are providing
or advice regarding their injury. Ensuring that quality care in extremely busy environments.
patients know where to go and who to talk to should The findings of this study correlate closely to the
their injury/health care problem deteriorate aims to findings of other research into ANPs in EDs in
maintain the safety of the patient. Ireland.2 Despite the foundation of evidence already
The results of this survey revealed that the completed, further research is required to assess
opportunity to impart health promotion advice established ANP services throughout Ireland and also
(eg, smoking cessation) by the ANP was not used to the potential for the expansion of further ANP
its full potential. Just under one fifth of the partici- services. This piece of research provides a summary of
pants were given health promotion advice through the current ANP service and highlights some of the
this ANP service. Time-related pressures of this ANP opportunities that can improve quality of
service may account for this apparent shortfall in the service.
imparting health promotion advice. The vast major-
References
ity of these patients received comprehensive advice
1. Gagan MJ, Maybee P. Patient satisfaction with nurse practitioner care in
specifically tailored to their particular injury. In some primary care settings. Aust J Adv Nurs. 2011;28:12-19.
2. Begley C, Murphy K, Higgins A, et al. Evaluation of Clinical Nurse and Midwife
instances, it was considered that providing additional Specialist and Advanced Nurse and Midwife Practitioner Roles in Ireland
health promotional advice may have diluted the (SCAPE) Final Report. Dublin: National Council for the Professional
Development of Nursing and Midwifery; 2010.
importance of comprehensive injury advice imparted 3. Thompson W, Meskell P. Evaluation of an ANP (emergency care)ean Irish
perspective. J Nurse Pract. 2012;8:200-205.
at that time. 4. Ingram S. Advanced nurse practitioner registration in Ireland: an RANP
All of the confirmed fractures had been correctly cardiology’s experience. Br J Cardiol Nurs. 2014;9:177.
5. Nursing and Midwifery Board of Ireland. http://www.nmbi.ie/. 2016. Accessed
identified by the ANPs at this ED. Competency in March 20, 2016.
6. National Clinical Programme for Emergency Medicine. A Guide to Enhance
the skill of radiologic diagnostics by ANPs has been ANP Services Across Emergency Care Networks in Ireland. 2013. Dublin,
acknowledged in previous studies.3,14 ANPs in Ireland: Office of the Nursing and Midwifery Services Director.
7. Letterkenny University Hospital (2015) Patient attendance numbers at the
Ireland have been acknowledged as being able to Emergency Department. BLANK Hospital
8. Jennings N, Lee G, Chao K, Keatings S. A survey of patient satisfaction in a
enhance the patient experience with less recalls for metropolitan emergency department: comparing nurse practitioners and
missed fractures and fewer unplanned reattendances.6 emergency physicians. Int J Nurs Pract. 2009;15:213-218.
9. Touché R. Evaluation of Nurse Practitioner Pilot Projects. London: NHS
The patients’ perception of this ANP service Executive; 1994.
10. Byrne G, Richardson M, Brundsdon J, Patel A. Patient satisfaction with
would appear to be largely positive. A global question emergency nurse practitioners in A&E. J Clin Nurs. 2000;9:83-93.
11. McDevitt J, Melby V. An evaluation of the quality of the emergency nurse
in this survey revealed that the vast majority of the practitioner services for patients presenting with minor injuries to one rural
participants thought that the overall quality of the urgent care centre in the UK: a descriptive study. J Clin Nurs. 2015;24:523-535.
12. Drennan J, Naughton C, Allen D, Hyde A, Felle P, O’Boyle K, et al. National
care provided by the ANP service was excellent. independent evaluation of the nurse and midwife prescribing initiative.
Dublin: University College Dublin; 2009.
Conversely, none of the participants in this survey 13. Moore A. Nurse/midwife prescribing deemed a success. World Irish Nurs.
indicated that the quality of the quality of care was 2009;17:20.
14. Snaith B, Hardy M. Emergency department image interpretation accuracy: the
average, poor, or very poor. It would appear that influence of immediate reporting by radiology. Int Emerg Nurs J.
2014;22:63-68.
the provision of a high-quality seamless service is
being achieved.
Both authors are affiliated with Letterkenny University Hospital
CONCLUSION in Donegal, Ireland. Miriam Griffin MSc, APRN, is a registered
This survey examined patient satisfaction and quality advanced nurse practitioner. Joe McDevitt MSc, APRN,
with an ANP service in an Irish ED. The findings is a registered advanced nurse practitioner and can be reached at
of this study indicate that ANPs can provide high- joe.mcdevitt@hse.ie. In compliance with national ethical
quality, safe, and effective care, which is reflected in guidelines, the authors report no relationships with business or
high levels of patient satisfaction. ANPs working industry that would pose a conflict of interest.
autonomously in EDs can provide a quality service
for those children and adults with so-called minor 1555-4155/16/$ see front matter
© 2016 Elsevier Inc. All rights reserved.
injuries and complaints. Despite the many challenges http://dx.doi.org/10.1016/j.nurpra.2016.05.024