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Do patients feel that they are satisfied following a consultation with a Nurse Practitioner?

1- Abstract
The objective of the study is to formulate a research proposal to ascertain the level of patient satisfaction following consultation with a nurse practitioner within the primary care setting in a general practice surgery.  The design of this research proposal will incorporate a patient satisfaction questionnaire based survey of patients seeing the nurse practitioner on the same day as booking and having an appointment. The study will be taking place in on general practice with the United Kingdom and it will use 64 patients who will be required to do the questionnaire over a period of one month. Over the past sixteen years the role of nurse practitioner has developed as a response to the ever increasing demands upon the general practice within primary care, and has become a valuable commodity with which to enhance the service. In previous research studies, patient satisfaction has been high in regard to seeing nurse practitioners. The numbers of these studies are low however and patient satisfaction in many of these studies has not been the primary factor for the study. A larger scale study should be undertaken using multiple data collection methods toensure validity when looking at patient satisfaction in seeing nurse practitioners. Adequate patient population and multiple practice involvement with other nurse practitioners would also ensure validity and reliability of results.

2- Introduction
This study aims to systematically review five studies looking at the nurse practitioners working within the primary care setting. After reviewing current literature, a research proposal which the author developed after discussion with other colleagues within the GP practice will be discussed. Though the literature currently available tells of a nurse practitioners role, none specifically aims to look at patient satisfaction which led to the formulation of this hypothesis as there appears to be a gap in research. The research holds importance as patients opinion of healthcare standards is vital as Donabedian (1980) highlighted; one of the factors by which quality of care can be defined is how well it meets the public standards as to how care should be provided.
There have been few studies on the viability of nurse practitioners taking on the extra workload of GP's in the United Kingdom, though as nurse practitioners have been well established within the United States, studies have been favorable when discussing nurse practitioners taking on some of the GP's workload. (Rabin and Spector, 1980) It is known that specialised trained nurses can diagnose and treat a large proportion of those people who currently seek access to a GP. (Marsh and Dawes, 1995) However, Braspenning et al (2004) suggest that nurse practitioners could supplement or extend GP care rather than substitute it. It can be suggested that a study analysing patients' satisfaction following a consultation with a nurse practitioner is important therefore.

5- Discussion and Conclusion
The role of the nurse practitioner is a relatively new addition to primary care and has already been seen to be a valuable asset to the future of primary care in meeting the increased demands upon it and to enable the service to become ever more enhanced.
Nurse practitioners have been able to provide a quality of care which is as good as, and in some way, better than doctors. (Horrocks et aI, 2002) However, it has also been observed in recent studies that they are no substitute, but a supplementation for GP care. (Braspenning, 2004) Previous studies have outlined that patient satisfaction with the nurse practitioner role is high; however more detailed larger studies regarding this are required to examine and reinforce this view. As nurse practitioners are still relatively new to the United Kingdom this study could provide valuable research in the area of primary care. As discussed in the study, many studies have focused on the United States but one may suggest that it is important to produce a study that will mirror a true meaning for practices in the United Kingdom. This study will provide research that will be original for the United Kingdom as it will focus on the patients' satisfaction after seeing a nurse practitioner. The patients' views and satisfaction should be at the forefront of any healthcare service and a study such as this will enable the service to develop and meet the needs of the patient.

The author of this research is situated in an ideal position as stated earlier in the methodology; research would be taken over the course of one month, as the author who would have had the role of nurse practitioner held two surgeries a week seeing 8 patients per surgery which would give optimum sample size of 64 patients. This enables easy access to gaining sufficient participants and ultimately results. Also the use of questionnaires will provide a quick way of gaining results as they are very easy to produce on a large scale. The methodology states that data collection would be achieved through a self filling questionnaire based approach to collect the information from the patients immediately post consultation. The questionnaire would be given to the patient by the receptionist, who would also receive the completed one. This represents an easy method of discovering if patients are satisfied with the service provided. The results will be collected over a period of one month which should give adequate time to finding 64 patients who are willing to complete the questionnaire. This study has taken influence from the research by Kinnersley et al (2002), described in the literature review, in terms of its framework and use of questionnaire. Although their research used a vast amount of patients in its study (1368) one can still take influence from this even though this study is only small in scale. It can be suggested that the more participants an investigation contains, the more reliable and valid it will become as it will represent more of the population. Although this study is similar to Kinnersley et al's in the use of same day as the consultation questionnaires, this study upholds its originality as its focus remains with the patients' satisfaction rather than a comparison between nurse practitioners and general practitioners.

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