Tesi: "Nurse practitioners"

1

Crumbie, Alison. "A nurse practitioner's tale : an autoethnographic interpretive study of the values of nurse practitioners, general practitioners and district nurses". Thesis, Swansea University, 2005. https://cronfa.swan.ac.uk/Record/cronfa42455.

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Nurse practitioners began practising in the UK in the 1980s. Since then the numbers have grown and a body of research has developed relating to the role. The criticism of nurse practitioners has been that they work as "mini doctors" and that they no longer belong to the family of nursing. If nurse practitioners have more in common with medicine than they do with nursing one might expect to find that nurse practitioners have moved away from the values of nursing and have instead moved toward the values of medicine. To date we know relatively little about the role of the nurse practitioner. The aim of this study was to determine to what extent nurse practitioners share the values of nursing or medicine. In recognition of the author's own role as a nurse practitioner an autoethnographic approach was used. Unstructured interviews were carried out with general practitioners (GPs), nurse practitioners and district nurses and their values were revealed through descriptions of meaningful practice. Significant and important differences were found between the three groups of practitioners both in the form and the content of the narratives. The form of the narratives revealed the cultural connection of the nurse practitioners to nursing. The content of the narratives revealed the pioneering nature of the role and the nurse practitioners' concern with acceptance, recognition and respect. When analysed from a Maclntyrean perspective, the nurse practitioners lacked the purpose and goals that were evident in the descriptions of meaningful practice from the GPs and district nurses. Such a finding seems to be congruent with an emerging practice and challenges the nurse practitioner community to determine for itself the nature of its contribution to patient care.

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2

Shea, Mary Louise. "Determined Persistence: Achieving and Sustaining Job Satisfaction among Nurse Practitioners". Fogler Library, University of Maine, 2008. http://www.library.umaine.edu/theses/pdf/SheaML2008.pdf.

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3

Dunaway, Linda J. "Job satisfaction among Nevada nurse practitioners". abstract, 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453535.

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4

Harper-Femson, Lee Anne. "Nurse practitioners' role satisfaction". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0012/NQ35403.pdf.

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5

Abney, Laura Ann. "Obstetrical Screening Practices of Nurse-Midwives and Nurse Practitioners". UNF Digital Commons, 2009. http://digitalcommons.unf.edu/etd/243.

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With the continued growth in the numbers of nurse practitioners and certified nurse-midwives, more and more women will receive prenatal care from advanced practice nurses. The purpose of this research was to assess the routine screening practices of advance practice nurses providing prenatal care and to compare those practices with current guidelines. The study focused on five areas of prenatal screening: bacterial vaginosis, group B streptococcus, gestational diabetes, maternal serum markers, and fetal movement monitoring. The interaction model of client health behavior by Cheryl Cox, specifically professional-technical competencies, part of the client-professional element of the model, provided the theoretical framework for this study. The sample was obtained :from two major nursing organizations involved in prenatal care: the National Association of Nurse Practitioners in Women's Health and the American College of Nurse-Midwives. A random sample of250 members from each organization was sent a postcard explaining the study and directing them to the online survey. In four out of five screening areas, there was no significant difference in the screening practices of NPs and CNMs. Bacterial vaginosis was the only screening with a significant difference. There was inconsistency with what the advanced practice nurses state they do and current guidelines with respect to screening for group B streptococcus and maternal serum markers.

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6

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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7

Mayne, Susan. "Strengthening Dermatology Education for Nurse Practitioners". Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent161419836186678.

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8

Snow, Sharon K. Russell Jan Wampler. "The nurse practitioner's experience with obese patients". Diss., UMK access, 2006.

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Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2006.
"A dissertation in nursing." Advisor: Jan Russell. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Nov. 9, 2007. Includes bibliographical references (leaves 117-128). Online version of the print edition.

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9

Bertness, Janette A. "Rhode Island nurse practitioners : are they legally practicing medicine without a license? /". abstract and full text PDF (UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1461532.

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Thesis (M.J.S.)--University of Nevada, Reno, 2008.
"December, 2008." Includes bibliographical references (leaves 50-58). Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2009]. 1 microfilm reel ; 35 mm. Online version available on the World Wide Web.

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10

MacDonald, Jane A. T. "Physicians' perceptions of nurse practitioners and collaboration". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ63829.pdf.

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11

Quinlan, Amy. "Attitudes of nurse practitioners toward interprofessional collaboration". Thesis, The William Paterson University of New Jersey, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3680893.

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Effective interprofessional collaboration between nurse practitioners and physicians is imperative to meet the health care needs of all Americans. This project measures attitudes of nurse practitioners to determine the barriers to effective interprofessional collaboration with their physician colleagues. It was hypothesized that there is a positive relationship between nurse practitioner attitudes and interprofessional collaboration and a positive relationship between years in practice and interprofessional collaboration. Sixty-three nurse practitioners participated by completing the Collaborative Practice Scale and Jefferson Scale of Attitudes toward Physician and Nurse Collaboration. The Core Competencies for Interprofessional Collaborative Practice served as the framework for this project. Findings of this project revealed nurse practitioners are overall accountable for their patient care and report high levels of interprofessional collaboration. These results are a foundation for future inquiry in providing and evaluating programs to enhance interprofessional collaboration.

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12

Suarez, Maria. "Shared governance for advanced registered nurse practitioners". NSUWorks, 2015. https://nsuworks.nova.edu/hpd_con_stuetd/13.

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13

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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14

Chan, Seung-chuen. "The development of four advanced nursing roles in the United States, the United Kingdom, Australia, and Hong Kong a comparative analysis of nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist /". Click to view the E-thesis via HKUTO, 2002. http://sunzi.lib.hku.hk/hkuto/record/B31972809.

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15

Woolsey, Mary Helen. "Nurse practitioner preparedness for entry into practice". Laramie, Wyo. : University of Wyoming, 2006. http://proquest.umi.com/pqdweb?did=1203574201&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.

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16

Schindler, Mary Jean. "Selected Functions of Nurse Practitioners in Oregon and Some Implications for Nurse Preparation". PDXScholar, 1987. https://pdxscholar.library.pdx.edu/open_access_etds/56.

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Purpose. This study was designed to determine the perceptions of the Oregon-certified nurse practitioners (NPs) with respect to their usage, competency, and preparation for selected functions. Clarification of what NP's perceive themselves doing and with what degree of competence could give structure and direction to their preparation. In Oregon, NPs provide specialized primary care in collaboration with physicians and other health care professions and agencies. The performance of an NP may vary according to the specialty, setting, and needs of the consumer. If some functions of the NP could be brought into clearer focus, then not only could benefits come to the health care consumer, but also health care professionals could work together more efficiently and productively. Furthermore, educators could build programs with a clearer sense of purpose and structure. Procedure. The data were obtained through a survey of 574 NPs certified in Oregon. A four-part questionnaire was adapted from instruments developed by researchers of NPs in North Carolina, Arkansas, and Colorado. The analysis of service diaries provided by Oregon nurse practitioners, additions by the Oregon State Board of Nursing, and pretesting in the field resulted in statements about selected characteristics and attitudes, practice settings, and clinical and community functions of Oregon nurse practitioners. Questionnaires were mailed, and 386 were analyzed. Summary of Findings and Conclusions. Three research hypotheses were formed and tested by chi-square. The following findings and conclusions were identified: (a) Some relationships did exist between NP functions and specialty groups with respect to competency, frequency of performance, and preferred preparation. (b) Most nurse practitioners serve a large number of consumers in low or very low economic circumstances through community or home health agencies. (c) Some functions of high competency and usage are needed in the preparation of all nurse practitioners at the baccalaureate and master's level. (d) Higher education is preferred for preparation of nurse practitioners in a sequence of baccalaureate in nursing followed by a master's degree which qualifies for certification in a nursing specialty. (e) For the functions of lower competency and usage, reduced emphasis or deletion from nurse practitioner preparation is desirable. (f) Some functions are suitable for major emphasis in continuing education programs with the standards of higher education.

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17

Maxwell, Laurie. "Patients' Attitudes Toward the Use of Nurse Practitioners". TopSCHOLAR®, 1997. http://digitalcommons.wku.edu/theses/794.

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Since the advent of the role of nurse practitioner in the mid 1960s, nurse practitioners have practiced in traditional settings such as health departments, clinics, and physicians' offices. More recently, nurse practitioners have been utilized in non-traditional settings such as the emergency department. Some studies have been done that support the theory that nurse practitioners can function effectively in this setting; however additional studies are needed on this topic. The purpose of this study was to explore patients' attitudes toward the use of nurse practitioners and to determine what patient variables were related to these attitudes. More specifically, this study focused on patients' attitudes about nurse practitioners working in the emergency department, a nontraditional practice setting for nurse practitioners. Two research questions were answered: (1) What are patients' attitudes about nurse practitioners? and (2) What subject variables are related to positive and negative attitudes about nurse practitioners? A telephone survey was conducted to adult patients who presented to the emergency room for treatment of conditions that were classified as "non-emergent" during the triage process. Patients were asked to answer questions concerning their visit to the emergency department. They were then asked to respond to 12 items on the Kviz Acceptance Questionnaire, which measured attitudes about nurse practitioners. Demographic data were collected from the medical record following the interview. The most significant finding of this study was that the role of nurse practitioner was generally accepted by patients presenting for treatment of non-emergent conditions in the emergency department. This finding is significant since the emergency department is not a traditional practice setting for nurse practitioners. Correlation coefficients showed that patients who had seen a nurse practitioner before were more accepting that those who had not seen a nurse practitioner. Patients who were younger, female, and who perceived their health as good or excellent had the most positive attitudes about nurse practitioners. Additional studies are needed to support the belief that nurse practitioners can function efficiently in the emergency department and other nontraditional settings. Information is also needed on the financial feasibility of such a plan. This time is one of great opportunity and challenge for advanced practice nurses to expand their roles in a rapidly changing health care environment.

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18

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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19

Lucas, Maxine Ann. "Nurse Practitioners' Skin Cancer Prevention Counseling To Adolescents". Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/338884.

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Background: Skin cancer is the most common cancer worldwide and one of the most preventable cancers. Despite prevention efforts, skin cancer incidence continues to rise among adolescents. This is especially a challenge for the state of Arizona, which has a high incidence of skin cancer. The inconsistent evidence-based practice guidelines for skin cancer prevention create challenges for counseling adolescents. The knowledge, attitudes, and practices of primary skin cancer prevention by nurse practitioners who care for adolescents is unknown in Arizona or elsewhere in the U.S. Purpose: This doctor of nursing practice project investigates knowledge, attitudes, and practices of skin cancer primary prevention by Arizona nurse practitioners caring for adolescents on an outpatient basis and determines congruency of their counseling with primary prevention guidelines. Methods: The design is descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs to eligible Arizona nurse practitioners currently in practice. Participants' knowledge of skin cancer, skin cancer prevention, and current practice guidelines and recommendations were assessed using multiple choice items. Participants' attitudes regarding counseling for skin cancer prevention within the adolescent population and current nurse practitioner behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: Thirty-nine nurse practitioners responded to the online survey. Participant overall knowledge regarding skin cancer was moderate to low, and less was known about skin cancer in adolescents. Despite participants' overall positive attitudes toward skin cancer prevention, they reported low rates of skin cancer prevention counseling for adolescents in practice. Skin cancer prevention recommendations, identified by participants as used in practice, were not congruent with established clinical guidelines on counseling for primary prevention of skin cancer in adolescents.

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20

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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21

Barton, Thomas David. "Nurse practitioners : redefining occupational boundaries? : an ethnographic study". Thesis, Swansea University, 2005. https://cronfa.swan.ac.uk/Record/cronfa43031.

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This research project investigated aspects of the cultural and professional perceptions and experiences of individuals involved in the organisation, education and practice of the clinical role of the nurse practitioner. The study also examined the implications of that clinical role for the stability and nature of occupational boundaries, specifically the boundary between the professions of nursing and medicine. The project's focus on occupation, profession and culture ran a natural course in directing the methodological development. That development was grounded in the qualitative paradigm, and in concepts of cultural (anthropological) investigation. Practitioner ethnography was the methodological approach utilised in the design of this research project and it is evident throughout the data and findings. Over a two-year period, a sample of student nurse practitioners who were undertaking a clinical degree programme, was observed. Data were also collected from other individuals involved in the degree programme: teachers, physician mentors and senior academics. No predetermined framework or structure was imposed on the data prior to the analysis. The data were systematically analysed and structured, leading to the inductive identification of sub-themes. These were refined to five broad interconnected transition themes. These themes were then further structured and analysed by comparing and contrasting them within the conceptual framework proposed by Van Gennep (1960) in his work on the symbolic rite of passage. Finally, four broad processes emerged that reflected the events observed within the data. The theoretical framework of transitional rite of passage was used to conceptualise the findings regarding the lived experience of the sample. The findings have revealed that the overall sample experience took the form of a rite of passage and that this process was central to the evolution of new career structures and identities associated with advanced nursing practice. Overall, the nurse practitioner degree programme involved a series of transitions and reappraisals of identity, but ultimately it left them located within the nursing profession.

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22

Ogle, Kathleen Theresa. "Following the yellow brick road the lived journey of nurses becoming nurse practitioners /". College Park, Md. : University of Maryland, 2007. http://hdl.handle.net/1903/6801.

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Thesis (Ph. D.) -- University of Maryland, College Park, 2007.
Thesis research directed by: Education Policy, and Leadership. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

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23

Peckham, Samantha Sophia. "Evaluating the Readiness of Nevada Nurse Practitioners for Clinical Practice Post-Graduation Utilizing the Nevada Nurse Practitioners' Prepardness for Practice Survey". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/560799.

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As a result of changing demographics and an increasing need for access to healthcare, in 2013, the Nevada Legislature passed Assembly Bill 170 (AB170) allowing nurse practitioners (NPs) full practice authority in Nevada in 2013 (VanBeuge & Walker, 2014). With the movement from collaborative agreement to independent practice, recent NP graduates need to be prepared for transitioning from the NP student role to an independent practitioner role. Historically, speaking there have been numerous studies citing that NPs provide high-quality health care and have high patient satisfaction, yet there has been almost no research regarding the readiness for clinical practice post-graduation (Hart & Macnee, 2007). The purpose of this project was to develop a better understanding of readiness to practice, perceived barriers, and to develop recommendations for post-graduation nurse practitioners in Nevada. A brief survey was provided electronically to NPs who were members of the Nevada Advanced Practice Nurses Association (NAPNA).

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24

Borbasi, Sally. "Surviving clinical nursing : a phemomenological text about the lifeworld of the clinical nurse specialist". Phd thesis, Faculty of Nursing, 1995. http://hdl.handle.net/2123/9043.

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25

Chan, Seung-chuen, e 陳湘銓. "The development of four advanced nursing roles in the United States, the United Kingdom, Australia, and Hong Kong: a comparative analysis of nurse practitioner, clinical nursespecialist, nurse midwife, and nurse anesthetist". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31972809.

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26

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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27

Kissick, Leila. "An Educational Framework for Doctorally Prepared Family Nurse Practitioners". Thesis, The University of Arizona, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3741023.

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The purpose of this Doctor of Nursing Practice (DNP) Project was to establish preliminary evidence for validity of the Kissick Framework for DNP education and practice of Family Nurse Practitioners (FNPs). The history of the education of nurse practitioners (NPs) was explored to determine which frameworks should be considered in planning future curricula. The current need for more primary care practitioners due to the Affordable Care Act and the response in nursing to increase the number of primary care providers is discussed.

The role of the NP has expanded and in 2004 the American Association of Colleges of Nursing (AACN) endorsed the DNP as the terminal practice degree to replace the Masters’ of Science in Nursing (MSN) requirement for NPs. Frameworks for education and practice of doctorally prepared FNPs were examined and compared to the Kissick Framework.

The Kissick Framework integrates the Essentials of Doctoral Education for Advanced Nursing Practice recommended by the AACN, the National Organization of Nurse Practitioner Faculties (NONPF) Core Competencies, and Ida J. Orlando’s Theory of the Nurse-Patient Relationship. Preliminary evidence supports consideration of the Kissick Framework for the education of doctorally prepared FNPs and as a guide for practice.

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28

Sand, Lindsey Rae. "Emergency Skill Competency Among Rural North Dakota Nurse Practitioners". Diss., North Dakota State University, 2019. https://hdl.handle.net/10365/29390.

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Many people with medical emergencies in rural areas would go untreated without the presence of critical access hospitals. Nurse Practitioners employed as rural healthcare providers commonly assume the roles of primary care provider in the clinic and hospitalist and emergency room provider in the critical access hospital. In a rural setting, comprehensive emergency care training is imperative as the nurse practitioner may be the sole provider on-call when a critical patient presents to the emergency room. Increased initial emergency care education and continued sustainment of rural nurse practitioners? emergency skills is essential to the future of rural healthcare and patient safety. The purpose of this practice improvement project was to identify rural nurse practitioners? perceived level of preparedness and competency in implementing emergency skills and develop an emergency skills seminar to increase rural nurse practitioners? perceived level of preparedness and competency in implementing emergency skills. Secondary data analysis of the Rural Nurse Practitioner Skills Needs Assessment, previously administered to rural North Dakota nurse practitioner preceptors, was completed. Analysis of the needs assessment revealed a majority of the rural nurse practitioner preceptors felt unprepared or somewhat prepared in implementing 41 of the 51 emergency care skills within the needs assessment. Analysis of the needs assessment led to the development of the Rural Emergency Skills Seminar, providing education on three emergency skills: Procedural sedation and airway management, cervical spine management, and imminent childbirth and post-delivery care. Participants were rural North Dakota nurse practitioner preceptors and North Dakota State University Doctor of Nursing Practice students. Participants were offered a posttest to complete at the conclusion of the seminar. Comparison of the needs assessment results with seminar posttest results revealed an increased perceived level of preparedness in completing the emergency skills taught during the Rural Emergency Skills Seminar. The project served to highlight knowledge gaps in emergency care competencies and develop an educational emergency skills seminar for rural nurse practitioners.

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Raimey, Deirdre D. "NURSE PRACTITIONERS’ UNDERSTANDING OF SEXUAL HEALTH INTERVENTIONS". Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1491944101518218.

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30

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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31

McGee, Angela Ann, e Angela Ann McGee. "Physician Readiness for Nurse Practitioners in the Emergency Department". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625666.

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Background: Emergency Department (ED) overcrowding is a national healthcare problem, and despite awareness and efforts to alleviate excessive patient volume, it continues to be an epidemic. One improvement technique proposed is to increase employment of independently licensed APRNs in the ED. Objective: The objective of this study was to determine if LMC and USACS physicians are willing and ready to implement and collaborate with NPs in the ED. Design and Methods: A non-experimental descriptive study design was employed, and sixty emergency medicine providers were surveyed. Eighteen participants (14 MDs, 4 DOs) completed an online questionnaire which consisted of 21 Likert-style questions, an open-ended question, and six demographic questions. Research questions: 1) What are physician perceptions regarding the tasks and resources required for NPs to practice in emergency medicine? 2) What are physician perceptions regarding the need, importance, and benefits of NPs in the ED? 3) What are physician perceptions of contextual factors regarding NPs’ working in the organization? Results: Entire Questionnaire: Mean = 2.02 (SD = .35); Subscale 1: Mean = 2.13 (SD = .33); Subscale 2: Mean = 1.79 (SD = .48); Subscale 3: Mean = 2.06 (SD = .49). Conclusion: This study concludes that, overall, there is a readiness to change among the USACS physicians. Evaluation of subscale 2 and 3 from this study indicates that USACS physicians are willing and ready to implement an NP service in LMC's ED. Furthermore, while discrepancies occurred in subscale 1, these differences can be mitigated through education, credentialing requirements, and policy development.

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Haupt, Eric F. "Predictors for Florida Nurse Practitioners' Characterization of Organizational Climate". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3101.

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Healthcare managers are failing to meet the increasing demand for services while experiencing a growing shortage of healthcare workers. The restrictive scope of practice regulations and organizational barriers have a negative effect on the number and growth of nurse practitioners available to meet the required demand. Researchers have focused on the organizational climate of the nursing profession in general, yet there is an absence of research regarding the perceptions of the advanced registered nurse practitioners (ARNPs) in their local practice environment. The purpose of this study was to examine if ARNP role identification, autonomy, and collaboration were predictive of perceived organizational climate. Lewin’s field theory formed the theoretical framework for the study. A sample of 187 ARNPs practicing in the state of Florida specializing in primary care completed the nurse practitioner–primary care organizational climate questionnaire administered via an online third party survey administration service. The results of the multiple linear regression analyses indicated the model as a whole was able to significantly predict organizational climate F(3, 183) = 12.498, p = .001, R2 = .681. Role identification (β = .346) provided the most contribution to the model, followed by collaboration (β = .296) and autonomy (β = .275). The implications for social change could include providing Florida state policymakers and healthcare managers with the meaningful information needed to develop concrete strategies for optimizing and retaining the ARNP workforce. Improving nurse practitioner engagement could lead to improved patient results and safety.

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33

Bell, Janet Deanne. "Articulating the nature of clinical nurse specialist practice". Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/d1018623.

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Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.

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White, Patricia A. "Exploration of nurse practitioner practice with clients who are grieving /". View online ; access limited to URI, 2007. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3277012.

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Simmonds, Katherine Elisabeth. "Nurse Practitioners' and Certified Nurse Midwives' Experiences Providing Comprehensive Early Abortion Care in New England". Thesis, University of Rhode Island, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10792692.

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Access to safe abortion care has been linked to better maternal and child health outcomes (Sedgh et al., 2012) and identified as essential for advancing women’s economic and social equality (Lang, 2013; Bengsch, 2015). Around the world, nurses, including nurse practitioners (NPs) and certified nurse midwives (CNMs), are integral members of the health care teams that provide care to women considering or electing to have an abortion. Evidence supports NPs and CNMs as safe and effective providers of comprehensive early abortion care, and acceptable to patients (Barnard, Kim, Park, & Ngo, 2015; Kallner et al., 2015; Weitz et al., 2013).

Currently in the United States (US), almost one million women have an induced abortion each year (Jones & Jerman, 2017). National abortion data reveal significant disparities in rates, and inequities in access (Jerman, Jones, & Onda, 2016). An inconsistent legal and regulatory landscape precludes NPs and CNMs from providing comprehensive abortion care in many states, including some where there are few providers. Vermont and New Hampshire comprise two of the four states where laws and practice regulations allow NPs and CNMs to perform aspiration abortion, and across New England. These advanced practice nurses (APRNs) are extensively involved in providing and managing the care of women undergoing medication abortion.

Little literature describes nurses’ experiences providing comprehensive early abortion care around the world, including in the US. The aim of this qualitative, exploratory, descriptive research study was to explore the experiences of NPs and CNMs who provide comprehensive early abortion care in New England. Data were collected through in-person individual interviews with seven NPs and one NP/CNM. Providing comprehensive early abortion care was generally a positive experience for most participants, though it did include challenges. Critical influences to becoming an NP or CNM who provided comprehensive early abortion care included the era in which participants came of age, values of their family of origin, exposure to feminism, reproductive rights and social justice during emerging adulthood, having a role model or mentor, and a personal experience of having an abortion were. Support at every level from interpersonal to societal was found to be a key enabling or constraining factor. Laws and regulations at the societal level were also noted to facilitate or impede abortion care provision by NPs and CNMs in the study. Finally, participants offered words of wisdom to others considering providing comprehensive early abortion care that ranged from clinical pearls to inspirational statements. They were universally encouraging in recommending this as a service to incorporate into clinical practice. This study has a number of implications for the future including the need for further research on NPs and CNMs experiences providing early abortion care in other regions of the US, and to remove state legislative and regulations that constrain practice for clinicians in this area of reproductive health care.

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Pounds, Karen Vincent. "Client nurse interactions with schizophrenic clients : a descriptive study /". View online ; access limited to URI, 2008. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3314447.

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37

Stamp, Kelly D. "Advanced registered nurse practitioners' judgments of coronary heart disease risk". [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001811.

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38

MacDonald, Janet M. "A higher level of practice : community nurse practitioners at work". Thesis, University of Sunderland, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251286.

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Community nurse practitioners from different parts of England were researched, who worked in General Practice, minor treatment centres or with homeless people. The aim of the research was to establish whether or not they were actually nursing, and if so, identify whether they were able to achieve a 'higher level of practice' ,as articulated by the UKCC Grounded theory, the qualitative research methodology developed by Glaser and Strauss, was used as a framework for the research. Data was gathered using primary observation with some participation (five hundred and eighty-one consultations being observed in the process), and by interviewing the community nurse practitioners and their clinical managers. The data was analysed using Glaser and Strauss' constant comparative method. Three theoretical frameworks emerged from the analysis. 'Negotiation for autonomy' is the core category at the heart of the overall theoretical framework that emanated from the research data. Those community nurse practitioners who were working at a 'higher level of practice' had the ability to negotiate for autonomy with GPs and multidisciplinary staff. It was this ability that allowed them the opportunity to practice with the autonomy required to be able to hold consultations with patients with undifferentiated diagnoses, as first point of access, providing care through to discharge or referral on to others. From a category, 'combination model of care,' within the overall theoretical framework, the researcher has developed a theoretical model of care, and a framework for the process - 'HADPIPE'. This model of care (and HADPIPE) is unique, as there is no other model of care, as opposed to a model of nursing, which has been developed, certainly in the UK, from researching the practice of nurses. The third theoretical framework sets down the characteristics of those practising at a 'higher level of practice. , This research highlights the nursing oriented approach to care taken by nurse practitio~ers, counteracting the argument that they merely perform a technical role.

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Connolly, Margaret Julia. "Nurse Practitioners: Limiting the Trade-Off between Quality and Cost". Thesis, Boston College, 2012. http://hdl.handle.net/2345/2627.

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Thesis advisor: Christopher Maxwell
Though much research has been done on the subject of substituting nurse practitioners for physicians as health care providers, both analytic methods and results have been inconsistent. Various studies have shown nurse practitioners to provide equivalent or improved care especially in primary care settings. However, no consensus has been reached on whether or not and under what conditions this substitution is economically efficient. Because of variation in productivity and substitution rates, the economic viability of nurse practitioners must be assessed on a department specific basis, taking into account differences in nurse practitioners’ job descriptions.One specific area this economic efficiency could be assessed in is in the diagnosis of ear infections. A study conducted through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey showed that 15% of pediatric visits included a diagnosis of middle ear infection (Freid, 1998). If employed properly, nurse practitioners could be used to achieve significant cost savings in this area.This thesis is intended to address the economic efficiency of nurse practitioners as compared to physicians in diagnosing ear infections. First nurse practitioner quality in this specific area will be assessed by comparing nurse practitioner diagnosis error rates to physician error rates based on surveys asking both types of providers to provide diagnoses based on tympanic membrane images collected through previous telemedicine visits. Next the economic practicality of employing nurse practitioners in this field will be assessed in terms of the relative costs of these errors, measured as the cost of unnecessary prescriptions in the case of overdiagnosis and the cost of an unnecessary follow-up visit in the case of underdiagnosis
Thesis (BA) — Boston College, 2012
Submitted to: Boston College. College of Arts and Sciences
Discipline: College Honors Program
Discipline: Economics Honors Program
Discipline: Economics

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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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Hamilton, Robert M. "Knowledge, Attitudes, and Perceptions of Nurse Practitioners about Antibiotic Stewardship". BYU ScholarsArchive, 2019. https://scholarsarchive.byu.edu/etd/8550.

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Background: Antibiotic stewardship (ABS) is a set of strategies to optimize the use of antibiotics with the goal of reducing antibiotic resistance, improving patient outcomes and decreasing unnecessary costs. ABS affects all venues of patient care, including outpatient, inpatient, and long-term care. While many strategies for ABS exist and best practice continues to evolve, successful ABS programs utilize a multidisciplinary approach. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study is to describe the knowledge, attitudes, and perceptions of NPs towards ABS.Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey developed for use in a previous study conducted at a university-affiliated hospital in Florida. Descriptive statistics were used to assess normality. Chi-Square test of independence was used to test differences categorical scores by NP setting, gender, and level of education. Pearson r correlation was completed to measure the relationship between age and years in practice.Results: Two hundred NPs completed the questionnaire (88% female; 70% Master’s degree). The range of experience was 0-45 years (mean 11 years). Most NPs worked in a private office (23%) or community setting (29%). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). NPs in this study also based their antibiotic decisions on the antibiogram (63%) in their setting, while 56% indicated they start with broad spectrum and tailor antibiotic choices when culture results are received. NPs reported understanding that inappropriate use of antibiotics causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important for their job (94%) and felt confident in their use of antibiotics (86%). However, while 94% of respondents somewhat or strongly agreed that antibiotics are overused nationally, only 62% thought antibiotics were overused in their health care setting. Conclusion: In this study, most NPs reported that antibiotic resistance is a problem and antibiotics are overused nationally. Fewer believe that antibiotic resistance is a problem locally and fewer still that they, personally, contribute to the problem. NPs recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.

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Moody, N. B., P. L. Smith e L. Lee Glenn. "Client Characteristics and Practice Patterns of Nurse Practitioners in Tennessee". Digital Commons @ East Tennessee State University, 1999. https://dc.etsu.edu/etsu-works/7536.

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This study's purpose was to describe the practice patterns of nurse practitioners (NPs) in Tennessee--specifically, the demographic characteristics and health problems of their clients and the therapeutic services they provide. A random sample of NPs practicing 20 or more hours per week in primary care in Tennessee provided data on a total of 680 clients seen during one selected day of care. An instrument adapted from the National Ambulatory Medical Care Survey (NAMCS) allowed comparison of the NP findings with a national survey of office-based physicians in five areas: client demographics, client health status, diagnostic tests ordered, therapeutic interventions provided, and client disposition. Although many similarities were seen, differences included the tendency of NPs to care for more younger and female clients, to perform fewer office surgical procedures, and to provide more health teaching/counseling interventions.

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Bevan, Jeffrey L. "The Contemporary Use of Nurse Practitioners in U.S. Emergency Departments". Otterbein University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1428664328.

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O'Rourke, Nancy C. "Political Efficacy and Political Participation of Nurse Practitioners: A Dissertation". eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/47.

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In many states, outdated rules and regulations restrict nurse practitioners (NPs) from practicing to their full potential, often limiting patients’ access to primary care. Modernizing NP state scope of practice laws and allowing patients greater access to NPs services is a priority. Unlike other professions, nurse practitioners have been unable to consistently influence legislative changes to health policy. This study examined the political efficacy and participation of nurse practitioners in the United States today (N=632). A descriptive cross sectional design, in conjunction with a political efficacy framework, evaluated nurse practitioners’ participation in political activities and their internal and external political efficacy. Increased internal political efficacy was significantly (p < 0.001) associated with NPs who were older, had specific health policy education, and have been mentored in health policy. Our findings show that NPs vote at consistently higher rates (94%) than the general population and almost 50% report contacting legislators via mail/email/phone. As a group however, NPs report limited participation in other political activities, especially grassroots efforts. These findings hold significant implications for the profession as we strive to make policy changes across the country. It is important that educators assess our current methods of educating NPs about politics and health policy. Professional organizations and policy makers must reexamine outreach and strategies to inspire greater grassroots engagement of NPs.

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Berglund, Carolyn. "Nursing Staff Development for Novice Nurse Practitioners in Acute Care". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6401.

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An acute care practice site reported 75% turnover of novice nurse practitioners (NPs), which indicated a gap in the transition from student to practitioner within the first year of clinical practice. This gap can leave novice NPs unprepared to manage patients effectively and contribute to high turnover. The practice-focused question addressed whether an evidence-based staff development program for novice NPs at an acute care site could be developed. The purpose of this project was to create a framework based on evidence to transition novice NPs successfully into practice. Benner's skill-acquisition in-nursing theory informed this project. Evidence was obtained by searching electronic databases, reviewing professional organization websites, and consulting with experts. The search revealed journal articles, best-practice guidelines, and useful insights from experts. The Elkins literature review matrix was used to organize, summarize, and weigh the evidence. A summary of consultations with experts was used. Commonalities within the evidence included guided clinical experiences and nonclinical activities such as (a) formal didactic sessions, (b) professional development, and (c) quality improvement. Outcomes include recommendations for a 12-month postgraduate development program framework and educational content. Recommendations were also provided for formative and summative evaluations. The implications of this project for social change include effective preparation of novice NPs and stabilization of the NP workforce at the project site.

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Lucero, Samantha. "Defining the Scope of Practice for Nurse Practitioners in MIAM". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4074.

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Minimally invasive aesthetic medicine (MIAM) is a relatively new field, which lacks a clearly defined scope of practice. The purpose of this project was to clarify the scope of practice for nurse practitioners in MIAM in California. Without a clearly defined scope of practice, nurse practitioners are unable to practice to the full extent of their license which causes them to be underutilized and face liability issues. This project sought to answer the question: What is the scope of practice of the nurse practitioner in MIAM in the state of California? The model of professional nursing practice regulation was the model used to guide this project. Sources of evidence included case law that has emerged since 1983; reviewing documents from 3 state boards of nursing; and a survey of nurse practitioners who practice in the field of MIAM. The evidence was analyzed noting themes while determining what the legal backbone is for nurse practitioner's scope of practice in California. This project found that nurse practitioners in this field keep up to date in their knowledge, educate their patients, utilize methods to maintain competency, feel support in their environment, assess and refer to others when appropriate, and teach both staff and patients evidence-based practices. It also found that standardized procedures are the legal backbone to understanding the scope of practice in California. A scope of practice was developed based on the findings of this project which was then reviewed by an expert. It is recommended that nurse practitioners utilize their resources to obtain and maintain knowledge as well as learn what the standardized procedures are in their facility. The implications for clarifying the scope of practice will serve this population to fully utilize their capabilities and practice safely, as well as help to develop this relatively new field.

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Myers, Trisha A. "Nurse practitioners in burn centers: an exploration of the developing role /". Click here to access thesis, 2006. http://www.georgiasouthern.edu/etd/archive/spring2006/trisha%5Fa%5Fmyers/myers%5Ftrisha%5Fa%5F200605%5Fmsn.pdf.

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Thesis (M.S.N.)--Georgia Southern University, 2006.
"A thesis submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Master of Science" ETD. Includes bibliographical references (p. 54-58) and appendices.

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Buhler, Patricia Lynn. "Prenatal care : a comparative evaluation of nurse-midwives and general practitioners". Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24489.

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The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate". Seventy-seven percent of the records of the NM cases received a "superior" score, where as 60% of the GP controls' records received an "inadequate" score [mathematical formula omitted] Overall, the general practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

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Sutherland, Jodi L. "Predicting nurse practitioners' intentions and behaviors to perform routine HIV screening". Thesis, State University of New York at Binghamton, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3713645.

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HIV/AIDS epidemic is a significant public health issue in the United States (U.S.). A dearth of research focusing on the need to increase HIV screening across healthcare settings (Branson et al., 2006; Centers for Disease Control and Prevention [CDC], 2010) exists, yet few studies focus on the healthcare providers perspective. Utilizing the Theory of Planned Behavior (TPB), this study examined nurse practitioner (NP) attitudinal, normative, and control beliefs toward routine HIV screening and their associations and relationships with intentions and behaviors.

A cross sectional study was conducted using a random sample of 600 members from the American Academy of Nurse Practitioners. A total of 180 NPs completed a questionnaire. SPSS Version 22 was used for analysis. Although NPs care for a majority of patients aged 13 - 64, few (25.3%) report routine HIV screening while almost half (48.2%) report having intentions. NPs with higher HIV screening intentions were associated with higher HIV screening behaviors, positive attitude scores, higher normative expectation scores, higher normative priority scores, higher facilitator scores, and lower control barrier scores. Logistic regression revealed that social normative expectations and control facilitators predicted intentions toward routine HIV screening. Higher HIV screening behaviors were associated with positive attitude scores, higher normative expectation scores, and lower control barrier scores. Logistic regression revealed that social normative expectations and attitudes predicted behaviors toward routine HIV screening. Logistic regression revealed few beliefs or demographic variables predicted intentions and behaviors. Practicing for 10 -20 years predicted HIV screening intentions, while belief of obtaining consent from a parent/guardian in patients <18 years of age, both rural and suburban communities, and having little to no specialty education in HIV screening were found to be most predictive of not routinely screening for HIV. Office staff support was found to be most predictive of HIV screening behaviors. The TPB is a valuable framework to examine healthcare provider behavior. The NP plays an important role in screening and case finding while focusing on health promotion and disease prevention. Greater coordinated efforts are needed to help NPs incorporate universal HIV screening into healthcare settings.

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Klein, Cara, e Cara Klein. "Treatment Practices of Arizona Nurse Practitioners for Older Adults with Depression". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624490.

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Depression is not a normal part of aging; despite this, 15-17% of older adults have symptoms of depression (Lakkis & Mahmassani, 2015). Depression in older adults not only negatively impacts quality of life, but also negatively impacts co-morbid disease progression (Gallagher et al., 2016; Oza, Patel, & Baptist, 2016; Sinnige et al., 2013; Song et al., 2014). Depression treatment improves co-morbid disease outcomes (Bogner et al., 2016; Wood et al., 2015). Arizona has a large population of older adults and the number of older adult is projected to increase 174% by the year 2050 (Arizona Department of Health Services, n.d.). The majority of depressed patients seek treatment in the primary care setting (Lakkis & Mahmassani, 2015; Samuels et al., 2015). Arizona has over five thousand nurse practitioners working in primary care (Arizona Department of Health Services, 2014b). The purpose of this project was to determine the treatment practices of nurse practitioners caring for older adults with depression in southern Arizona. A needs assessment, using a self-administered survey, was conducted to determine how southern Arizona nurse practitioners self-identify their ability to recognize and treat older adult depression. Results revealed that southern Arizona nurse practitioners have barriers to recognition and treatment of depression in older adults. Barriers to the recognition of depression in older adults included the older adult patient’s medical complaint, limited appointment times in the primary care setting, and limited experience as a nurse practitioner. Treatment barriers identified by survey results included the older adult patient’s attitude toward depression, financial status, and ability to participate in depression treatment. The majority of these barriers are consistent with evidence established in previous studies. The ability of the older adult to participate in depression treatment was a barrier identified in the results not found in the synthesis of evidence. This project supports existing evidence regarding barriers to the recognition and treatment of older adult depression in the primary care setting. Further research is indicated to evaluate if removing the identified barriers will increase the nurse practitioners’ ability to recognize and treat depression in the older adult.

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