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Rowand, Leanne Christine. "Primary Care Nurse Practitioners and Organizational Culture." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4169.
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Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and Resources and NP-Physician Relations were comparable (M = 3.00, SD = 0.86; M = 2.98; SD = 0.73). NPs scored lowest on Professional Visibility (M = 2.74, SD = 0.76) and NP-Administration Relations (M = 2.63, SD = 0.79). Recommendations included optimization of NPs as advance practice nurses, establishing adequate administrative and clinical support, provision for interprofessional team development and function, distribution of standardized information about the NP role across and within institutions, and further exploration of NPs' experiences related to work hours and agency culture. Positive social change was supported as the NP practice model was extended throughout the current health care system, contributing to the shifting health care narrative/culture (from illness-focused care to wellness-focused care), and demonstrating full appreciation of patient/client-centeredness.
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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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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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McDonald, Jacqueline. "Managing Diabetic A1C at a Primary Care Center: A Nurse Practitioner Perspective." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/53.
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Background: At a primary care center in Brooklyn, New York, approximately 27% of diabetic patients with abnormal Hgb A1C fail to return for follow-up appointments, as recommended by the Centers for Disease Control and Prevention (CDC). According to electronic medical records (EMR), healthcare providers demonstrated inconsistency in ordering and monitoring Hgb A1C and clinic follow-up appointments for patients.
Purpose: The purpose of this quality improvement project was to determine retrospectively the healthcare providers’ ordering, monitoring, and follow-up appointments for adult diabetic patients with abnormal Hgb A1Cs; to develop and implement astandardized process for healthcare providers to monitor and follow these patients, especially those with possible nonclinic follow-up compliance and abnormal Hgb A1C; to determine prospectively healthcare providers’ ordering, monitoring, and follow-up appointments; and to evaluate the prospective charts to determine if Hgb AIC results changed from abnormal to normal or elevation over time until the next follow-up appointment.
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Nuttall, Craig, and Craig Nuttall. "Development of an Education Module on Concussions in Youth for Primary Care Nurse Practitioners in Utah." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/622925.
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Background: Sports-related concussions (SRC) are very common in youth in the US and represent a major clinical challenge. Clinical Practice Guidelines (CPG) have been developed to help guide the health care provider (HCP) in the diagnosis and management of SRC. Seventy-three percent of HCPs report that they deviate from current concussion CPGs in their clinical practices. The Protection of Athletes with Head Injuries Law in Utah requires HCPs caring for youth with concussions receive continuing education (CE) regarding SRC every three years. Currently, there are no CE modules on SRC developed for nurse practitioners (NPs) in the state of Utah. Project Purpose: The purpose of this DNP project was to develop and pilot an evidence-based educational module for primary care NPs in Utah on the evaluation and management of SRC in children and adolescents under the age of 18 years old. Methods: The education module integrates the concussion education curriculum developed by Pamela Mapstone DNP, PCNP. The module incorporates current CPGs and an extensive literature search. Following development of the module three clinical experts in SRC independently reviewed the module. Modifications were made accordingly and a pilot study evaluating the quality and usability of the education module was conducted. Sixteen NPs working in Utah were invited to complete the module followed by a short survey related to user satisfaction. The final version of the education module was modified based on the results of the pilot study. Results: An education module on SRC in youth for NPs working in primary care in Utah was successfully developed and piloted for quality and usability. The results of the pilot study support the content addressing the learning objectives; and that the module was easy to use. Conclusion: The education module tailored to the needs of NPs working in primary care in Utah has the potential to improve NPs’ knowledge of SRC in youth. Further study is recommended to evaluate the effects of the education module on clinical practice outcomes.
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Martin-Misener, Ruth. "A case study on the nature of primary health care nurse practitioner work." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0021/MQ57241.pdf.
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Anderson, Helen. "Professional identity and the advanced nurse practitioner in primary care : a qualitative study." Thesis, University of York, 2017. http://etheses.whiterose.ac.uk/17287/.
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Background: Health professional roles are being adapted in response to increased demand and declining medical workforces, both in England and internationally. This is exemplified by advanced nurse practitioners (ANP) in primary care. However, evidence suggests ANP practice may lack acceptability and understanding, leading to underutilisation. Professional identity (how colleagues are perceived by themselves and others) may influence how professionals work together to utilise such roles. Previous research has explored ANP professional identity during transition and in isolation from workplace cultures. Less is known about relationships between professional identity and established ANP practice within primary healthcare teams, or how ANP practice is affected by workplace cultures. Wider societal level influences have not been fully explored. This study aimed to explore the relationship between professional identity and ANP practice in a context where ANP practice was established. Methods: The study consisted of a qualitative cross-sectional study which explored professional identity of ANPs on a sample of general practice websites. Then the relationship between professional identity and ANP practice was explored, in-depth, in an ethnographic study of two general practices in England. Findings: ANPs lacked visibility on general practice websites. Both studies found ANPs were framed within a traditional nursing identity. This impacted on ANP practice and has implications for how professionals and the wider public understand ANP roles. Individual characteristics and interactional relationships were central to acceptance and utilisation of ANPs within the workplace, but were limited by broader societal level understanding of professional identities. ANPs negotiated their place within the workforce by utilising established understanding of professional identity. Intra-professional tensions were identified between ANPs and nursing. Conclusions: Professional identity is a useful framework within which to develop contextual understanding of ANP practice. Primary healthcare team members utilised shared understanding of professional identity to shape ANP roles, which both supported and inhibited ANP utilisation.
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Offredy, Maxine. "Decision making by nurse practitioners in primary care." Thesis, University of Hertfordshire, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.394140.
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Krook, Maura. "Advanced nurse practitioners in emergency and primary care settings." Thesis, Sophiahemmet Högskola, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1395.
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Rys, Gregory Paul. "Nurse Practitioner Residency Programs: An Educational Journey." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2056.
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Primary care is in a state of crisis due to the lack of clinicians and increasing numbers of insured patients. Encouraging more students to go directly through school for their doctor of nursing practice degree and nurse practitioner (NP) certifications is one proposal to alleviate this crisis. However, this approach would deliver graduates with minimal leadership and clinical experiences directly into practice. One resolution to mitigate this concern would be an NP residency program. Evaluating the knowledge and attitudes of stakeholders prior to the implementation of a NP residency program is an important first step to this implementation plan. The purpose of this project was to assess the knowledge and attitudes about NP residency programs of 2 stake holders: administrators and NPs at a rural upstate New York health care system, Bassett Healthcare, and to compare responses of those fiscally with those clinically oriented. Using literature less than 6 years old about NP residencies, a 28-question survey tool was created to assess knowledge and attitudes of NP residency programs. Content validity was established by 6 hand-selected NPs and administrators who had expert knowledge of residency programs. Once validity was established, the tool was distributed to a convenience sample of NPs and administrators at Bassett Healthcare Network via e-mail. The sample included 20 administrators and 44 NPs. A Mann-Whitney U test revealed no statistical differences between the 2 groups on any item. However, a majority of both groups felt the programs should be mandatory for all NPs. This project may be the first step in formation of a NP residency program that could alleviate transitional stress, decrease turnover, and produce better clinically-prepared NPs, thus benefitting the profession and society.
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O'Rourke, Tammy. "Stakeholder Participation in Primary Care System Change: A Case Study Examination of the Introduction of the First Nurse Practitioner-Led Clinic in Ontario." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24277.
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Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario.
Design: Qualitative case study guided by the principles of stakeholder and system change theory.
Setting: Northern Community in Ontario, Canada.
Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders.
Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results.
Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision.
Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.
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Barratt, Julian. "A case study of the nurse practitioner consultation in primary care : communication processes and social interactions." Thesis, London South Bank University, 2016. http://researchopen.lsbu.ac.uk/476/.
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Background: Nurse practitioners are increasingly conducting consultations with patients on the same basis as medical doctors. However little is known about communication within nurse practitioner consultations. Research on communication in nurse practitioner consultations has identified nurse practitioners communicate with patients in a hybrid style, combining biomedical information with the discussion of subjective information from everyday life. Research has not fully explained why this hybrid style occurs in nurse practitioner consultations, nor determined its links to consultation duration, patient expectations, satisfaction, and enablement. This study was developed to address these gaps in research of communication in nurse practitioner consultations. Aim: This study aims to advance understanding of the discrete nature of the communication processes and social interactions occurring in the nurse practitioner consultation, including explicating the reasons for the occurrence of the particular communication processes and interaction styles observed in those consultations. Methods: The study was conducted in a nurse-led primary care clinic providing general practice care. Within a case study research approach mixed methods were utilised, combining structured analysis of video recorded observations of nurse practitioner consultations, questionnaire-based measures of patient expectations, satisfaction, and enablement, and interviews with some of the participants of the consultations. The sample for video recording comprised three nurse practitioners employed at the clinic, and 30 patients registered at the clinic. Questionnaire responses were provided by 71 patients, including 26 whose consultations had been video recorded. All three nurse practitioners participated in post-consultation individual interviews, and 11 patient / carers participated in post-consultation individual interviews. The video recorded consultations were analysed with the Roter Interaction Analysis System (RIAS), a method of quantified interactions frequency analysis. The questionnaire responses were analysed with descriptive statistics. Transcripts of the interviews were analysed using computerised qualitative data analysis with NVivo. Findings: A significant majority of observed social interaction in the consultations used patient-centred communication styles (p=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse ii practitioners guided the sequence of consultation interaction phases, but patients and carers participated through asking questions and involvement in negotiations for care planning. Patient / carers were highly satisfied with their consultations, and significantly higher general satisfaction was noted when participants expected the nurse practitioners to be able to diagnose their presenting problem (p=0.043). Patient / carers expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (p=0.003). The mean consultation time length of 10.97 minutes is comparable with studies of general practitioners. The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes; Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style issues; Nurse practitioner role ambiguity; Creating the impression of time; and Expectations for safety netting. Contribution to knowledge: This study reveals nurse practitioner consultations comprise collaborative openness to peoples’ agendas and questions, expressions of everyday lifeworld experiences, expanded impressions of time, clear explanations augmented by integrated clinical reasoning, and participatory negotiations. These communicative features arise from a combination of social, ideological, and epistemological factors, prompting nurse practitioners to privilege how they interact with patients and carers, and to adopt a hybrid patient-centred style combining the nursing ideology of holism and their knowledge of biomedicine. This form of communication has been characterised as a stylistic exemplar for good consultation communication practice, which potentially facilitates shared decision-making. This research has resulted in new knowledge of the communication processes and social interactions used in nurse practitioner consultations, which demonstrates the importance of clinicians giving precedence to how they communicate and interact with patients so as to optimise their therapeutic outcomes without compromising the duration of consultations.
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Czapiewski, Dustin Joel. "Enhancing the Orientation Process for Nurse Practitioners Entering Primary Care." Diss., North Dakota State University, 2017. http://hdl.handle.net/10365/25934.
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Novice nurse practitioners (NNPs) face many challenges when transitioning to practice, which include, but are not limited to, time management, interprofessional relationships, role ambiguity, transition shock, inconsistent onboarding, and lack of mentorship. The process of transitioning from an experienced registered nurse (RN) to a NNP creates role ambiguity, self-doubt, and feelings of inadequacy (Yeager, 2010). A structured orientation fosters a smoother transition, increases role satisfaction and confidence. When healthcare organizations are able to anticipate and minimize barriers, they increase the likelihood that NNPs experience a seamless and successful transition. The orientation process provides a roadmap for NNPs to navigate role acquisition, develop interprofessional relationships, and enhance job satisfaction. A well-planned and structured orientation should meet the needs of NNPs with and without familiarity with the organization?s operations. Feedback obtained from NPs about the inconsistencies and deficits in NP and PA provider orientation at the health care organization prompted evaluation, revision, and re-structure of the orientation process. The purpose of this project was to evaluate the orientation process at a healthcare institution. Using a plan-do-study-act (PDSA) model the orientation process was evaluated, barriers identified, and recommendations made to the organization. Two cohorts of NNPs were interviewed. Cohort 1 worked at the healthcare organization for 12-18 months, while Cohort 2 worked at the healthcare organization for 1-5 months. Both cohorts had the same general orientation; however, Cohort 2 had a more structured clinical orientation. Through the interviews, major themes emerged, and then categorized into the following: general-provider orientation, clinical orientation, clinical competencies, and electronic medical record (EMR). NNPs requested a more structured orientation process, wanted a designated preceptor or mentor, needed guidance on skill validation, and preferred individualized EMR education. Limitations include a small sample size, an inconsistent interview process, and variable orientation processes in the cohorts. There is a need for further research to identify best practices to improve and nurture the transition of the NNP to an expert nurse practitioner (NP). Outcome studies are needed that focus on how NNPs successful transition effects quality of patient care.
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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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Thal, Wendy Renee. "Use of Standards of Care by Nurse Practitioners in Providing Care to Adolescents with Asthma at an Academic Nurse-Managed Primary Care Clinic." Diss., The University of Arizona, 2010. http://hdl.handle.net/10150/194947.
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Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.
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Housden, Laura Michelle. "Examining the impact of nurse practitioner-led group medical visits for patients with chronic conditions in primary care." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/60176.
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The aging Canadian population, increasing incidence of chronic conditions, and rising healthcare costs have contributed to concerns that the current healthcare system may not meet healthcare needs. Canada has sought innovative ways to meet patients’ healthcare needs through reforms such as group medical visits (GMVs) and care by nurse practitioners (NPs). While studies have shown that care with NPs and GMVs is effective, there is limited evidence examining how NPs engage in innovative care delivery. The purpose of this study was to examine the impact of NP-led GMVs for patients with chronic conditions in primary care. This study used multiple methods, including a systematic review and meta- analysis and a multisite case study (N=3). The systematic review and meta-analysis included studies published between 1947 and 2012 for patients with type 1 or 2 diabetes who attended GMVs. Of the 94 studies identified, 13 met final inclusion criteria. Group medical visits had a positive effect on clinical and patient-reported outcomes, with significant reductions in glycated hemoglobin (HbA1c reduction −0.46%, 95% confidence interval −0.80% to −0.31%).
The case study consisted of two cases where NPs were using GMVs and one where NPs were not using GMVs. Open-ended interviews with patients (N=12), providers (N=14) and 10 hours of direct observation were completed. Analysis of the data suggests that GMVs facilitated an environment that was patient centered, interprofessional and increased patients’ confidence managing chronic conditions. Furthermore, the processes of care within the GMVs disrupted power differentials in primary care, between patients and providers and amongst healthcare providers.
Yet, these same power differentials constrained NPs’ ability to adopt GMVs, with NPs indicating that they had limited agency to diffuse healthcare innovations. Unique contributions of this study were a systematic review and meta-analysis of GMVs among those with diabetes and new knowledge on how power differentials influence the diffusion of innovations in primary care. These findings demonstrate that GMVs provide opportunities to meet clinical, team-based, and patient-centered healthcare objectives. Ongoing research that considers the context of practice environments, power differentials, and conditions that limit NPs ability to diffuse healthcare innovative is needed.Applied Science, Faculty of
Nursing, School of
Graduate
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Bort, Nicole L. "Strengthening Dermatology Education for Nurse Practitioners." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1613586476133546.
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McLaughlin, Sarah J. "Nurse Practitioners' Discussion Of Sexual Identity, Attraction And Behavior." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/443.
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ABSTRACT
Background: Sexual orientation is comprised of distinct components, including sexual identity, sexual attraction and sexual behavior. Lesbian, gay and bisexual adolescents are at an increased risk of experiencing poor health outcomes compared to non-sexual minority youth. Health care professional organizations recommend that health care providers discuss each component of sexual orientation at every adolescent health supervision visits in order to best assess the adolescent's health risks and needs for intervention and education.
Objective: This survey assessed the frequency with which nurse practitioners (NPs) in the state of Vermont discussed sexual identity, attraction and behavior with adolescents during annual health supervision visits.
Design: A cross sectional study that analyzed descriptive statistics of a small convenience sample of Vermont NPs.
Setting and Participants: Attendees of the Vermont Nurse Practitioner Association 2015 annual conference. Participants in the study were licensed, practicing NPs in the state of Vermont responsible for the health supervision of adolescents.
Results: Participants were overwhelmingly female (93%), with a median age between 40-49 years old, and a median length of years in practice of six to ten years. Sixty-two percent of respondents specialized in family practice. Respondents reported that they always asked adolescents about the sex of sexual partners at 49% of health supervision visits. Respondents always discussed sexual attraction and sexual identity at 31% and 24% of health supervision visits, respectively. Twenty percent of respondents reported rarely or never discussing sexual attraction, and 38% reported rarely or never discussing sexual identity.
Conclusions: The Vermont NPs who participated in this survey were demographically similar to national NP cohorts. Vermont NPs discussed the adolescent's sexual behavior at health supervision visits as frequently as health care providers nationally, and Vermont NPs discussed sexual attraction and sexual identity more frequently than providers nationally. However, Vermont NPs discussed sexual attraction and identity much less frequently than they discussed sexual behavior. Results of this survey illustrate that there is substantial room for improvement regarding the frequency with which Vermont NPs discuss the three components of sexual orientation with adolescents, particularly the components of sexual identity and attraction.
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Barnes, Ellen Sue M. "Perceived Importance of the Characteristics and Functions of the Advanced Nurse Practitioner." Thesis, North Texas State University, 1987. https://digital.library.unt.edu/ark:/67531/metadc330779/.
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The purpose of this study was two-fold: to identify role functions and characteristics perceived as important to Advanced Nurse Practitioners (ANPs) in Texas, and to identify differences in perceived importance of role functions and characteristics of ANPs according to gender, educational preparation, practice setting, and whether the practitioner entered practice before or after the current rules and regulations for ANP practice were adopted. Two questionnaires and a demographic data form were mailed to 300 ANPs in primary health care in Texas, with 152 responding. Data from the questionnaire, "Characteristics of the Advanced Nurse Practitioner," were analyzed using independent group t-tests. The findings indicated that the characteristics "person-oriented," "perceptive," and "skilled in problem-solving" were the most valued by the practitioners, while aggressive" was the least valued. Independent group t-tests were used to analyze data from the instrument, "Advanced Nurse Practitioner Functions." The results of this analysis were not significant. The Chi square test was used to further examine data from this questionnaire to determine if the responses differed from chance. With the exception of four items, all of the responses differed significantly from chance. The responses "extremely important or important" were selected significantly more frequently that any of the other options. Not appropriate," was selected significantly more often than could be expected by chance for two functions: suturing minor lacerations and performing incision and drainage of wounds. Fourteen functions were examined further using frequency, percentage of responses, and the Chi square test to determine if there were differences in responses between groups. There were significant differences in responses between ANPs in nurse-managed settings and those in physician-managed settings on four functions: ordering diagnostic tests, prescribing medications in consultation with a physician, suturing minor lacerations, and performing incision and drainage of wounds. Practice setting and educational preparation were the variables which had the greatest impact on perceived importance of the characteristics and functions to ANP practice.
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Reimann, Morgan, and Morgan Reimann. "Celiac Disease Diagnosis Among Primary Care Nurse Practitioners: A Quality Improvement Project." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626661.
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INTRODUCTION: Celiac disease (CD), an inflammatory condition of the small bowel, is now
recognized as the most common of the autoimmune disorders (Kenrick & Day, 2014). Unfortunately, due to poor awareness among primary care providers (PCPs) this disease remains highly underdiagnosed despite its increasing prevalence (Catassi & Fasano, 2008). Aims of this quality improvement project were to examine current knowledge and practices of nurse practitioners in the primary care setting that influence the screening and diagnosis of CD. METHODS: A 32-item survey was sent out to nurse practitioner primary care providers (NP- PCPs) in the Dallas-Fort Worth Metroplex over a four-week period. The survey assessed demographic characteristics, knowledge and clinical practices of nurse practitioners as it relates to CD diagnosis. Data was analyzed using SPSS and descriptive statistics.
RESULTS: Eighteen valid responses were received for analysis. The majority of respondents reported having no familiarity with the American College of Gastroenterology (ACG) and National Institute for Health and Care Excellence (NICE) guidelines. Two thirds of the respondents reported their education did not properly prepare them to accurately diagnose celiac disease. The vast majority also reported they do not test patients, pediatric or adult, using any celiac related blood test. The same results were true for patients being sent for intestinal biopsy. Although able to list typical symptoms of CD, many respondents were unaware of atypical symptoms. Most also omitted family history as important when considering celiac related testing. CONCLUSIONS: Overall NP-PCPs are not aware of and therefore do not follow clinical guidelines related celiac disease. It is clear that NP-PCPs need to be made aware of the prevalence of this disease and should be directed to follow evidence-based practice guidelines in their primary care practices. One step for doing this includes providing better education for NP- PCP students. Educators should include lectures or discussions about CD in their curriculum and provide students with resources such as the NICE and ACG guidelines. For practicing NPs, free continuing education can be offered. Lastly, clinicians who are aware of the high rates of underdiagnosis can present CD related information at conferences and meetings.
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Bickerton, Jane E. "Videos of communication in primary care : a study exploring nurse practitioner and patient consultations in a walk-in centre." Thesis, City University London, 2015. http://openaccess.city.ac.uk/14541/.
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The researcher (an experienced advanced nurse practitioner) examined and interpreted twenty videos of consultations between six nurse practitioners and patients aged between 18 and 65 years. A qualitative visual research method (VS) was used drawing on phenomenology, video elicitation, reflexivity, and narrative hermeneutics. The findings demonstrated shared verbal and visual aspects of conversations. The majority of the videos elicited knowledge-based, rather than predominately emotion or movement-based conversations with both parties both empathic and engaged or task focused. The consultation dynamic in most interviews was harmonious rather than in tension, although there were occasions where the nature of the communication varied during the consultation. Furthermore, each NP demonstrated preferences for one of the three different conversation styles (i.e. knowledge, emotion or movement), as well as different ways of responding to patients who were either active or passively involved in an interaction. This theoretically derived video schema was further developed into a video tool (a process and coding guide along with a coding form). The video tool (VT) provided evidence of good video coding interrater reliability when compared with the results of the VS. The study recommends that WiC NPs could use the video schema to reflect on their personal consultation styles as there is potential to develop greater awareness of emotion, movement and knowledge in shared conversations, and a facilitative approach that asks open questions and encourages active shared and flexible approaches to consultation communication. Additionally, research using the video tool could further investigate the psychometric properties of the VT and ultimately the effect of the different styles on patient outcomes such as compliance and satisfaction.
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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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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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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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Rogers, Melanie. "Spiritual dimensions of advanced nurse practitioner consultations in primary care through the lens of availability and vulnerability : a hermeneutic enquiry." Thesis, University of Huddersfield, 2016. http://eprints.hud.ac.uk/id/eprint/28469/.
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Introduction: There is a scarcity of research examining spirituality and spiritual dimensions of Advanced Nurse Practitioner practice. This thesis explores the findings of a hermeneutic enquiry into the spiritual dimensions of Advanced Nurse Practitioner consultations in Primary Care through the lens of Availability and Vulnerability. The findings include Advanced Nurse Practitioners’ understandings and conceptualisation of spirituality, the place of spirituality in practice and some of the concerns related to integration in practice. The participants’ interviews explored their own personal and professional experiences which added to their conceptualisation of spirituality. The lens of Availability and Vulnerability (A&V) was used intentionally and openly to explore, in depth, spiritual dimension of practice with the participants. The utility and effectiveness of the concepts of A&V in this context was explored. Methods/Methodology: A hermeneutic phenomenological enquiry was chosen to explore spirituality through the lived experiences of the Advanced Nurse Practitioners (ANPs). Eight participants were interviewed face to face during 2 in-depth interviews spaced 18 months apart. The concepts of A&V were introduced to the participants before the second interviews. The lens of A&V was utilised within these interviews to discover whether or not these concepts were helpful for operationalising spirituality in practice. The prolonged engagement allowed dialogue to occur between the researcher and participants allowing data to be captured which provided a thick description of the phenomenon of spirituality. A thematic analysis was chosen to interpret the data in order to enable a deeper understanding of the spiritual dimensions of ANP consultations to be gained. Findings The participants recognised that spirituality can be difficult to conceptualise and operationalise in practice. However, many of the participants were able to articulate the meaning of spirituality for themselves and gave examples of when they had witnessed a spiritual dimension occurring in practice. Particular themes were expressed in the interviews in relationship to spirituality. These included the context for spirituality to be integrated into care, the emotional engagement needed and the emotional impact on the ANP and the patient. Having introduced the concepts of A&V to the participants, after deep exploration, they recognised and identified that A&V were concepts which could be a useful lens for understanding spirituality in ANP consultations. Conclusion This study has uncovered new knowledge and understanding in the realm of spirituality in ANP consultations in Primary Care. The conceptual understanding of spirituality and the framework of Availability and Vulnerability provides a new approach to spirituality within ANP consultations in Primary Care.
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Story, Delia Mary Hearn. "Evaluating Knowledge And Barriers To The Use Of Cognitive Behavioral Therapy By Nurse Practitioners In The Treatment Of Depression And Anxiety In Primary Care." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/333459.
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Depressive and anxiety disorders are the most commonly encountered mental health problems seen in the primary care setting; they represent a serious public health concern, and are inordinately time consuming for the primary care provider. Cognitive behavioral therapy (CBT) is an effective tool for the treatment of both depression and anxiety, and can be delivered in a variety of abbreviated forms appropriate for use in the primary care setting. Despite its apparent benefits, few primary care providers report using CBT in their practices. The purpose of this project was to develop a better understanding of provider knowledge and perceived barriers regarding the use of CBT for the treatment of depression and anxiety in the primary care setting. A better understanding of practitioners' knowledge of CBT and their perceived barriers to its use will establish a baseline for further exploration of the issue, and will help guide the development of strategies to address the gap in practice. A brief questionnaire was provided to a convenience sample of Nurse Practitioners (NP) during a regular meeting of the Southern Arizona Advanced Practice Nurse/Nurse Practitioner Society. The results of the data analysis showed that 90% of the sampled NPs considered themselves to be skilled in detecting depression and anxiety in their patients, and 80% were confident in their abilities to treat patients with these disorders. However, only 30% of sampled NPs currently use CBT in their practices. The sample indicated a broad lack of knowledge related to multiple aspects of CBT including technique, training, implementation, and reimbursement. Education and training were revealed to be the strongest predictors of willingness to use CBT. Only 30% of NPs were introduced to the use of CBT in their NP programs. The results suggest that increased education in the proper technique, process, and billing methods for CBT may contribute to greater utilization by NPs in the primary care setting.
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Aboueid, Stephanie. "Nutrition Care Practices of Family Physicians and Nurse Practitioners in Primary Health Care Settings in Ontario – A Qualitative Study." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36500.
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This study aimed to provide an in-depth understanding of the way in which the macro, meso, and micro levels of the health care system affects nutrition care practices of family physicians (FPs) and nurse practitioners (NPs). It also examined how current practices compare to the clinical practice guidelines on the management and prevention of obesity. Three different types of team-based primary care settings were included: 2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic. Within each type of setting, six to eight FPs and NPs were interviewed (for a total n= 20). Site-specific documents and government reports were also analyzed. Findings suggest that the team-based nature improves nutrition care due to the accessibility to dietitians and cost-free service. Electronic Medical Records was an important enabler for chronic disease management. Duration of medical visits and increasing prevalence of complex patients were barriers for addressing nutrition and weight. Despite the importance of addressing obesity in primary care, the topic was approached in terms of chronic disease management rather than prevention. FPs and NPs spared the dietitian on site for patients who have more severe chronic conditions. Nevertheless, the presence of a dietitian on site increased the likelihood of primary care providers bringing up the topic of nutrition. Addressing site-specific barriers could improve nutrition care practices for weight management and chronic disease prevention in the primary care setting.
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Stratton, Delaney Baker. "Acceptance of Mobile Teledermoscopy of Primary Care Nurse Practitioners in the State of Arizona." Thesis, The University of Arizona, 2014. http://hdl.handle.net/10150/321967.
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Quam, Jennifer M. "Knowledge of Assessment and Management of Childhood Obesity Among Rural Primary Care Nurse Practitioners." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/612863.
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Objective: New Mexico nurse practitioners contribute to the prevention and management of pediatric obesity. This study aimed to assess nurse practitioners' knowledge, attitudes, and behaviors, which were unknown in New Mexico, to counseling frequency in the assessment and management of overweight and obese pediatric patients. This was done using clinical practice guidelines (CPG). The study also sought to learn nurse practitioners' insights on needed resources for clinical practice. Rural and urban nurse practitioners' responses were then compared to the study aims. Methods: This descriptive pilot study surveyed members of the New Mexico Nurse Practitioner Council (NMNPC) to evaluate their knowledge, attitudes, and behaviors, in addition to the counseling frequencies expected to result in patient change. The survey used the platform Qualtrics and measured answers using a four-point Likert scale. Rural and urban comparisons were evaluated for each variable (knowledge, attitudes, and behaviors) in order to investigate relationships. Despite the underpowered sample size, data were analyzed for feasibility of future studies using descriptive statistics, Spearman's Rho Correlation, and Mann-Whitney U testing. Results: Fifteen nurse practitioners were included in the statistical analysis. The data found the nurse practitioners' self-reported responses exhibited knowledge, positive attitudes, and confident behaviors using pediatric obesity CPGs. The increases in these parameters correlated reported needing a quick CPG tool that can be used in practice. In all, rural nurse practitioners reported a slightly higher usage of pediatric obesity CPGs than urban nurse practitioners. Conclusion: The feasibility of this study's assessment of nurse practitioners' knowledge, attitudes, and behaviors using CPGs will assist in developing interventions to impact patient outcomes. The study also found that resources needed by New Mexico nurse practitioners were similar to those desired by other providers throughout literature. Rural compared to urban nurse practitioners findings indicated the need for further research. Future studies should include all health care providers in New Mexico in order to further explore aims of this study and development of interventions on overweight and obese pediatric CPGs to positively impact practice.
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Stratton, Delaney, and Lois J. Loescher. "The acceptance of mobile teledermoscopy by primary care nurse practitioners in the state of Arizona." WILEY-BLACKWELL, 2016. http://hdl.handle.net/10150/620863.
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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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Dalhaug, Heidi Lynette, and Heidi Lynette Dalhaug. "An Assessment of Nurse Practitioners' Knowledge in Managing Childhood Obesity in the Primary Care Setting." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/622971.
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Despite the numerous recommendations for care, childhood obesity continues to be a growing problem in the United States. Approximately one third of the United States population of children ages 2–17 is now considered overweight or obese (American Heart Association, 2014a). The obesity epidemic in children can lead to greater health risks and concerns when entering adulthood. Primary care providers were previously identified as key personnel that could identify and treat overweight and obese children during opportunities, such as well child visits. In addition, several studies have been published providing key recommendations for the diagnosis and management of childhood obesity. One such study, in association with the American Academy of Pediatrics (AAP), created the 2007 AAP Expert Committee Recommendations for childhood obesity management. Despite the publishing of these recommendations, providers have not consistently utilized their opportunities to diagnose and treat overweight or obese children. There have been many barriers and concerns identified by studies looking at provider practices and inconsistencies including provider lack of comfort in diagnosing obesity, lack of training in obesity treatment options, lack of training in motivational interviewing, lack of familial/patient readiness for change, and lack of time available to properly assess and treat the child. With those barriers and inconsistencies in mind, it is concerning that Arizona’s childhood obesity rates have continued to rise. Thus, this survey was designed to review Arizona Nurse Practitioners knowledge and practices regarding the diagnosis and management of childhood obesity as they related to the 2007 AAP Expert Committee Recommendations for childhood obesity management and determine how they compare to previous studies completed on provider barriers and practices. Based upon the data received with this study, Arizona nurse practitioners are also inconsistent in their knowledge and practices regarding childhood obesity management.
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Eby, Donald Harold. "The nature of the relationship between comprehensive primary care nurse practitioners and physicians : a case study in Ontario." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8531.
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The purpose of this thesis was threefold – First to investigate the emergence from the existing health system of nurse practitioners as a new occupation. Second to make sense of how nurse practitioners developed as primary care providers in the province of Ontario. Third to understand the nature and development of the intra-professional relationship between primary care nurse practitioners and physicians in local practice settings. I used a case study approach, with both historical (document review) and empirical (ethnography and interview) components. The empirical data was analyzed from an interpretive perspective using thematic analysis. A number of theoretical perspectives were drawn on, including Kingdon’s Agendas, Alternatives and Public Policy model, Abbott’s Occupational Jurisdiction model, Van de Ven et al’s Innovation Journey model, and Closure Theory. The study makes 3 contributions to new knowledge. First it documents the unfolding of events and actions over time, and thus serves as a historical summary. Second it adds an analysis of the case of nurse practitioners as an emergent occupation to the existing body of sociological analyses of professions. Third, it provides insight into how nurse practitioner - physician relationships are impacted at the local level because nurse practitioners are obligated to develop a relationship with a physician in order to be able to deliver comprehensive primary care services. The empirical component of the thesis analyzes and describes the nature of this relationship at a practice level. It also describes the use of ‘workarounds’ to bypass legislated restrictions in nurse practitioners’ scope of practice. It analyzes how structural differences in the manner of regulation, payment, and employment status between nurse practitioners and family physicians contribute to different styles of practice and perpetuate the hierarchical relationships between nurses and physicians. This knowledge has potential generalization to other emerging occupations, such as physician assistants and paramedics.
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Groll, Kelley Eileen. "Childhood Sexual Abuse Screening And Prevention In The Primary Care Setting: A Survey Of Pediatric Healthcare Providers In The State Of Vermont." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/435.
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ABSTRACT
Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA.
Objective. The overall goal of this study is to gain an understanding of the current state of sexual abuse screening and prevention in pediatric primary care settings in the state of Vermont.
Methods. An anonymous, 20-item survey was distributed to Vermont pediatric primary care providers via the electronic mailing lists of three Vermont-based professional organizations for healthcare providers. The online survey was conducted with the Limesurvey software through the secure University of Vermont server. The survey remained active for three weeks, and potential participants received three weekly reminder emails inviting them to complete the survey. As an incentive for volunteer participation in the study, all participants received a list of the available local, statewide, and national resources available to them to assist in sexual abuse detection and prevention following survey completion.
Results. There were 37 participants who completed the survey. The groups were divided based on professional title, patient population, years of experience in practice, geographic location, and access to a social worker. Each of these groups was analyzed against the survey data to determine any underlying trends that existed.
Conclusions. Nurse practitioners were found to be more likely than physicians to routinely screen every child and their caregivers during health supervision visits. NPs were also more likely to report that the electronic health record prompted these screenings. A positive correlation was found between the likelihood of routinely screening children and increased provider confidence with screening. However, no differences were found between NPs and physicians in confidence with screening, nor were there differences in perceived educational sufficiency between the two groups.
Across all professional titles, pediatric providers reported greater confidence in their ability to detect risk factors and red flags than family practice providers. A greater perceived sufficiency of education was positively correlated with provider confidence and comfort with screening. Educational sufficiency was also positively correlated with the perception that area resources are highly available and are effectively used in practice.
Time was reported as the greatest barrier to screening and prevention by those who have the highest perceptions of their ability to make an impact on prevention. Also, those who felt that there were highly available and accessible resources at their disposal also reported time as their greatest barrier. Additionally, those who reported greater than 20 years of experience in practice were significantly less likely to view access to the patient as the greatest barrier that providers face in their efforts to detect and prevent sexual abuse. Further study is indicated to confirm these findings.
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Riley, Ruth. "How do GPs, nurse and pharmacist prescribers manage patients' emotional cues and concerns in healthcare encounters?" Thesis, University of Bath, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642041.
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In healthcare encounters, patients communicate wide-ranging concerns relating to their health and illness experience, treatment or wider psychosocial world. This research draws upon a normative understanding of patient centred approaches which recognise the clinical and psychotherapeutic value in having the opportunity to talk to someone who will listen empathetically and to have expressed concerns acknowledged and understood. The aim of this research was to understand how GPs, nurse and pharmacist prescribers manage patients’ emotional cues and concerns in healthcare encounters. This research employed a mixed method study underpinned by an interpretative epistemology to understand, in particular, how nurse and pharmacists as ‘new prescribers’ manage emotionality during consultations in primary care. The study also critically reflected on the value and limitations of the study methodology to explore this topic. Phase one employed a coding framework to code 528 consultations with 20 GPs, 19 nurses and 12 pharmacist prescribers. The nature and content of patients’ cues and concerns and healthcare professionals’ responses were coded and analysed quantitatively. Phase two undertook qualitative analysis on a sub-sample of 30 transcribed recordings to understand barriers and facilitators to offering emotional labour during the consultation process. Phase one found that patients communicate on average 3.4 cues and concerns per consultation and of those concerns expressed, half related to biomedical concerns. Other cue and concern types related to medication, the impact of a patient’s condition/symptoms on their day-to-day life and cues and concerns related to psychosocial issues, including job stress, family problems, or bereavement. Phase one found that there were significant differences between the type of positive/missed responses to patients’ cues and concerns across the groups. 81% of pharmacists’ responses were coded as positive compared with 72% of nurse prescriber responses and 52% of GP responses. Male GPs were significantly more likely to miss patients’ cues and concerns compared to female GPs. Phase two drew upon emotion work theory and models of patient centred care to identify the ways in which emotions are communicated and managed within healthcare encounters recorded for this study. Phase two identified facilitators (such as attuning to the patient’s world, evidence of listening, providing space, validating and legitimising patients’ concerns) and barriers (emotional disengagement, task focused and structured/agenda driven consultations) to the employment of emotional labour. These findings identify that a complex inter-play of individual, socio-cultural and political factors have potential to influence the way in which emotionality is managed during the consultation process. The findings reinforce the importance of patient centred approaches and communication skills training and the need for support, supervision and training to enable healthcare professionals to manage their emotionality and that of their patients.
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Brom, Heather. "The Changing Landscape of Ambulatory Care: Provision and Utilization as Influenced by the Patient Protection and Affordable Care Act." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1491814890562107.
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Crowe, Mary Lind. "Allocation of Health Care Resources at the Point of Care: An Exploratory Study of the Perceptions and Decision Making of Nurse Practitioners Delivering Primary Care Services in Community Clinics." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1333401296.
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Arsov, Svetoslav A. "Primary Care and Behavioral Health Services in a Federally Qualified Health Center." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6966.
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Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.
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Ward, Megan Lynn. "Barriers to Decreasing Hospital Readmission Rates for Chronic Disease Patients in North Dakota as Perceived by Primary Care Nurse Practitioners." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/613136.
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Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.
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Sharu, Debra. "Learning in the workplace : a study of primary health care nurse practitioners (NPs) in their first year of postgraduate employment." Thesis, University of Sussex, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442426.
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Knopp, Jennifer Ann. "A comparison of nurse practitioners versus physicians in managing ambulatory infectious diseases of children, ages 1 to 5, in primary care." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ60404.pdf.
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Kurtzman, Ellen T. "Delivery of High Quality Primary Care in Community Health Centers| The Role of Nurse Practitioners and State Scope of Practice Restrictions." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3746006.
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In response to the increased demand for primary care in the United States—a byproduct of a growing elderly population and insurance expansion under the Affordable Care Act (ACA)—the total number and capacities of community health centers (HCs) is expected to grow. While HCs have historically depended on physicians to deliver the majority of their care, more and more, they are shifting to non-physician clinicians, especially nurse practitioners (NPs); yet, little is known about the quality of care delivered by NPs in HCs or about the role state occupational restrictions have on these practitioners or their patients.
Using quasi-experimental methods and data from the community health center subsample of the National Ambulatory Medical Care Survey (NAMCS), this dissertation explores three distinct, but related, research questions regarding NP-delivered care in HCs—its effectiveness and comparability to physician care, the extent that tradeoffs in the quantity and quality of care are made, and the real-world risks and benefits of states easing their scope of practice restrictions. Findings, which suggest that NP care is comparable to physician care in most ways and that the quality of NP-delivered care does not significantly vary irrespective of states’ NP independence status, have important implications for policy and practice.
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Raleigh, Mary. "Multiple perspectives of community nurse practitioners' use of medical physical assessment skills in primary care : a qualitative study of current practice in the UK." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/809067/.
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Aim: To explore the use of medical physical assessment skills (PAS) by community nurse practitioners in primary care in the UK. Background: Physical assessment skills are commonly practiced by community nurse practitioners in primary care. These skills are used to support GPs to deliver a wide range of services in primary care. There is no evidence on how physical assessment skills are used by community nurse practitioners in primary care. Methods: A qualitative interpretative embedded case study design. Results: Participants reported that community nurse practitioners used medical PAS in integrated ways, by bringing together their clinical expertise, leadership, education and liaison skills to work across professional boundaries, to deliver a range of services. Specialist nurses caring for patient with one or more chronic long-term condition use these skills within the constructs of a person-centred framework, which is relationship focussed, holistic and collaborative. Nurse practitioners use physical assessment skills to work as generalists and make independent diagnostic decisions. Competence, capability and performance are necessary to make complex decisions. Failure of community nurse practitioners to take responsibility for assessment decisions creates inter-professional tensions and conflict. Conclusions: Medical physical assessment skills are successfully being used by community nurse practitioners to deliver a wide range of services in primary care. These skills improve competence, capability and performance for advanced nursing practice roles. Physical assessment skills education and training at universities needs to be validated by allied health professional bodies for advanced practice roles. Relevance to clinical practice: • Physical assessment education and training prepares nurses with higher levels of theoretical assessment knowledge and skills that are fit for purpose. • GPs believe that education and training of physical assessment skills are vital for nurses to manage the burden of assessment work in primary care. • Common sets of assessment practices between disciplines have better outcomes for patients • Registered nurses require a standard of competence which allows them to perform physical assessment skills to the same level as doctors. • Competence and performance are best achieved when working with patients and experienced clinicians. Key words: medical physical assessment skills, community nurse practitioners, cross boundary working, diagnostic skills.
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Shackelford, Katya A. "Complexities of Participation: Education and Authority in Primary Care Patient-Provider Interactions in the age of the Internet." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/scripps_theses/72.
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This thesis is about primary care medicine in the United States today. Specifically, I look into primary care providers’ experiences working with patients in the context of the public’s current access to extensive health and medical information online. In this thesis, I discuss and analyze my conversations with physicians, nurse practitioners, and a physicians’ assistant about their objectives in primary care, the challenges they face, and their perceptions of patients’ ability to seek out information on their own. I explore providers’ educational emphasis in primary care consultations, and argue that this focus on education informs their views of patients’ independent research and involvement in care. I further argue that regardless of my informants’ enthusiasm about patient involvement and the merits of patient-education, these providers still hold and express a strong authority over medical knowledge and decisions. Thus in looking at the influence of what could be seen as a democratization of medical knowledge through public access and the Internet, it seems that the limitations of such access are still great in U.S. medical practice.
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Smock, Carissa Ruby. "Provider Acceptance, Training, and Utilization of Place-Based Exercise Prescriptions." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1492008967709141.
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Novosel, Lorraine Marie. "Depressive symptomatology, patient-provider communication, and patient satisfaction : a multilevel analysis." [Tampa, Fla] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0001866.
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Newbold, David Anthony. "An evaluation of the rheumatology nurse practitioner." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263598.
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Bryar, Rosamund Mary. "The transition of practitioner to practitioner researcher in primary health care." Thesis, Cardiff University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393863.
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Salcedo, Maria Victoria Trinidad. "Needs Assessment for a Nurse Practitioner-Led Transitional Care Program." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1450.
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The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.