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1
Woolsey, Mary Helen. "Nurse practitioner preparedness for entry into practice." Laramie, Wyo. : University of Wyoming, 2006. http://proquest.umi.com/pqdweb?did=1203574201&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Grose, Wendy. "Nurse Practitioner Navigator Policy and Procedure Protocols in Private Practice." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4063.
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In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly along with the use of Skype when team members were unavailable. A literature review explored methods to improve communication between hospitals and PCHM to reduce readmission rates. Thirty-two peer-reviewed articles were identified in a search of CINAHL and ProQuest Nursing and Allied Health Source databases that served as the primary pool of evidence used for this project, supplemented by context considerations provided by the project team. Evaluating the evidence based research provided support for this project using a NPN led MDT to reduce readmission rates. Coleman's transition of care (TOC) model was used as a framework for both the policy and procedure to integrate patient, provider, and environmental contexts, support health care policy changes, and reduce health care spending. This scholarly project supports the role of DNPs as leaders in the medical field working to translate existing evidence into policy and practice and lead interdisciplinary health care teams.
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Stokes, Allison, and Allison Stokes. "Describing the Needs of Advanced Practice Registered Nurses (APRNs) Who Plan to Specialize in Cardiology." Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626615.
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Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers.
Purpose: This study describes the needs of APRNs who plan to specialize in cardiology.
Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities.
Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation.
Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.
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Peckham, Samantha Sophia. "Evaluating the Readiness of Nevada Nurse Practitioners for Clinical Practice Post-Graduation Utilizing the Nevada Nurse Practitioners' Prepardness for Practice Survey." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/560799.
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As a result of changing demographics and an increasing need for access to healthcare, in 2013, the Nevada Legislature passed Assembly Bill 170 (AB170) allowing nurse practitioners (NPs) full practice authority in Nevada in 2013 (VanBeuge & Walker, 2014). With the movement from collaborative agreement to independent practice, recent NP graduates need to be prepared for transitioning from the NP student role to an independent practitioner role. Historically, speaking there have been numerous studies citing that NPs provide high-quality health care and have high patient satisfaction, yet there has been almost no research regarding the readiness for clinical practice post-graduation (Hart & Macnee, 2007). The purpose of this project was to develop a better understanding of readiness to practice, perceived barriers, and to develop recommendations for post-graduation nurse practitioners in Nevada. A brief survey was provided electronically to NPs who were members of the Nevada Advanced Practice Nurses Association (NAPNA).
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Christianson-Silva, Paula Frances. "The Influence of Doctor of Nursing Practice Education on Nurse Practitioner Practice." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556445.
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Nurse practitioners (NPs) have been undergoing a rapid transition in their entry-level degree, from Master of Science in Nursing (MSN) to Doctor of Nursing Practice (DNP). At this time, it is important to establish research evidence on the effects of doctoral education on NP practice. Therefore, a qualitative study of practicing NPs that have returned for the DNP degree was conducted. The purpose was to describe NPs' perceptions of their DNP education, and particularly its influence on their professionalism and patient care. A literature review and evidence synthesis process showed that the available body of research provides little insight into the question of how DNP education affects NP practice; therefore, qualitative description methodology was used to describe this phenomenon. The research questions that guided the study were: 1) What changes do practicing NPs describe about their clinical practice after the experience of completing a DNP?; and, 2) What are the NPs' perceptions of and concerns about the influences of their DNP educational experience on their clinical practice? Two published models and the DNP Essentials (AACN, 2006) informed and guided the data collection and analysis process. Purposive sampling and analyses continued concurrently until data saturation was achieved. Ten DNP prepared NPs were interviewed, and there was wide variation in the sample. The overarching theme Growth into DNP Practice summarizes the participants' perceptions of the changes that have occurred as a result of their DNP educational experience. Four major themes that support the overarching theme are: (a) Broader Thinking and Work Focus; (b) New Knowledge and Interests; (c) New Opportunities; and, (d) "Doctor" Title an Asset. Conceptual categories under each major theme are described. Participants were overwhelmingly positive about the influences of their DNP education on their practice, but the role of the DNP graduate in knowledge translation has yet to be fully operationalized.
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Christianson-Silva, Paula. "The influence of doctor of nursing practice education on nurse practitioner practice." Thesis, The University of Arizona, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3702907.
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Nurse practitioners (NPs) have been undergoing a rapid transition in their entry-level degree, from Master of Science in Nursing (MSN) to Doctor of Nursing Practice (DNP). At this time, it is important to establish research evidence on the effects of doctoral education on NP practice. Therefore, a qualitative study of practicing NPs that have returned for the DNP degree was conducted. The purpose was to describe NPs' perceptions of their DNP education, and particularly its influence on their professionalism and patient care. A literature review and evidence synthesis process showed that the available body of research provides little insight into the question of how DNP education affects NP practice; therefore, qualitative description methodology was used to describe this phenomenon. The research questions that guided the study were: 1) What changes do practicing NPs describe about their clinical practice after the experience of completing a DNP?; and, 2) What are the NPs' perceptions of and concerns about the influences of their DNP educational experience on their clinical practice? Two published models and the DNP Essentials (AACN, 2006) informed and guided the data collection and analysis process. Purposive sampling and analyses continued concurrently until data saturation was achieved. Ten DNP prepared NPs were interviewed, and there was wide variation in the sample. The overarching theme Growth into DNP Practice summarizes the participants' perceptions of the changes that have occurred as a result of their DNP educational experience. Four major themes that support the overarching theme are: (a) Broader Thinking and Work Focus; (b) New Knowledge and Interests; (c) New Opportunities; and, (d) "Doctor" Title an Asset. Conceptual categories under each major theme are described. Participants were overwhelmingly positive about the influences of their DNP education on their practice, but the role of the DNP graduate in knowledge translation has yet to be fully operationalized.
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White, Patricia A. "Exploration of nurse practitioner practice with clients who are grieving /." View online ; access limited to URI, 2007. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3277012.
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Smith, P., N. Moody, L. Lee Glenn, and J. D. Garmany. "Nurse Practitioner Research Network: Patterns of Practice in Northeast Tennessee." Digital Commons @ East Tennessee State University, 1996. https://dc.etsu.edu/etsu-works/7547.
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Van, Roper Stephen. "Evidence Based Practice Among Primary Care Nurse Practitioners." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/217049.
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This study describes primary care nurse practitioner (PCNP) beliefs in, knowledge, implementation and utilization of evidence based practice (EBP). Research questions answered are: 1. What are the levels of belief, implementation, knowledge and utilization of EBP among PCNPs? 2. Is there a relationship with PCNP demographics (personal, professional, and practice), belief, knowledge, implementation and utilization of EBP? 3. Do PCNP demographics (personal, professional, and practice) and scores on belief, knowledge and implementation influence EBP utilization? EBP is considered a standard of care and essential to nurse practitioner practice. The primary advantages of EBP include improved quality of care through the utilization of patient resources, provider resources and experiences, current research and scientific information. However, few studies describe nurse practitioner beliefs, knowledge in EBP and the extent to which this may affect primary care nurse practitioners' (PCNP) utilization of EBP in their practice. Four questionnaires incorporated into one survey were used to examine PCNP beliefs, knowledge, implementation and utilization of EBP. JNC7 guideline knowledge and self-reported use was used to measure EBP utilization. A convenience sample of 202 FNPs, ANPs and GNPs were obtained during the American Academy of Nurse Practitioners National Conference 2011 in Las Vegas, Nevada. PCNPs surveyed were found to have a high level of belief in EBP but did not report implementing EBP more than 3 times in the past 8 weeks. Belief was statistically higher in doctorally prepared PCNPs. Ninety-five percent of the participants were familiar with the JNC7 guideline but the group scored a mean of 69% on knowledge of JNC7 guideline specifics. Only 25% of respondents indicated they utilized guidelines in hypertension management. Future studies should include quantitative and qualitative evaluation of EBP implementation facilitators and obstacles. Findings in this study have provided initial information to better understand PCNPs and EBP.
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Cruz, Anna Maria, and Anna Maria Cruz. "Patient Satisfaction with Nurse Practitioner Care on Guam." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/623005.
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Patient satisfaction has been identified as an indicator of quality care. There is no research on patient satisfaction with Nurse Practitioner (NP) care on Guam. Therefore, a cross sectional descriptive study was conducted to assess patient satisfaction with NP care at three primary care clinics on Guam. A convenience sample of patients 18 years and older, seen by an NP were invited to participate in completing the Nurse Practitioner Satisfaction Survey (NPSS). Data collection concluded after a one-month period (N = 108). Descriptive statistics, between group differences, and correlational analyses were conducted. Participation in the survey was voluntary and anonymity, confidentiality, and privacy were ensured. General patient satisfaction was very high for NP care on Guam. "My NP is caring" was the highest scoring item on the NPSS with a mean score of 4.43 (n=56). Participants selected the NP as providing the health education and care the patient found most satisfying. A statistically significant weak negative correlation between patient satisfaction and age and level of injury was found. Singles reported significantly higher patient satisfaction scores than widowers. Study limitations included the small sample size, convenience sampling, social desirability and selection bias. Caring is an essential tenet of NP care and patient satisfaction. Improving NP role clarity is vital to the continued success and growth of the NP profession. The value that NPs bring to primary care is substantiated by the high patient satisfaction levels consistently produced from studies across the globe. In order for NPs to significantly impact the primary care provider shortage all 50 states and the US territories must enact full practice authority (FPA).
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Miller, Robin, and Robin Miller. "Creating a Postgraduate Advanced Practice Nurse Fellowship in Cardiovascular Medicine." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626687.
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The Affordable Care Act has changed the face of health care provision and services in this country, expanding access to more than 30 million people (Buerhaus et al., 2012). With increased coverage comes increased use of health care systems, in a system already saddled with a deficient number of providers (HIS Inc., 2016). The solution to this has been the inclusion of advanced practice nurses (APNs) into both primary and specialty care services. Within cardiovascular medicine, there has been a surge in the recruitment of APNs to care teams (Virani et al., 2015). With this increased need comes the recognition that generalist education and preparation does not prepare an APN to be a competent cardiovascular medicine provider. Advanced practice nurse training has long left specialization to the postgraduate orientation period (Kells, Dunn, Melchiono, & Burke, 2015), and the demands of the healthcare system outweigh the current training models. This has opened the door for the creation of postgraduate fellowship programs for APNs (Taylor, Boryhill, Burris, & Wilcox, 2017). This project focused on the evaluation of existing cardiovascular APN fellowships and proposed the creation of a postgraduate APN fellowship in cardiovascular medicine at Oregon Health and Science University (OHSU).
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Harris, Sharon Eileen Jellings. "Start-Up Private Practice Business Plan for Advance Practice Nurse Practitioner in Northeast Iowa." Thesis, Montana State University, 2005. http://etd.lib.montana.edu/etd/2005/harris/HarrisS1205.pdf.
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Business concepts and business development are not routinely a part of nursing education at the undergraduate or at the graduate level. Business plans are vital if a business is to have a chance to succeed. Many talents of the advanced nurse practitioner are transferable to the development of a business plan. Assessing, identifying problems (diagnosing), developing interventions, implementing solutions, and evaluating activities are equally important to the business plan and to the clinical practice of the nurse practitioner. This project addresses the problem of how nurse practitioners can use their talent to develop a business plan that is sound and can be implemented. The completed project identifies the components of a business plan in business terms and in health care terms. It includes discussions of the relevant components of a business plan that include: an executive summary, the vision and mission statement, a business strategy and strength, weakness, opportunities, and threat analysis (SWOT), an industry analysis, market strategy and plan, operational plan, and a financial plan that includes a projected cash flow for the development of a privately owned, entrepreneurial, family nurse practitioner practice. Included in this project is a specific business model for a practice in rural Northeast Iowa. The entrepreneur nurse practitioner will be able to use this business plan as a model to personalize a business plan, to seek funding, or to actually implement a private nursing practice. Throughout the completion of this project, it was realized that no one plan can solve every problem that may arise. A good plan can determine if a business practice is feasible, provide warning signs for when it is time to reexamine the idea of establishing a private practice and guide contingency plans for unpredicted events in the life of a business.
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Rees, Sharon. "The role of nurses in general practice: general practitioners' and practice nurses' perceptions." University of Southern Queensland, Faculty of Sciences, 2004. http://eprints.usq.edu.au/archive/00001489/.
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The role of nurses in general practice: General Practitioners' and Practice Nurses' perceptions is a study that identifies the beliefs of Practice Nurses (PNs) and General Practitioners (GPs) of the PN role and how those roles impact on the general practice. Ethnographic techniquess were used for this study, with data collected through interviews, observation and questionnaires. Interviews were conducted with four PNs and four GPs in practices that employed nurses in an increased role similar to that described in the Nursing in General Practice Fact Sheets (Royal College of Nursing Australia, 2002). Two practices were observed to identify work practices and the nurses' interaction within the practice. The main finding of the study was the importance placed on the general practice team. Both GPs and PNs believed that working as a team was vital. They indicated that working together provided holistic care and enabled the practice to provide quality care. The role of the PN in this study was consistent with other studies in Australia. However, the nurses in this study appeared to have more autonomy in regard to care of people with chronic illness and the aged. Continuing education was considered important for the further development of the PN role. However, participants believed that the PN also needed to have considerable and varied experience together with good people skills. To further develop the PN role innovative ways of providing education to PNs should be investigated to ensure nurses have the necessary skills to undertake their role. Payment issues in general practice should also be examined and addressed to ensure that PNs are able to be employed, and receive remuneration appropriate for their experience and job description.
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Mechling, Eileen. "Nurse practitioner clinic utilization by elderly women." Thesis, The University of Arizona, 1994. http://hdl.handle.net/10150/144648.
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The purpose of this study was to explore the utilization patterns of elderly women in a nurse managed clinic (NMC). A convenience sample of 20 women, 65 and older, attending an NMC completed an questionnaire and an interview. A pilot study guided the development of the questionnaire. Interrater reliability was performed to enhance the reliability of the pattern categories developed from the interviews. The findings of this research were that elderly women utilized this NMC for: physical assessment and monitoring; health care information; evaluating a physical need; referral; emotional support; socialization; convenience; cost; familiarity/comfort; health care need; and reliability. Satisfaction was the main component of the clients' perception of their visit to the NMC. Conclusions reached were that utilization of this NMC was based mainly on perceptions of health care needs and that cost, convenience, and familiarity influenced clients in choosing this clinic in addition to their primary care provider.
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Lucero, Samantha. "Defining the Scope of Practice for Nurse Practitioners in MIAM." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4074.
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Minimally invasive aesthetic medicine (MIAM) is a relatively new field, which lacks a clearly defined scope of practice. The purpose of this project was to clarify the scope of practice for nurse practitioners in MIAM in California. Without a clearly defined scope of practice, nurse practitioners are unable to practice to the full extent of their license which causes them to be underutilized and face liability issues. This project sought to answer the question: What is the scope of practice of the nurse practitioner in MIAM in the state of California? The model of professional nursing practice regulation was the model used to guide this project. Sources of evidence included case law that has emerged since 1983; reviewing documents from 3 state boards of nursing; and a survey of nurse practitioners who practice in the field of MIAM. The evidence was analyzed noting themes while determining what the legal backbone is for nurse practitioner's scope of practice in California. This project found that nurse practitioners in this field keep up to date in their knowledge, educate their patients, utilize methods to maintain competency, feel support in their environment, assess and refer to others when appropriate, and teach both staff and patients evidence-based practices. It also found that standardized procedures are the legal backbone to understanding the scope of practice in California. A scope of practice was developed based on the findings of this project which was then reviewed by an expert. It is recommended that nurse practitioners utilize their resources to obtain and maintain knowledge as well as learn what the standardized procedures are in their facility. The implications for clarifying the scope of practice will serve this population to fully utilize their capabilities and practice safely, as well as help to develop this relatively new field.
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Hummer, Kirk A. "Assessing the Lived Experience of the Family Nurse Practitioner in Urgent Care Practice." Otterbein University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1368536937.
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Seymour, Yetrevias. "Transitioning from Student to Nurse Practitioner Using the One-Minute-Preceptor Model." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6809.
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Nurse practitioners (NPs) are significant members of the health care team. Variation and lack of standardization in the practicum preparation of the NP has been identified as problematic. There is a need to improve NPs preparation to efficiently and independently impact health care. This project presented the 1-minute-preceptor (OMP) model as a standard tool in the practicum preparation of the NP through a preceptor-focused continuing education session. The aim of the OMP is to help ensure that students are exposed to the level of critical thinking and problem solving needed in the role of an independent, efficient NP. Knowles's adult learning theory and the educational design process model provided the theoretical framework and guided the development, implementation, and evaluation of the continuing education program. Participation in the continuing education program was voluntary. Pretests, posttests, and evaluations of the continuing education session were collected and analyzed. Ten preceptors participated in the educational session and evaluation. Based on pretest and posttest results, knowledge of the OMP model improved from 70% before the education program to 100% after the program. Participants also indicated interest in using a tool capable of ensuring an effective student-preceptor encounter, and 100% stated they would use the information presented in future preceptor–student interactions. Continuing education program evaluation results indicated participant satisfaction with the presentation. To positively impact social change, the findings of this project may be used by NPs and preceptors to effectively and efficiently impact patient outcomes early in practice.
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Carlsen, Stephanie Ann. "Identifying Practice Barriers to Use of Adult Gerontology-Acute Care Nurse Practitioners in the Northern Nevada Region." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/578410.
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The number of adult gerontology acute care nurse practitioners is increasing, as well as the number of patients requiring care in the northern Nevada region. The specialty training of adult gerontology nurse practitioners (AGACNPs) enables them to provide care for the increasing number of patients in the acute setting. Unfortunately, there are perceived barriers that inhibit the implementation of AGACNP into practice within this region. There is a need to understand the barriers to use of AGACNPs and provide feedback to organizational leaders throughout the region. Purpose and Objective: While many studies show the benefits of adding AGACNPs or nurse practitioners in general to an organization, there is a need for further literature on the evidence of the barriers to AGACNP use. This study attempts to identify those barriers, specifically looking into the northern Nevada region. Methods: A survey was sent out to 19 hospital and critical care group administrators in the northern Nevada region. There was an attempt made for phone interviews, if the survey was not completed during the allotted timeframe. The survey consisted of both quantitative and qualitative questions that were used to identify potential barriers influencing AGACNP role use. Results: Out of the 19 surveys sent out, six surveys were returned. A total of six surveys from six different organizations were completed for this study. Five of the six respondents do not currently have any AGACNPs within their organizations and the one that did use AGACNPs had less than 10. Four out of six respondents reported confusion on scope of practice as a current barrier to use within their organization. Conclusions: This survey helps AGACNPs understand the barriers to use within the northern Nevada region when looking for an acute care job. For the organizations in the northern Nevada region, there is a need for organizational education regarding the scope of practice of AGACNPs and how to utilize them within their organization, as well as create an effective collaborative practice model for their acute care organization.
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Lamb, Gerri S. "NURSE PRACTITIONER JUDGMENTS ABOUT INTERACTION AND PARTICIPATORY DECISION-MAKING IN PRIMARY CARE SETTINGS." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184244.
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The purpose of the study was to test a theoretical model explaining nurse practitioner judgments about the amount of interaction and participatory decision-making between nurse practitioners and physicians. The specific aims of the study included: (1) to examine the influence of nurse practitioner perceptions of care complexity and expected benefit-cost ratio of physician involvement on interaction and participatory decision-making; (2) to test a theory that integrates two alternative explanations of amount of interaction and participatory decision-making derived from social exchange theory and technology theory; and (3) to investigate the effect of practice rules on the relationships in the theoretical model. The study used a mathematical correlational design with a causal modeling methodology for model testing. A convenience sample of 38 nurse practitioners participated. Major concepts in the model were measured using a four scale magnitude estimation instrument developed for the study. The instrument consisted of operational definitions for each of the concepts and a set of 18 clinical situations scaled according to care complexity. Psychometric properties of the instrument including stability, internal consistency, content and construct validity were estimated. Matching of responses across two modalities was used to validate the production of ratio level data. Multiple regression techniques were used for theoretical model testing. In the test of the theoretical model, both care complexity and expected benefit-cost ratio had a significant impact on the nurse practitioners' judgments about amount of interaction and participatory decision-making. Predictions derived from social exchange theory and technology theory were supported. The effect of practice rules on the relationships in the model could not be determined since the index of practice rules did not achieve an acceptable level of stability. Nurse practitioner judgments about interaction and participatory decision-making were influenced by perceptions of care complexity and expectations of the benefits and costs of interaction with a specific physician. An understanding of the factors that affect nurse practitioner judgments about interaction and participatory decision-making may be used to guide interventions that enhance the fit between these structures and outcomes of care.
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Cyr, Julia Anne, and Julia Anne Cyr. "Evaluation of a Nurse Practitioner Led Program on Decreasing Emergency Room Visits." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626651.
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Background: The overuse of the emergency department (ED) for non- critical patients has been associated with overcrowding and a rise in healthcare cost. Green Valley Fire Department (GVFD) has created a program, Fire-Based Urgent Medicals Service (FBUMS) with a nurse practitioner (NP). Patients can call 9-1-1 or the ""NP hotline"" and request to be seen by the NP instead of being immediately transported to the hospital via ambulance.
Purpose: The purpose of this project is to evaluate the impact of the nurse practitioner led FBUMS, on ED visits and ambulance transports.
Methods: A survey was mailed to all persons, age 18 and older, who were seen by the NP with FBUMS between February 2017 and March 2017. The survey asked about the reasons for contacting GVFD, the type of treatment received, and whether they went to ED after treatment.
Data analysis: Descriptive statistics including frequencies, percentages, means and standard deviations were used to analyze each of the answered survey questions in Microsoft Excel©.
Results: Surveys completed (n=42). The majority, 39 (92.9%) stated they did not receive care at the ED within 72 hours following their appointment with the NP, three (7.1%) stated they did. By dramatically decreasing transport to the hospital and associated ED treatment, it is estimated to have saved approximately $53,425 in ambulance costs and $54,210 in ED treatment for a total savings of $99,632.52.
Conclusion: A Fire-Based Urgent Medical Service led by a nurse practitioner decreased emergency room visits and ambulance transports.
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Reid, Marcia Andrea. "Effect of a Cardiology Nurse Practitioner Service on the Reduction in Length of stay for Low Risk Chest Pain Patients." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/2374.
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Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed by the American Heart Association for the treatment of patients with low risk for chest pain was adopted by the NP service. The project was guided by both the Donabedian model of quality care and the Aday and Anderson theory of access to medical care. The project design proposal is a comparative study using retrospective data obtained from the medical records of LOS pre- and post-implementation of the project. Implications for social change include improvement in patient care on a national level, not only for patients with low risk for chest pain, but also for patients with other chronic diseases. Streamlining care will improve the financial standing of hospitals as well as provide care that is equal and equitable regardless of race or financial status. The findings of this project have strengthened the role of the APN globally as a social advocate for change, actively participating in designing and implementing programs to improve patients' outcomes.
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Rychlec, Gail L. "Nurse Practitioner Practice Satisfaction and Subsequent Career Decisions Related to Participation in a Mentoring Program." Thesis, Capella University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13428605.
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The purpose of this quantitative study was to assess the impact of mentorship on job satisfaction and intent to stay in the current position among NPs. The theoretical frameworks that provided context for this study were interpersonal relations theory and novice to expert theory. Using a convenience sample of NPs belonging to private LinkedIn and Facebook groups, data was collected through an online survey consisting of the Misener Nurse Practitioner Job Satisfaction Scale and demographic questions. An independent samples t-test was used to test the null hypothesis. The study findings indicated that there were significant differences in job satisfaction scores between the group that was mentored and the group that was not mentored. No significant difference was found in intent to stay between NPs that were and were not mentored. The findings suggest that NPs who are mentored have higher job satisfaction and provides evidence to organizations that employ nurse practitioners to consider the development and initiation of mentorship programs. Further interventional research is recommended to confirm the findings of this study.
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Stock, Nancy Jean. "A Transition-to-Practice Residency That Supports the Nurse Practitioner in a Critical Access Hospital." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/404.
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Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to guide the project include rural health theory, novice to expert, and from limbo to legitimacy frameworks. Global outcomes include increased quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of institutional and community stakeholders (n = 10) to develop primary products including the residency program, curriculum modules, and the secondary products necessary to implement and evaluate the project. Implementation will consist of a pilot followed by expansion throughout the rural health network. Evaluation will involve the CAH dashboard to monitor patient outcomes, Misener NP job satisfaction scale, and employee turnover rates. The project expands understanding of the on-boarding needs of rural NPs. The results of this project will serve as a guide to publish outcome data and collaborate with higher education to develop programs to award academic credit for paid clinical experiences leading to academic degrees.
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Riggs, Kelli J., and Kelli J. Riggs. "Assessing Arizona's Pediatric Nurse Practitioner's Attitudes, Knowledge, and Practice Behaviors for Adolescent Mental Health Screenings." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624530.
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Introduction: Adolescent Mental health is a growing topic of concern for pediatric nurse practitioners. Adolescents are known for risky behaviors that can lead to poor health habits, unintentional and intentional injuries. There are recommendations from the US Preventive Services Task Force (USPSTF), the American Academy of Pediatrics (AAP), and the National Prevention Council (NPC) to screen adolescents for mental health concerns including depression and suicide. There are established guidelines and evidenced based screening tools to assist practitioners in screening for at risk adolescents. Yet many practitioners are unaware of these screening tools or do not feel comfortable discussing these difficult topics with adolescent. Objective: The purpose of this study was to assess Arizona’s Pediatric Nurse Practitioners' attitude, knowledge, and practice behaviors towards adolescent mental health screenings. The Theory of Planned Behavior was used to address the relationship between the practitioner’s perceived predictive behaviors and actual behaviors. By assessing practitioners’ experience with adolescence mental health screening, barriers were identified for planned future implementation studies. Methods: From this DNP project, a survey was created and electronically distributed to members of the Arizona Chapter of NAPNAP. There were 23 participants who completed the survey. A Likert-scale was used to allow the participants to express their experiences and concerns. Results: The survey showed that most pediatric nurse practitioners strongly agreed about the importance of screening adolescent for mental health concerns such as depression and suicide. The survey also found that although the PNPs felt willing to discuss the topics, their lack of knowledge about the recommendations resulted in them not screening every adolescent every time. Conclusion: The survey showed that PNPs identified adolescent with mental health concerns including depression and suicide in their practice. The results of the survey showed the PNPs are willing to discuss these topics, but need more knowledge and training regarding screening tools. In addition, the survey identified the barriers in screening of adolescents' mental health which include financial reimbursement and time management. Future studies should focus on improving mental health education for pediatric practitioners and resources to assist them in screening their adolescent patients.
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Duncan, Cameron Gene. "The Full Practice Authority Initiative: Lessons Learned from Nevada." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/337306.
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Purpose: Identify specific legislative barriers to full practice authority (FPA) legislation and describe how they were overcome during the 2013 legislative session in Nevada. Background: Legislative restrictions in 31 states prevent nurse practitioners from practicing to the full extent of their education and training. FPA legislation is introduced, but not often signed into law. A comprehensive literature review revealed multiple barriers to autonomous practice: conflict between medical and nursing roles, lack of nurse practitioner role recognition, financial challenges, and a lack of business knowledge. Barriers caused by policy limitations were most frequently mentioned: limited scope of practice, limited prescriptive authority, limited clinical privileges, credentialing limitations and reduced reimbursement rates. Methods: This study employed a qualitative, multiple case study design. Semi-structured interviews were conducted with four actively-involved contributors to the 2013 FPA initiative in Nevada. Homogeneous questions were used, guided by the use of a predetermined set of questions based on Kotter’s (1995) Change Management Model. Each interview began with the question, "What prompted this movement and why was it introduced at this time?" Participants were asked to identify perceived barriers to FPA legislation, and how they were overcome. Recorded interviews were transcribed into text, which led to thematic analysis. Results: Repetition of shared perceptions revealed eleven barriers separated into six main themes. 1) Vision includes the barrier of lacking a clear and shared vision. 2) Physician Support includes the barrier of lacking the support of physicians and Organized Medicine. 3) Addressing Stakeholders includes the barriers of the inability to address stakeholders, lack of role recognition and community support, and social media. 4) Community Organization Support includes the barriers of having a Board of Nursing with a poor reputation, and a lack of support from the Board of Pharmacy. 5) Leading Coalition includes the barriers of lacking a strong, leading coalition lacking history of leadership and legislative experiences, and choosing a legislator without experience, authority, and respect in the legislature and the community. 6) Resources include the barrier of lacking necessary resources including time and preparation. Implications: The findings of this study may be useful for those living in one of the 31 states without FPA legislation. This is one of the first published studies to identify the importance of literature identifying legislative barriers to FPA, and starts to fill the current gap in the literature surrounding this topic. This information may be invaluable in the preparation and introduction of FPA legislation in other states. The findings may also act as a stepping-stone to addressing the provider shortage in the U.S., and may be instrumental in improving access to care. Further research is needed to identify whether similar barriers found in this study are prevalent in other states with FPA legislation for nurse practitioners.
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Lochner, Mary Beth. "Depression and Coronary Heart Disease: Improving Patient Outcomes in Outpatient Cardiology Practice." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/145105.
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Strong evidence has been found to link the diagnosis of CHD with depression, and patients with all CHD-related diagnoses and co-morbid depression display higher morbidity and mortality from CHD than those individuals without depression. Screening and treatment of depression by cardiology clinicians continues to be limited due to poor symptom recognition and lack of desire to treat perceived primary care conditions in specialty practice. The American Heart Association has designated timely assessment and treatment/referral of depression as primary goals for high-quality evidenced-based cardiology care to improve patient outcomes in CHD.This study employed a quasi-experimental descriptive pretest-posttest study design for the purposes of (1) understanding diagnostic and treatment practices for depression in the presence of CHD by nurse practitioner and physician cardiology providers (n=35) in a large metropolitan private outpatient cardiology practice and; (2) adaptation of a valid and reliable depression screening tool (Patient Health Questionnaire-9) to an existing electronic medical record system for use in the sample practice.Findings from the study showed that even though all providers (100%) believed that depression inhibited patients' ability to make positive CHD risk-reducing lifestyle changes, and the majority (73.7%) felt that depression contributed to the progression of CHD, no formal screening for depression was being performed. Less than half (42.1%) of providers in the sample treated depression in their clinic practice, and the large majority (89.5%) referred patients back to primary providers for all depression care.Since 2008 guidelines for depression care by cardiology providers were recommended by the American Heart Association (endorsed by the American Psychiatric Association), it is questionable if these recommendations are filtering down to outpatient cardiology practice. Provider education to improve confidence with depression screening and treatment, and provision of concise easy-to-use care templates in outpatient EMR systems may help to improve compliance with recommendations while maximizing patient outcomes for depressed CHD patients.Advanced practice nurses have been consistently instrumental in the development and management of performance-enhancing processes that improve care quality and patient outcomes. As nursing practice leaders, nurse practitioners should be progressive in supporting implementation of best-practice for depression care in outpatient cardiology practice settings.
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Harvey, Clare Lynette Eden, and clare harvey@flinders edu au. "Through the Looking Glass: The Politics of Advancing Nursing and the Discourses on Nurse Practitioners in Australia." Flinders University. School of Nursing and Midwifery, 2010. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20100708.110421.
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Nursing has a tradition of subservience and obedience. History provides an account of secular and religious orders of nursing shaping a view of virtuous and tireless dedication in carrying out the doctors orders. Nurse Practitioners were first introduced to the health care system in the 1960s as a solution to the medical shortage being experienced in United States of America at that time. They assumed clinical tasks, traditionally regarded as doctors work. Since then the Nurse Practitioner movement has expanded globally.
Australia introduced the Nurse Practitioner role in 1998, heralding a new era in the health system of that country. Its introduction has created diverging views which are influence role implementation. This study examines social and political discourses that are affecting the development of Nurse Practitioners in Australia, using text and language to identify discursive practices. It has set out to determine whether Nurse Practitioners have the autonomy that professional nursing leaders have described in policy, or whether the introduction of the role has merely shifted nursings sphere of influence within a traditional health care system.
Using Faircloughs notion of power behind discourse, the language and discourses of Nurse Practitioners were explored in relation to what was happening around role development and how Nurse Practitioners positioned themselves within the environment where they worked. The use of a Critical Discourse Analysis has allowed for the various social, historical and political perspectives of nursing to be examined. Faircloughs three levels of social organisation have been used to identify the divergent discourses between the truths of implementation of the role at individual and organisational level and comparing it to that of the rhetoric of health policy.
The discourses surrounding the creation of this advanced nursing role have been the focus of analysis. This analysis has revealed how role development is controlled by powerful groups external to the nursing profession. The dominant discourses use the traditional health care divisions of labour to maintain control through a financially driven focus on health care which does not necessarily revolve around clinical need. Further complicating the position of Nurse Practitioners is the internalisation of those dominant discourses by the nurses themselves. It reinforces Faircloughs view that the dominant power lies behind the discourse, using the system itself to maintain a status quo, rather than overtly opposing it.
Nurse Practitioners, despite being held out by the nursing profession as clinical leaders, are not able to influence change in health care or in their own roles. The results have further shown that nursing managers do not have an influence over the direction that health care and nursing takes. Further research is necessary to examine the broader leadership role of nursing within health care nationally and internationally, in order to establish the real position of nursing within the decision making framework of health care service development.
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Campbell, Kami S. "Enhancing Interest and Knowledge of How to Start a Nurse Practitioner-Led Clinic." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461151661.
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Shelby, Debra Michelle. "Knowledge, Attitudes, and Practice of Primary Care Nurse Practitioners Regarding Skin Cancer Assessmnets: Validity and Reliability of a New Instrument." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5124.
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Abstract
Background: Despite the rise in the occurrence of skin cancer, primary care nurse practitioners are reluctant to perform skin cancer assessments during patient visits. Melanoma is almost always curable if detected in the early stages, but invasive disease accounts for 9,000 deaths per year (American Cancer Society, 2013). Changing knowledge, attitudes and practice regarding skin cancer assessments potentially leads to early detection and treatment of skin cancers and impacts patient outcomes. However, in order to change knowledge and attitudes, we must first assess them. Purpose: The purpose of this research was to validate a new skin cancer assessment tool instrument called KAP-SCA to measure knowledge, attitude, and practice in primary care NPs. Methods: Sequential mixed methods were used. First, focus group interviews with 14 primary care nurse practitioners were conducted during Phase I. Interviews were audio-recorded then transcribed verbatim and imported into ATLAS.ti. Phase II involved instrument development from a blueprint and calculation of content validity indexes (CVI) for items and
subscales. Phase III of this study included testing the validity and reliability of a KAP instrument using quantitative methods. This new instrument assesses primary care nurse practitioner knowledge, attitudes, and practice regarding skin cancer assessment. Results: Content validity for the subscales was evaluated by CVI ranged from .90 to .95. The Cronbach's alpha was highest for the practice subscale (alpha =.89) while the lowest was seen with the knowledge subscales (alpha =.50). Construct validity assessed by exploratory factor analysis indicated the presence of three underlying factors, confidence in practice, confidence relating to education and NP role in practice. Implications for Practice: Interventions need to be developed based on the knowledge deficits and barriers to practice identified by these NPs including educational programs that focus on increasing primary care NPs' knowledge and confidence levels regarding skin cancer assessments and identification of malignant lesions. Conclusion: Beginning evidence of validity and reliability were found for the Knowledge, Attitudes and Practice-Skin Cancer Assessments (KAP-SCA), however further studies are warranted.
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Revely, Shirley. "Introducing the nurse practitioner into a group general medical practice : operational and theoretical perspectives on the role." Thesis, Lancaster University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310358.
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Vaflor, Amy Louise. "Advanced Practice Registered Nurses and Medical Executive Committee Membership: A Quality Improvement Proposal." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1616670175777308.
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Whalley, Diane. "Why do practitioners work in deprived areas? : identifying affinity factors for urban deprived general practice." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/why-do-practitioners-work-in-deprived-areas-identifying-affinity-factors-for-urban-deprived-general-practice(c746ea8e-4202-4d58-b099-1fc8c2ef91ad).html.
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Background: Inequity in general practice workforce distribution remains a significant issue despite the increasing numbers of general practitioners (GPs) in the UK. Problems with recruitment and retention in England are particularly evident in urban deprived areas. The aim of the current study was to explore affinity for working in urban deprived areas, focusing on practitioners’ background, values and care orientation. Methods: There were two stages to the research: 1) semi-structured qualitative interviews with 25 GPs and practice nurses to explore their background, values and care orientation in relation to location; 2) questionnaire survey with approximately 1200 GPs and practice nurses to determine the association between affinity factors and current location. The sample of practitioners was drawn from general practices located in the most and least deprived areas in the northwest region of England. Results: 25 qualitative interviews were conducted and the data analysed using a framework analysis approach. The analysis indicated that location preferences were formed early in practitioners’ careers. While an overt affinity for deprived areas was more likely among GPs, pragmatism could dominate location decisions for all. The narrative of practitioners in deprived areas suggested benevolent, universalistic and stimulation personal values, and a patient-centred care orientation. Satisfaction derived from making a difference, having a challenge, addressing social injustice, and having a sense of belonging. Coping strategies included: structure and organisation, support from colleagues, emotional detachment, reassessment of expectations, and distraction. The response rate to the postal questionnaire survey was 30.9% for GPs and 41.2% (practice level) for nurses. Although there were few differences in the personal values of practitioners working in deprived and affluent areas, there were more differences in specific work values. Stepwise logistic regression showed that for GPs, determinants of working in a deprived area included: having trained in a deprived area; not being influenced by the convenience of the location in choosing their current practice; and valuing control in decision-making. For nurses, determinants included: having worked in a deprived area before; not being influenced by quality of care in the practice when choosing their current practice; and not valuing being respected by practice colleagues. Subgroup analyses suggested different predictors for practitioners with different role status: GP principals were more likely to work in a deprived area if they valued providing care to those in greatest need of help, in addition to having trained in a deprived area. Discussion: The training location of GPs was a consistent factor in determining current location. This differs from the literature on location choice in rural and remote areas, for which childhood exposure is considered to be the dominant factor. Differences in personal values were reflected more clearly in specific work values. Future research should look at how GPs choose their training practice and how such experiences could be exploited to enhance recruitment to underserved urban areas. Strategies to aid retention could look to the coping strategies employed by practitioners to deal with the demands of working in a deprived area.
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McGaughy, Melinda Kay. "Innovative Access to Integrative Health Education for Advanced Practice Nurses: A Pilot Project." Otterbein University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=otbn149269683868965.
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Nye, Carla, Suzanne H. Campbell, Susan H. Hebert, Candice Short, and Marie Thomas. "Simulation in Advanced Practice Nursing Programs: A North American Study." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7354.
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Simulation is an effective pedagogy and is used extensively in prelicensure nursing education. Advanced practice nursing (APN) programs also use simulation as a component of their curriculum even though APN accreditation and certification organizations do not allow students to substitute simulation hours for the minimum 500 clinical hours. There is a lack of rigorous research studies supporting the benefits or describing the outcomes of using simulation in APN programs. This article presents the results of a descriptive survey on the use of simulation in APN programs in the United States and Canada. Data obtained from the survey provide a base for current simulation use, so do data on the use of the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice as an organizing framework for the implementation of simulations in APN programs. The results of the survey include courses in which simulation is used, modalities of simulation used, purposes for simulation use, and the number of hours of simulation. Data on barriers to simulation use and faculty educational needs are provided. Key findings include the following: 98% of respondents report using simulation in their APN programs, and 77% of respondents support the replacement of a percentage of clinical hours with simulation. The results from this study provide a base to build further rigorous research on how simulation can enhance the education of APN students, improve knowledge transfer, impact behaviors, and improve outcomes. In addition, the outcomes of this study may help educators develop training and support systems that can enhance the quality of APN simulations.
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Marshall, Ashley M. "Development of a Practice Guideline for DNP Prepared Nurse Practitoners Working in Long-Term Care Facilities." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2093.
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Clinical evidence-based practice guidelines providing recommendations for health care decision making have become vital components of long-term health care practice in the United States. Frequently changing guidelines have complicated nurse practitioners' (NPs) efforts to implement evidence-based practice into the daily care that they provide to patients. The purpose of this project was to develop an evidence-based practice guideline for doctoral-prepared NPs working in long-term care facilities. This project is important because practitioners use practice guidelines to provide patients with the most appropriate, evidence-based care. Kolcaba's comfort theory was used to guide this project. Kolcaba's theory holds that comfort exists in 3 forms: relief, ease, and transcendence. Comfort theory, with its emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will lead to a proactive, diverse, and multifaceted approach to providing patient care. A complete practice guideline was developed for doctoral-prepared NPs. For the review of the scholarly evidence, an electronic search that yielded 34 articles was completed. Twenty-six of these articles were excluded because the articles were more than 20 years old and/or focused on a specialty. Findings from the 8 articles were used to develop the practice guideline, which was reviewed by an advisory committee of 7 experts. The AGREE tool was used by the advisory committee to provide feedback on the quality of the practice guideline. Implementation of the practice guideline will take place in a facility in Indiana that currently uses 3 NPs. A doctoral-prepared NP will evaluate the practice guideline annually for patient trends including hospital readmission and infection rates.
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DiChiacchio, Toni. "An Evidence Based Web Intervention to Facilitate Nurse Practitioner Participation in the Policy Making Process Related to Scope of Practice." Thesis, West Virginia University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3618096.
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Historically nurses have been strongly engaged in the political process, however in recent decades the profession has moved away from the policy arena. Without political engagement, issues that are important to the nursing profession are not addressed timely, if at all. One such issue is that of full practice authority for advanced practice registered nurses (APRNs). Well over 100 studies have been completed over the past 40 years showing the safe and quality care APRNs provide independently. Numerous well-respected, non-nursing organizations support the removal of state laws that impede the ability of APRNs to practice to the full extent of their education and training, particularly in light of the looming extinction of primary care physicians and the simultaneous increase in demand for primary care services (American Association of Retired People, 2011; Federal Trade Commission, 2012; Institute of Medicine, 2010; National Governor's Association, 2012). The purpose of this capstone project was to provide a website in which APRNs and APRN students could communicate quality information to legislators in support of full practice for APRNs in West Virginia during a legislative session in which a full practice bill was introduced. Website visitors who were APRNs or APRN students were asked to complete a survey on the website comparing their communication with legislators last year to their communication or intended communication, after they had been introduced to the website, during the current session. Findings included a strong statistical association between use of the website and communication with legislators along with a statistical association between use of the website and conveyance of quality information supporting full practice authority. The findings suggest that websites related to specific nursing issues could be a method to increase political involvement of nurses.
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Leslie, Andrew. "Change at work : a study of outcome and practice innovation in advanced nurse practitioner-led transport of sick newborn infants." Thesis, Loughborough University, 2003. https://dspace.lboro.ac.uk/2134/33871.
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This study is concerned with the introduction of a new group, Advanced Neonatal Nurse Practitioners (ANNPs), into the practice of interhospital transfer of critically ill newborn Infants. These transfers have traditionally been performed by a team led by a doctor, but ANNPs may replace doctors in this setting. Diverse methodologies are brought to bear on two main questions. First: What impact do ANNP-led transfers have on outcome? Second: How can we understand the process whereby the change to ANNP-led transport was brought about?
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Salako, Abiodun. "The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/7025.
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Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature.
Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate)
I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts.
These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.
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Haynes, Angela. "Assessing Nurse Practitioners' Knowledge and Clinical Practice with Regard to the Oral-Systemic Link." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etd/3848.
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Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.
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Krogue, Paul Anthony, and Paul Anthony Krogue. "Barriers to Practice: Understanding Phsyician and Hospital Administrator Knowledge, Beliefs, and Attitudes of the Role and Scope of Practice of Acute Care Nurse Practitioners in the Acute Care Setting in Rural Montana." Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626676.
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Purpose: to describe the knowledge, beliefs, and attitudes of physicians and hospital administrators regarding the role and scope of practice of acute care nurse practitioners in rural Montana.
Background: Nurse practitioners have been increasingly called upon to provide high quality and cost-effective healthcare in variety of settings and have consistently shown to provide a high-level of patient care in both the primary and acute care settings. The acute care nurse practitioner specialty is relatively new, and with very few licensed acute care nurse practitioners in the state of Montana, the role and scope of practice is not well understood by physicians and hospital administrators who are often tasked with hiring and recruiting providers in the hospital setting. The Consensus Model, which served as the conceptual framework for this project, advocates that nurses provide care for the population that is specific to their licensure, accreditation, certification, and education.
Method: Some 28 physicians and hospital administrators completed a survey that included 21 Likert scale statements that were divided into the subscales of Knowledge, Belief, and Attitude.
Results included: 1) An existing gap in knowledge regarding the role and scope of practice of acute care nurse practitioners, 2) acute care nurse practitioners should always have some form of physician oversite, and 3) there is disparity in patient outcomes when patient care is provided by nurse practitioners.
Conclusion: Attitudes of survey respondents were overwhelmingly positive for the future of acute care nurse practitioners filling various provider roles in the hospital setting. These results can provide a foundation for future inquiry and can assist in the development of education and collaborative efforts to further advance the utilization of acute care nurse practitioners in Montana.
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Mayers, Patricia Margaret. "Nurses’ experiences of guideline implementation in primary health care settings." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/1437.
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Thesis (DPhil (Psychology))—University of Stellenbosch, 2010.ENGLISH ABSTRACT: This dissertation examines how nurses in primary health care in South Africa make use of guidelines. Primary level health care is reliant primarily on nurses, who are under-resourced and often overwhelmed by the complex needs of their clients in the context of the TB and HIV/AIDS epidemic. Despite various continuing education strategies to promote current and evidence-based practice, there are many barriers to providing optimal care. Clinical practice guidelines using best evidence are an important tool for updating health professionals in current practice, particularly at primary care level, where busy practitioners often do not have time or sufficient access to the best evidence. Despite this, we know little of the practitioners’ experiences of guideline use. This study describes experiences of nurses in implementing clinical practice guidelines in the delivery of health care in selected primary level contexts in the Free State Province. The primary research question for this study was “What are the experiences of nurses in using guidelines in primary health care facilities?” A qualitative research approach, drawing on a psychoanalytic framework, was adopted. Three linked studies were conducted, utilising secondary data analysis of transcripts collected during the PALSA (Practical approach to Lung Health in South Africa) RCT study (sub-study 1), document description and review of guidelines used in primary care settings (sub-study 2), observation of nurses in practice and during patient consultations, and focus group discussions with nurses in primary health care facilities (sub-study 3). After the introduction of new format guidelines with onsite training and access to good support and updates, nurses reported feeling more confident, as the guidelines were explicit and gave them clear direction as to when a patient would need referral to the medical practitioner. When the guidelines were followed, and the patient responded positively to an intervention, this gave nurses a sense of credibility and validated their role as primary level health care providers. Guidelines available in the primary care clinics covered a wide variety of clinical conditions, were inconsistent, often outdated and even contradictory. A detailed comparison of two selected guidelines, the South African TB control guidelines and the PALSA PLUS guidelines, both in everyday use in the Free State province, shows that the preferences expressed by the nurses in sub-study 1 are evident in the layout, colour, and user-friendliness of the PALSA PLUS guideline. Nurses in the Free State province do use guidelines, but not consistently. Nurses make clinical judgments and decisions based on experience, alternative knowledges and intuitive responses, in consultation with colleagues and through the use of guidelines. Very few guidelines were used regularly, and each nurse had her preferences for a limited number of guidelines which she found useful. There is a clear need for integrated approaches to the information needs and support of nurses and nurse practitioners at primary care level. Guidelines play a role in promoting learning, changing professional practice and strengthening health care delivery by nurse practitioners at primary level. They can also be thought of as a strategy the health care system uses to defend against the possibility of its health professionals not meeting its expectations of providing quality care. Guidelines may contain anxiety and improve the quality of care, or compromise practice through the imposition of controls. The use of guidelines in primary care settings facilitates decision making, may contain practitioner anxiety and improve the quality of care, yet guidelines pose challenges to creative discernment of the patient’s symptoms in relation to his/her personal circumstances and may impact on the personalised holistic care approach which characterises the essence of nursing. Today’s primary care nurse and nurse practitioner needs to be a competent clinician, compassionate carer, and confident co-ordinator – the overlapping roles of caring, diagnosing and treating and managing. The challenge for the nurse in primary care is to combine her traditional caring and co-ordination role into a role which encompasses curing, caring and co-ordination, a new, yet critically important identity for the 21st century nurse.
AFRIKAANSE OPSOMMING: Die proefskrif ondersoek hoe verpleegsters in primêre gesondheidsorg in Suid-Afrika van riglyne gebruik maak. Primêre vlak gesondheidsorg steun hoofsaaklik op verpleegsters, alhoewel hulle verswelg word deur die komplekse behoeftes van hul kliënte in die konteks van die TB en HIV/AIDS epidemie. Ten spyte van verskeie volgehoue onderrigstrategieë om die huidige en bewese basiese te bevorder, is daar verskeie struikelblokke om optimale versorging te voorsien. Kliniese praktyk riglyne voorsien die beste bewyse en is 'n belangrike hulpmiddel om praktiserende professionele gesondheidswerkers, veral op die vlak van primêre gesondheidsorg, op hoogte van sake te hou. Besige programme en onvoldoende toegang tot hierdie riglyne weerhou dikwels die gesondheidswerkers van bestaande inligting. Dit is egter onbekend wat gesondheidswerkers se ondervinding en gebruik van riglyne is. Die studie beskryf versorgers se ervaring van die implementering van kliniese praktyk riglyne vir gesondheidsorg in primêre vlak kontekste in die Vrystaatprovinsie. 'n Kwalitatiewe navorsingsbenadering wat steun op 'n psigoanalitiese raamwerk, is gebruik. Drie verbandhoudende studies is gedoen wat sekondêre data analise transkripsies gebruik het wat verkry is gedurende die PALSA (Practical Approach to Lung Health in South Africa): RCT (Willekeurig Gekontroleerde Toets) studie (sub-studie 1), beskrywing van dokumentasie en oorsig van riglyne wat in primêre vlak ontwikkeling gebruik is (sub-studie 2), en observasie van verpleegsters in die praktyk en gedurende konsultasies met pasiënte, en fokusgroep besprekings met verpleegsters in primêre vlak gesondheidsorg fasiliteite (sub-studie 3). Na die bekendstelling van 'n nuwe formaat riglyne vir indiensopleiding en toegang tot goeie ondersteuning, het die verpleegsters meer selfversekerd gevoel omdat die riglyne duideliker was en aan hulle 'n beter aanduiding gegee het wanneer 'n pasiënt verwysing na 'n mediese praktisyn benodig het. Wanneer die riglyne gevolg is en die pasiënt positief op behandeling gereageer het, het dit aan hulle 'n gevoel van agting en deug vir hulle rol in primêre vlak gesondheidsorg gegee het. Beskikbare riglyne in primêre sorg klinieke dek 'n wye verskeidenheid kliniese kondisies, is onsamehangend, dikwels verouderd en selfs soms weersprekend. 'n Gedetailleerde vergelyking is tussen twee geselekteerde riglyne gedoen: die Suid-Afrikaanse TB kontrole riglyne en die PALSA PLUS riglyne. Beide word daagliks in die Vrystaatprovinsie gebruik. Die verpleegsters in sub-studie 1 het a.g.v. die uitleg, kleur en gebruikersvriendelikheid die PALSA PLUS riglyne verkies. Verpleegsters in die Vrystaat gebruik wel riglyne maar nie op 'n gereelde grondslag nie. Hulle maak eerder kliniese keuses en besluite gebaseer op ondervinding, alternatiewe kennis en intuïtiewe gevoel, in konsultasie met kollegas en na bestudering van die riglyne. Baie min riglyne is gereeld gebruik, en elke verpleegster het haar voorkeure vir 'n beperkte aantal riglyne wat sy bruikbaar vind. Daar is 'n duidelike behoefte aan 'n geïntegreerde benadering tot die informasiebehoeftes en ondersteuning aan verpleegsters en praktisyns op primêre sorg vlak. Riglyne speel 'n belangrike rol in die bevordering van onderrig, verandering van professionele praktyke en die versterking van gesondheidsorg wat deur verpleegsters in primêre vlak gesondheidsorg gelewer kan word. Dit kan ook gesien word as 'n strategie wat die gesondheidsorgsisteem kan gebruik om te verseker dat gesondheidswerkers kwaliteit diens lewer. Riglyne kan moontlik angstigheid beperk en verhoogde versorgingskwaliteit bring, of dit kan gesondheidsorg benadeel deur die afdwing van kontrolemaatreëls. Die gebruik van riglyne in primêre sorg fasiliteer besluitneming, en mag dalk angstigheid by die praktisyn beperk, wat dan die kwaliteit van versorging kan verhoog. Riglyne bied uitdagings aan die kreatiewe oordeelsvermoë om die pasiënt se simptome te sien binne die konteks van sy/haar omstandighede en mag 'n impak hê op persoonlike holistiese versorging wat die aard en kern van verpleging is. Die huidige primêre sorg verplegingspraktisyn moet 'n bekwame klinikus, ontfermende versorger en betroubare koördineerder wees – met oorvleuelende rolle van versorging, diagnosering en behandeling, en bestuur. Die uitdaging vir die verpleegster in primêre sorg is om die tradisionele versorging en koördinering te kombineer tot 'n omvattende rol van genesing, versorging en koördinasie; 'n nuwe, maar krities-belangrike identiteit vir die 21ste-eeuse versorger.
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Doodhnath, Manesh M. "Experiences of advanced psychiatric nurses on their practice in an Occupational Specific Dispensation hospital setting." University of the Western Cape, 2013. http://hdl.handle.net/11394/4075.
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>Magister Scientiae - MScIn South Africa, the Occupational Specific Dispensation (OSD) for professional nurses provides a structure for training and career progression in the Public Health Sector. It necessitates the urgency for professional nurses who are working in specialty units at hospitals, to study further in advanced post-graduate nursing sciences programmes, e.g. advanced psychiatric nursing. Professional nurses were not informed about the implications of the OSD for practice, prior to implementation. It was unclear how advanced psychiatric nurses were experiencing their practice in an OSD hospital setting. In this study, the experiences of advanced psychiatric nurses who were practising at an OSD psychiatric public hospital led to the description of guidelines for supporting these nurses during their practice in an OSD ward. A qualitative, exploratory, descriptive and contextual design was followed. The study population consisted of advanced psychiatric nurses (N = 50). Purposive sampling was conducted until data saturation was reached. Eight participants were included in the sample. In-depth unstructured individual interviews were conducted with each of these participants. Field notes were kept and voice recordings of all interview sessions were captured. The researcher conducted a pilot study with one participant in order to detect possible flaws that could occur during the data collection process. The data analysis where themes were identified was based on Tesch‟s method of qualitative analysis. A literature control supported the findings of this study. Subsequently, guidelines were described from the findings according to the method of Muller (2001:204-205). Trustworthiness was maintained by using the criteria of Guba‟s model; that is credibility, transferability, confirmability, and dependability. The ethical principles of the right to self-determination, withdrawal from the research study, privacy, autonomy and confidentiality, fair treatment, protection from discomfort and harm, and obtaining informed written consent was adhered to. Four themes emerged from the data that indicated: the under-utilisation of the full scope of advanced nursing skills, role conflict and overload, organisational structural barriers that delayed the implementation and practice of advanced nursing skills, and failure to conceptualise / clarify advanced nursing role that resulted in unrealistic and / or unmet expectations.
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Deehan, Anna Marie. "The changing role of primary care with problem drinkers : an exploration of the interface between the general practitioner and the practice nurse." Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322042.
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Alhaj, Ali Abeer A. Ph D. "The Impact of High Fidelity Simulation Debriefing Modalities on Cardiac Emergency Knowledge & Leadership Skills among Acute Care Nurse Practitioner Students." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522164911599868.
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Smith, Susan Lee. "Lived Experience of the Advanced Practice Provider on the Burn Surgery Service." Diss., NSUWorks, 2017. https://nsuworks.nova.edu/hpd_hs_stuetd/7.
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The purpose of this qualitative dissertation study was to examine the lived experience and meaning making of challenges, benefits, satisfaction, and professional sustainability for the advanced practice provider in the burn surgery specialty service. The problem addressed was the knowledge gap resulting from a lack of literature describing aspects of the advanced practice provider role in the burn specialty. An interpretive phenomenological analysis, informed by the philosophy of Dr. Martin Heidegger, was undertaken. Participants were solicited from the American Burn Association Advanced Practice Provider (APP) special interest group site. The results provided a thick description of the lived experience of the Burn APP offering, illuminating commonalities and distinctions to promote role gratification and fulfillment leading to professional success and prolonged engagement. Keywords: advanced practice provider, nurse practitioner, physician assistant, interpretive phenomenology, hermeneutics.
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Roberts, Amy. "Faculty Practice Among Commission of Collegiate Nursing Education Accredited Nursing Schools." Thesis, University of North Texas, 2002. https://digital.library.unt.edu/ark:/67531/metadc3317/.
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This descriptive survey study investigated the value of faculty practice among Commission of Collegiate Nurse Education (CCNE) Accredited Nursing Schools. The sample included all CCNE accredited schools that offered a Masters degree. Subjects from the 66 schools in the sample the dean and three Nurse Practitioner faculty who are teaching a clinical course. Response rate was 51% for the deans and 35% for the faculty. The opinions of deans were compared to the opinions of faculty on the views of faculty practice as research and the incorporation of faculty practice in the tenure and merit review system. The results showed faculty and deans differed on the value of faculty practice as research. However, only 6.5 % of statistically significance difference was contributable to whether the response was from a dean of a faculty. There was no significant difference to the inclusion of faculty practice in the tenure and merit review system.
Boyer's expanded definition of research was used as a theoretical background. Deans viewed faculty practice more important as compared to the traditional faculty expectation of research than faculty did. The operational definition of faculty practice was that it required scholarly outcomes from the practice. Deans were more willing than faculty to acknowledge there were scholarly measurable outcomes to evaluate faculty practice than faculty were. The greatest difference in opinion of outcomes was the deans were more willing to accept clinically focused articles as an outcome than faculty were.
Faculty were asked how the money from faculty practice was distributed. Faculty overwhelmingly reported that money generated from faculty practice most often goes to the individual faculty member. Suggested areas for future research involve investigation of the role of tenure committees in tenure decisions relating to research and faculty practice.
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Edwards, Joellen B., Jim L. Wilson, Bruce A. Behringer, Patricia L. Smith, Kaethe P. Ferguson, Reid Blackwelder, Joseph A. Florence, Bruce Bennard, and Fred Tudiver. "Practice Locations of Graduates of Family Physician Residency and Nurse Practitioner Programs: Considerations Within the Context of Institutional Culture and Curricular Innovation Through Titles VII and VIII." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etsu-works/6908.
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Background: Studies have described the aggregate results of federal funding for health professions education at the national level, but analysis of the long‐term impact of institutional participation in these programs has been limited. Purpose: To describe and assess federally supported curricular innovations at East Tennessee State University designed to promote family medicine and nurse practitioner graduate interest in rural and underserved populations. Methods: Descriptive analysis of a survey to determine practice locations of nurse practitioner graduates (1992‐2002) and graduates of 3 family medicine residencies (1978‐2002). Graduates’ (N = 656) practice locations were documented using specific federal designations relating to health professions shortages and rurality. Results: Overall, 83% of family medicine residency and 80% of nurse practitioner graduates selected practice locations in areas with medically underserved or health professions shortage designations; 48% of family physicians and 38% of nurse practitioners were in rural areas. Conclusions: Graduates who study in an educational setting with a mission‐driven commitment to rural and community health and who participate in curricular activities designed to increase their experience with rural and underserved populations choose, in high numbers, to care for these populations in their professional practice.
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Li, Miaozhen. "Using an APN-Led Transitional Care Program to Reduce 30-Day Hospital Readmissions." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4005.
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Heart failure (HF) is a serious public health problem associated with high mortality rates, hospital readmissions, and health care costs. Transitional care has emerged as a disease management model used to reduce readmissions for hospital-discharged patients with HF. However, the efficacy of an advanced practice nurse (APN)-led transitional care program (TCP) in readmission reduction is under debate. The practice question for this project examined the extent to which an APN-led TCP was effective in reducing 30-day all-cause readmissions for hospital-discharged HF patients. The logic model was the framework guiding this program evaluation. An analysis of quality improvement HF data from September 2015 to August 2016 was reviewed for one hospital in southern California. The APN-led TCP included 47 patients and had 7 patients with 30-day readmissions. The physicians' group included 298 patients and had 53 patients with 30-day readmissions. The results of chi-square analysis revealed a nonsignificant association between 30-day readmissions and post-discharge care providers [Ï? 2 (1, N = 345) = 0.236, p = 0.627], and the HF 30-day readmission rates were the same between two groups. The APN-led TCP served a large proportion of Medi-Cal patients (48.94%) who had less primary care access, while the majority of patients in the physicians' group were Medicare (51%) who had primary care providers. This project highlights the positive social changes that advanced practice nurses affect via their critical leadership and clinical roles in increasing care access for the low-income population. Further studies on payer sources and readmissions are recommended on the efficacy of APN-led TCP in readmission reduction.
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Abney, Laura Ann. "Obstetrical Screening Practices of Nurse-Midwives and Nurse Practitioners." UNF Digital Commons, 2009. http://digitalcommons.unf.edu/etd/243.
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With the continued growth in the numbers of nurse practitioners and certified nurse-midwives, more and more women will receive prenatal care from advanced practice nurses. The purpose of this research was to assess the routine screening practices of advance practice nurses providing prenatal care and to compare those practices with current guidelines. The study focused on five areas of prenatal screening: bacterial vaginosis, group B streptococcus, gestational diabetes, maternal serum markers, and fetal movement monitoring. The interaction model of client health behavior by Cheryl Cox, specifically professional-technical competencies, part of the client-professional element of the model, provided the theoretical framework for this study.
The sample was obtained :from two major nursing organizations involved in prenatal care: the National Association of Nurse Practitioners in Women's Health and the American College of Nurse-Midwives. A random sample of250 members from each organization was sent a postcard explaining the study and directing them to the online survey.
In four out of five screening areas, there was no significant difference in the screening practices of NPs and CNMs. Bacterial vaginosis was the only screening with a significant difference. There was inconsistency with what the advanced practice nurses state they do and current guidelines with respect to screening for group B streptococcus and maternal serum markers.
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Bell, Janet Deanne. "Articulating the nature of clinical nurse specialist practice." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/d1018623.
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Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.