title: Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective?
abstract: OBJECTIVE
  To explore patient and family perceptions of team effectiveness of teams those include nurse practitioners in acute and primary care.
  
  
  BACKGROUND
  Nurse practitioners provide safe and effective care. Patients are satisfied with the care provided by nurse practitioners. Research examining patient and family perceptions of team effectiveness following the implementation of nurse practitioners in teams is lacking.
  
  
  METHODS
  A descriptive qualitative design was used.
  
  
  METHODS
  We used purposeful sampling to identify participants in four clinical specialties. We collected data from March 2014-January 2015 using semi-structured interviews and demographic questionnaires. Content analysis was used. Descriptive statistics were generated.
  
  
  RESULTS
  Participants (n = 49) believed that the teams were more effective after the implementation of a nurse practitioner and this was important to them. They described processes that teams with nurse practitioners used to effectively provide care. These processes included improved communication, involvement in decision-making, cohesion, care coordination, problem-solving, and a focus on the needs of patients and families. Participants highlighted the importance of interpersonal team dynamics. A human approach, trust, being open to discussion, listening to patient and family concerns and respect were particularly valued by participants. Different processes emerged as priorities when data were examined by speciality. However, communication, trust and taking the time to provide care were the most important processes.
  
  
  CONCLUSIONS
  The study provides new insights into the views of patients and families and micro-level processes in teams with nurse practitioners. The relative importance of each process varied according to the patient's health condition. Patients and providers identified similar team processes. Future research is needed to identify how team processes influence care outcomes.
  
  
  CONCLUSIONS
  The findings can support patients, clinicians and decision-makers to determine the processes to focus on to promote effective team functioning, and involve patients and families as team members.
authors.affiliation: Faculty of Nursing, Research Centre Maisonneuve-Rosemont Hospital, CSA-RC-Aile Bleue, Université de Montréal, Montréal, QC, Canada.
authors.forename: Kelley
authors.initials: K
authors.lastname: Kilpatrick
authors.affiliation: CSA-RC-Aile Bleue, Research Centre Maisonneuve-Rosemont Hospital, Montréal, QC, Canada.
authors.forename: Mira
authors.initials: M
authors.lastname: Jabbour
authors.affiliation: Maisonneuve-Rosemont Hospital, Montréal, QC, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Fortin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D010465:Perception; D011320:Primary Health Care; D035502:Trust
keywords: acute care; family; nurse practitioner; patient; perceptions; primary care; qualitative description; team effectiveness; team process