Exploring nurse navigators’ contribution to integrated care: a qualitative study
Clare Hannan-Jones A , Charlotte Young B , Geoffrey Mitchell C and Allyson Mutch A DA School of Public Health, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia.
B School of Biomedical Sciences, The University of Queensland, St Lucia Campus, St Lucia, Qld 4072, Australia.
C Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia.
D Corresponding author. Email: a.mutch@uq.edu.au
Australian Journal of Primary Health 25(4) 339-345 https://doi.org/10.1071/PY19042
Submitted: 12 February 2019 Accepted: 30 April 2019 Published: 2 September 2019
Abstract
This paper examines nurse navigation as a model of integrated care operating across primary and secondary healthcare settings. A two-phase qualitative study involving a focus group with seven nurse navigators (NNs) to explore their understandings and perceptions of the role, followed by in-depth interviews with three NNs to examine current practice, was undertaken in Queensland, Australia. NNs’ role spanned a continuum of patient and population care, and involved engagement in clinical integration, coordinating patient care and providing education and points-of-contact for healthcare professionals. NNs also engaged in professional integration, fostering interdisciplinary collaboration, education and connections between healthcare professionals, while promoting integrated care across care settings. NNs were enabled through the establishment of relationships, trust and shared communication between stakeholders. NNs’ work transcended traditional clinical boundaries, operating horizontally across silos and specialties, which allowed them to avoid (some) system shortfalls. By contributing to a culture of integration, NNs can potentially support more sustainable integrated care practices that extend relationships between healthcare professionals and beyond individual patients. Increasing our understanding of nurse navigation as a model of integrated care, this study illustrates the complexity, diversity and breadth of the role and its ability to contribute to broader, system-wide integration.
Additional keywords: nurse navigation, patient-centred care, Rainbow Model of Integrated Care.
References
Angus L, Valentijn PP (2018) From micro to macro: assessing implementation of integrated care in Australia. Australian Journal of Primary Health 24, 59–65.| From micro to macro: assessing implementation of integrated care in Australia.Crossref | GoogleScholarGoogle Scholar | 29132497PubMed |
Australian Health Ministers’ Advisory Council (2017) National Strategic Framework for Chronic Conditions Australian Government. (Australian Government: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/content/A0F1B6D61796CF3DCA257E4D001AD4C4/$File/National%20Strategic%20Framework%20for%20Chronic%20Conditions.pdf [Verified 3 April 2019]
Baliski C, McGahan CE, Liberto CM, Broughton S, Ellard S, Taylor M, Bates J, Lai A (2014) Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center. American Journal of Surgery 207, 686–692.
| Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center.Crossref | GoogleScholarGoogle Scholar | 24791628PubMed |
Banfield M, Jowsey T, Parkinson A, Douglas KA, Dawda P (2017) Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia. BMC Family Practice 18, 2
| Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia.Crossref | GoogleScholarGoogle Scholar | 28073346PubMed |
Carter N, Valaitis RK, Lam A, Feather J, Nicholl J, Cleghorn L (2018) Navigation delivery models and roles of navigators in primary care: a scoping literature review. BMC Health Services Research 18, 96
| Navigation delivery models and roles of navigators in primary care: a scoping literature review.Crossref | GoogleScholarGoogle Scholar | 29422057PubMed |
Feather J, Carter N, Valaitis R, Kirkpatrick H (2017) A narrative evaluation of a community-based nurse navigation role in an urban at-risk community. Journal of Advanced Nursing 73, 2997–3006.
| A narrative evaluation of a community-based nurse navigation role in an urban at-risk community.Crossref | GoogleScholarGoogle Scholar | 28557014PubMed |
Fulbrook P, Jessup M, Kinnear F (2017) Implementation and evaluation of a ‘Navigator’ role to improve emergency department throughput. Australasian Emergency Nursing Journal 20, 114–121.
| Implementation and evaluation of a ‘Navigator’ role to improve emergency department throughput.Crossref | GoogleScholarGoogle Scholar | 28624270PubMed |
Harris MF, Dennis S, Pillay M (2013) Multimorbidity: negotiating priorities and making progress. Australian Family Physician 42, 850–854.
Helen N (2010) ‘Conducting Research in Conservation: Social Science Methods and Practice.’ (Taylor and Francis: New York, USA)
Hudson AP, Spooner AJ, Booth N, Penny RA, Gordon LG, Downer TR, Yates P, Henderson R, Bradford N, Conway A, O’Donnell C, Geary A, Chan RJ (2019) Qualitative insights of patients and carers under the care of nurse navigators. Collegian (Royal College of Nursing, Australia) 26, 110–117.
| Qualitative insights of patients and carers under the care of nurse navigators.Crossref | GoogleScholarGoogle Scholar |
Jessup M, Fulbrook P, Kinnear FB (2018) Multidisciplinary evaluation of an emergency department nurse navigator role: a mixed methods study. Australian Critical Care 31, 303–310.
| Multidisciplinary evaluation of an emergency department nurse navigator role: a mixed methods study.Crossref | GoogleScholarGoogle Scholar | 28941792PubMed |
Kodner D (2009) All together now: a conceptual exploration of integrated care. Healthcare Quarterly 13, 6–15.
| All together now: a conceptual exploration of integrated care.Crossref | GoogleScholarGoogle Scholar | 20057243PubMed |
Lee T, Ko I, Lee I, Kim E, Shin M, Roh S, Yoon D, Choi S, Chang H (2011) Effects of nurse navigators on health outcomes of cancer patients. Cancer Nursing 34, 376–384.
| Effects of nurse navigators on health outcomes of cancer patients.Crossref | GoogleScholarGoogle Scholar | 21242774PubMed |
Li W, Islam A, Johnson K, Lauchande P, Shang X, Xu S (2018) Understanding inter-organizational trust among integrated care service provider networks: a perspective on organizational asymmetries. Health Policy 122, 1356–1363.
| Understanding inter-organizational trust among integrated care service provider networks: a perspective on organizational asymmetries.Crossref | GoogleScholarGoogle Scholar | 30249447PubMed |
Liamputtong P (2011) ‘Focus Group Methodology: Principles and Practices.’ (SAGE: Los Angeles, CA, USA)
Loeb DF, Bayliss EA, Candrian C, deGruy FV, Binswanger IA (2016) Primary care providers experiences caring for complex patients in primary care: a qualitative study. BMC Family Practice 17, 34
| Primary care providers experiences caring for complex patients in primary care: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 27004838PubMed |
McMurray A, Cooper H (2017) The nurse navigator: an evolving model of care. Collegian (Royal College of Nursing, Australia) 24, 205–212.
| The nurse navigator: an evolving model of care.Crossref | GoogleScholarGoogle Scholar |
McMurray A, Ward L, Johnston K, Yang L, Connor M (2018) The primary health care nurse of the future: preliminary evaluation of the Nurse Navigator role in integrated care. Collegian (Royal College of Nursing, Australia) 25, 517–524.
| The primary health care nurse of the future: preliminary evaluation of the Nurse Navigator role in integrated care.Crossref | GoogleScholarGoogle Scholar |
Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, Jackson CL (2015) Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness? Australian Journal of Primary Health 21, 391–408.
| Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?Crossref | GoogleScholarGoogle Scholar | 26329878PubMed |
Queensland Health (2015a) Nurse navigators Information Sheet. (Queensland Health: Brisbane, Qld, Australia) Available at https://www.health.qld.gov.au/__data/assets/pdf_file/0032/666437/nn-info-sheet.pdf [Verified 3 April 2019]
Queensland Health (2015b) Nurse navigators frequently asked questions. (Queensland Health: Brisbane, Qld, Australia) https://www.health.qld.gov.au/ocnmo/nursing/nurse-navigators/nurse-nav-faqs [Verified 3 April 2019]
Valentijn PP, Vrijhoef HJM, Ruwaard D, Boesveld I, Arends RY, Bruijnzeels MA (2015) Towards an international taxonomy of integrated primary care: a Delphi consensus approach. BMC Family Practice 16, 64
| Towards an international taxonomy of integrated primary care: a Delphi consensus approach.Crossref | GoogleScholarGoogle Scholar | 25998142PubMed |
Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC (2018) What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Education and Counseling 101, 285–294.
| What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators.Crossref | GoogleScholarGoogle Scholar | 28935442PubMed |
West Moreton Hospital and Health Service (2017) West Moreton Hospital and Health Service Annual Report 2016–2017. (West Moreton Hospital and Health Service: Ipswich, Qld, Australia) Available at https://data.qld.gov.au/dataset/west-moreton-hospital-and-health-service-annual-report-data-2016-17/resource/144e7b27-de07-40d6-8bcd-24afe8521304 [Verified 3 April 2019]
Yatim F, Cristofalo P, Ferrua M, Girault A, Lacaze M, Di Palma M, Minvielle E (2017) Analysis of nurse navigators’ activities for hospital discharge coordination: a mixed method study for the case of cancer patients. Supportive Care in Cancer 25, 863–868.
| Analysis of nurse navigators’ activities for hospital discharge coordination: a mixed method study for the case of cancer patients.Crossref | GoogleScholarGoogle Scholar | 27830394PubMed |
