Project Update

The AGPNs was originally scheduled to wind up at the end of July 2008. Due to the complexity of our analysis and some unforeseen issues which have arisen for team members, we have negotiated an extension of the project timeframe. The AGPNS is now due for completion at the end of December 2008.
Meanwhile work progresses and we are currently analysing findings from Phases 1 and 2 prior to developing our final report.
The team presented a poster at the recent General Practice and Primary Health Care Research Conference in Hobart. Click here to view the poster and abstract.

Phase 2 summary and Bulletin #4

These two documents outlining the second phase of the study, and summarising progress, are now available. Click here to view them. If you have difficulty accessing them please email the project team on agpns@anu.edu.au

Phase 1 findings and Bulletin #3

A preliminary summary of findings from Phase 1 of the project has been released, and the third AGPNS bulletin is also now available.
Both can be viewed here as pdf files. Please contact the project team if you have any trouble accessing these documents.

Bulletin #3

The third project bulletin is now available. It can be viewed here, as a pdf. Please contact the project team if you have any difficulties accessing this link.

Phase 2 Sites Underway

Seven practices around Australia have been recruited to participate in Phase 2 of the study. These practices are located in New South Wales,Queensland,South Australia, Victoria & Western Australia. Individual change projects, using an action research approach, are now underway and will continue until late 2007.

Preliminary findings of Phase 1 of the AGPNS have been used to inform the development of Phase 2. These results are currently being formulated for dissemination and will be available early in 2007.

Phase 2 Begins

Phase 2 of the AGPNS is about to begin.
This phase of the study offers support to practices wishing to improve the way their Practice Nurses are used and thereby the quality of service they offer to their patients. The aim is to develop a series of case studies exploring the introduction of sustainable change in the role or activities of the practice nurse over a year, in one of seven focus areas. This builds on the first phase, which mapped the activities and roles of nurses in 25 general practices.
The specific objectives of this part of the project are to:
• institute specific small, scale change management projects in seven general practices in different settings addressing the activities and roles of the practice nurse;
• assess the effectiveness of each change project in meeting the specific aims articulated by that practice team; and
• evaluate the role of the practice nurse in the change management process.

The process differs somewhat from other change projects, in that practices will be involved in designing the change management process.

We are currently recruiting practices through the Divisions network, with expressions of interest due to close on Wed 4th October.

For more information on Phase 2, please contact the project team on agpns@anu.edu.au

Second Bulletin

The second bulletin has just been released. If you missed it, then you can view the bulletin HERE, as a pdf. if you have any trouble, contact the project team.

Observing Nurse Activity - Tell us what you think

In Phase One the AGPNS team used a Rapid Appraisal Tool (RAT) to gather information during practice visits. One element of the RAT was structured observation of an hour of nurse activity, at two different points in the day. We now have records of fifty hours of nursing time in general practice. Our data show that:
 Practice nurses cycle through many tasks in an hour, often returning to the same task several times.
Is this the most effective way for Practice Nurses to work?
 Nurses are extremely responsive to the request of others in the practice. Having a space dedicated to practice nurse clinical activities may reduce the number of interruptions a nurse experiences in an hour.
What are the pros and cons of having a dedicated clinical nurse space?
 Practice nurses range over the entire general practice throughout their day.
What does this say about the nature of a nurse’s role in a general practice?

Practice Nurses and their role in Quality & Safety

The excerpt below is a paraphrase from an interview with a practice nurse.

“We had this girl come in. She just appeared in the surgery in tears and I took her into the treatment room. Anyway she was suicidal and at that stage we didn’t have our other practice nurse as well, but you just have to prioritise. She needed me until I could get a doctor to her. So I just put everything into looking after her and that’s where the team works so well, because the girls out the front just said “We’ve got a medical emergency. The nurse will ring you back.” They just kept taking phone numbers and saying, “She’ll ring you back,” because I couldn’t be disturbed. This girl had come in and she was in a crisis. So anyway in the end I got the doctor to take over and that was it. As it turned out then I had to, sort of, do a lot of following up and ringing for them while they were with her.”

We are interested in what other practice nurses think about this situation. In particular:
 How did the nurse's actions contribute to quality and safety?
 What is the nurse's role in the team?
 What role does the doctor play? Is it appropriate?
 What does this say about access to services?