title: Identifying nurse practitioners' required case management competencies in health promotion practice in municipal public primary health care. A two-stage modified Delphi study.
abstract: OBJECTIVE
  The aims of this study were to identify and reach consensus among municipal primary health care participants on nurse practitioners' (NPs') required case management competencies in health promotion practices in eastern Finland.
  
  
  BACKGROUND
  The NP's role as a case manager of patients with chronic conditions has been found to have positive outcomes in health promotion, such as reduced hospital lengths of stay and readmission rates. However, the challenging work of health promotion requires NPs to have multidimensional competencies in health promotion, including communication, advocacy, assessment, planning, consultation and implementation.
  
  
  METHODS
  A two-stage modified Delphi study.
  
  
  METHODS
  Round 1 semi-structured interviews were conducted among municipal primary health care participants (n = 42) in 11 health centres from April-July 2009, and the round 2 questionnaire survey was conducted in the same health centres in eastern Finland in January and March 2011. The questionnaire was answered by 64% of those surveyed (n = 56). Content analysis and descriptive statistics were used for data analysis.
  
  
  RESULTS
  We identified a total of 18 required case management competencies for NPs' health promotion practices in municipal primary health care. In 17 of these competencies (such as knowledge, skills and ability to work independently in health promotion), a consensus was reached (51% or over). However, the need to be interested in municipal decision-making (44·6%) did not reach consensus.
  
  
  CONCLUSIONS
  Consensus was clearly achieved for 17 competencies that NPs were required to have, and these indicated the knowledge or abilities of health promotion. Nevertheless, there was no agreement on the NPs' need to be interested in municipal decision-making.
  
  
  CONCLUSIONS
  NPs need a variety of case management skills and abilities to realise health promotion in municipal primary health care and they need to be supported by primary health care leaders to develop health promotion activities.
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Virpi
authors.initials: V
authors.lastname: Maijala
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Kerttu
authors.initials: K
authors.lastname: Tossavainen
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hannele
authors.initials: H
authors.lastname: Turunen
mesh_terms: D000328:Adult; D019090:Case Management; D002983:Clinical Competence; D003697:Delphi Technique; D005260:Female; D005387:Finland; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: case management; competencies; health promotion; nurse practitioner