{"id":1054,"date":"2015-02-27T21:56:04","date_gmt":"2015-02-27T20:56:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=1054"},"modified":"2015-02-11T14:15:22","modified_gmt":"2015-02-11T13:15:22","slug":"shape-of-services","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2015\/02\/27\/shape-of-services\/","title":{"rendered":"Shape of services?"},"content":{"rendered":"<p>With the publication and debate around <a href=\"http:\/\/adc.bmj.com\/content\/100\/2\/119.full\">Shape of Training<\/a><a href=\"https:\/\/blogs.bmj.com\/adc\/files\/2015\/02\/bomb.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-1055\" src=\"https:\/\/blogs.bmj.com\/adc\/files\/2015\/02\/bomb-150x150.png\" alt=\"bomb\" width=\"150\" height=\"150\" \/><\/a> (a UK-based review of how training the medical workforce will be revised for a new era of health care) there is a fair bit of &#8230; conversation &#8230; about a number of things. Some of these things include the question about how a &#8216;medical&#8217; service is to be delivered with fewer doctors.<\/p>\n<p>Hot of the press, and in keeping with our <a href=\"https:\/\/blogs.bmj.com\/adc\/category\/qualitative\/\">new blog theme on qualitative work<\/a>, there is a <a href=\"http:\/\/onlinelibrary.wiley.com\/enhanced\/doi\/10.1111\/scs.12120\/\">systematic review and meta-ethnographic synthesis<\/a> of studies looking at how units have found the introduction of nurse practitioners (NP) into their clinical work.<\/p>\n<p><!--more--><\/p>\n<p>The paper <a title=\"Basics. Why bother with systematic reviews?\" href=\"https:\/\/blogs.bmj.com\/adc\/2014\/09\/07\/basics-why-bother-with-systematic-reviews\/\">systematically searched for, appraised, and synthesised evidence<\/a> from 26 studies that examined how teams had reacted, coped, and adjusted to working with nurse practitioners. They identified four main themes:<\/p>\n<blockquote><p>\u2018a threat to professional boundaries\u2019,<\/p>\n<p>\u2018a resource for the team\u2019,<\/p>\n<p>\u2018the quest for autonomy and control\u2019 and<\/p>\n<p>\u2018the ability to develop an interprofessional collaboration\u2019<\/p><\/blockquote>\n<p>They noted challenges with fitting NP into the understanding of the team hierarchies, but positives from the experience and support NP could offer nurses and inexperienced doctors alike, the effect on doctor workload was seen variably &#8211; some reporting relief from some duties, others reporting that supervision of the NPs took up that time again &#8211; and some NP commented on taking tasks that had previously been completed poorly and doing a better job. The arrangement of mentoring, independence, and interprofessional developments were tricky and negotiated differently in different settings.<\/p>\n<p>Where this leads us may be worth thinking through, particularly in re-designing times, and setting out a plan\u00a0that might address the twists and turns that others have seen. On the other hand, it might be that my thinking about them we make them happen &#8230;<\/p>\n<p>&nbsp;<\/p>\n<blockquote class=\"twitter-tweet\">\n<p>Would we improve <a href=\"https:\/\/twitter.com\/hashtag\/CYPExp?src=hash\">#CYPExp<\/a> if we changed what we said? \u201cThis may hurt\u201d predictions in procedural disclosure may do harm <a href=\"http:\/\/t.co\/EZwOcWnYGE\">http:\/\/t.co\/EZwOcWnYGE<\/a><\/p>\n<p>&mdash; ADC (@ADC_BMJ) <a href=\"https:\/\/twitter.com\/ADC_BMJ\/status\/565225461840891904\">February 10, 2015<\/a><\/p><\/blockquote>\n<blockquote class=\"twitter-tweet\">\n<p> <a href=\"https:\/\/twitter.com\/ADC_BMJ\">@ADC_BMJ<\/a> &#010;A short little practice modification you can do, ethically.  Tell children otoscopy tickles.  Then it does.<\/p>\n<p>&mdash; Ian Wacogne (@ian_wac) <a href=\"https:\/\/twitter.com\/ian_wac\/status\/565250825753489408\">February 10, 2015<\/a><\/p><\/blockquote>\n<p>&#8211; Archi<br \/>\n<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>With the publication and debate around Shape of Training (a UK-based review of how training the medical workforce will be revised for a new era of health care) there is a fair bit of &#8230; conversation &#8230; about a number of things. Some of these things include the question about how a &#8216;medical&#8217; service is [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2015\/02\/27\/shape-of-services\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2681,9800],"tags":[],"class_list":["post-1054","post","type-post","status-publish","format-standard","hentry","category-practice-of-medicine","category-qualitative"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Shape of services? - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2015\/02\/27\/shape-of-services\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Shape of services? - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"With the publication and debate around Shape of Training (a UK-based review of how training the medical workforce will be revised for a new era of health care) there is a fair bit of &#8230; conversation &#8230; about a number of things. 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