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Holland DE, Vanderboom CE, Mandrekar J, Borah BJ, Dose AM, Ingram CJ, Griffin JM. A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial. Trials 2020; 21:895. [PMID: 33115524 PMCID: PMC7594268 DOI: 10.1186/s13063-020-04806-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Transitioning care from hospital to home is associated with risks of adverse events and poor continuity of care. These transitions are even more challenging when new approaches to care, such as palliative care, are introduced before discharge. Family caregivers (FCGs) are expected to navigate these transitions while also managing care. In addition to extensive caregiving responsibilities, FCGs often have their own health needs that can inhibit their ability to provide care. Those living in rural areas have even fewer resources to meet their self-care and caregiving needs. The purpose of this study is to test the efficacy and cost-effectiveness of an intervention to improve FCGs’ health and well-being. The intervention uses video visits to teach, guide, and counsel FCGs in rural areas during hospital-to-home transitions. The intervention is based on evidence of transitional and palliative care principles, which are individualized to improve continuity of care, provide caregiver support, enhance knowledge and skills, and attend to caregivers’ health needs. It aims to test whether usual care practices are similar to this technology-enhanced intervention in (1) caregiving skills (e.g., caregiving preparedness, communication with clinicians, and satisfaction with care), (2) FCG health outcomes (e.g., quality of life, burden, coping skills, depression), and (3) cost. We describe the rationale for targeting rural caregivers, the methods for the study and intervention, and the analysis plan to test the intervention’s effect. Methods The study uses a randomized controlled trial design, with FCGs assigned to the control condition or the caregiver intervention by computer-generated lists. The intervention period continues for 8 weeks after care recipients are discharged from the hospital. Data are collected at baseline, 2 weeks, 8 weeks, and 6 months. Time and monetary costs from a societal perspective are captured monthly. Discussion This study addresses 2 independent yet interrelated health care foci—transitional care and palliative care—by testing an intervention to extend palliative care practice and improve transition management for caregivers of seriously ill patients in rural areas. The comprehensive cost assessment will quantify the commitment and financial burden of FCGs. Trial registration ClinicalTrials.gov NCT03339271. Registered on 13 November 2017. Protocol version: 11. Supplementary information Supplementary information accompanies this paper at 10.1186/s13063-020-04806-0.
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Affiliation(s)
- Diane E Holland
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Catherine E Vanderboom
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jay Mandrekar
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Bijan J Borah
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ann Marie Dose
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Cory J Ingram
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. .,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Fougère B, Lagourdette C, Abele P, Resnick B, Rantz M, Kam Yuk Lai C, Chen Q, Moyle W, Vellas B, Morley JE. Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries. J Nutr Health Aging 2018; 22:463-470. [PMID: 29582884 DOI: 10.1007/s12603-018-1008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.
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Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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Abstract
PURPOSE OF STUDY The has reduced payments to hospitals that have excessive readmissions. This mandate has made it imperative for hospitals to implement a plan to manage readmissions and transitions of care for patients they serve. The purpose of this study was to ascertain whether an advanced practice, nurse-led, community-based model is effective in reducing acute health care utilization. PRIMARY PRACTICE SETTING The community case management (CCM) program was created more than 20 years ago to assess and manage care of patients demanding frequent emergency department (ED) visits and frequent hospitalizations, by providing in-home visits and care coordination by an advanced practice nurse or masters-prepared nurse. METHODOLOGY AND SAMPLE The charts of 307 patients who were referred to CCM were reviewed to assess their utilization of the health care system after referral. There were 2 groups of patients: those who accepted CCM services (N = 151) and those who refused CCM services (N = 156) upon referral. RESULTS It was found that if patients accepted CCM services, they had 55% fewer visits to the ED and 61% fewer hospital admissions than patients who refused CCM services. Utilization of urgent care was decreased by 47% in the patients who accepted CCM services, but this decline was not statistically significant. IMPLICATION FOR CASE MANAGEMENT PRACTICE The results of this study indicate that CCM is effective in decreasing hospital admissions and ED visits for the patients using CCM services. Implementing a CCM program could be an effective method for decreasing utilization of the hospital and ED by adult patients with at least 1 chronic disease.
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Mountain G, Cahill J, Thorpe H. Sensitivity and attachment interventions in early childhood: A systematic review and meta-analysis. Infant Behav Dev 2017; 46:14-32. [DOI: 10.1016/j.infbeh.2016.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 10/20/2016] [Accepted: 10/22/2016] [Indexed: 01/05/2023]
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Sullivan-Bolyai S, Grey M, Deatrick J, Gruppuso P, Giraitis P, Tamborlane W. Helping Other Mothers Effectively Work At Raising Young Children With Type 1 Diabetes. DIABETES EDUCATOR 2016; 30:476-84. [PMID: 15208845 DOI: 10.1177/014572170403000319] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study examined the feasibility of a postdiagnosis parent mentoring intervention for mothers of young children (1-10 years old) newly diagnosed with type 1 diabetes. METHODS A mixed-method, prospective, randomized, controlled clinical trial design was used. Parent mentors (experienced mothers who have successfully raised young children with type 1 diabetes) and mother participants with young children newly diagnosed with type 1 diabetes were recruited from 2 regional pediatric diabetes centers. The mentors were trained to provide informational, affirmational, and emotional support using Ireys' modified parent mentor curriculum. During a 6-month trial, mentors provided home visits and phone call support to the mothers who were randomized to the experimental group. The control group had the option of receiving the intervention after the 6-month trial. RESULTS Mothers in the experimental group had fewer concerns, more confidence, identified more resources, and perceived diabetes having less of a negative impact on their family compared with mothers in the control group. Parent mentors provided important, practical day-to-day management information, reassurance, and emotional support during times of crises. CONCLUSIONS A postdiagnosis parent mentoring intervention for mothers of children with diabetes appears to be feasible and potentially effective.
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Affiliation(s)
| | - Margaret Grey
- Schools of Nursing and Medicene, Yale University, New Haven, Connecticut
| | - Janet Deatrick
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Philip Gruppuso
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence
| | - Pamela Giraitis
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence
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Fougère B, Morley JE, Decavel F, Nourhashémi F, Abele P, Resnick B, Rantz M, Lai CKY, Moyle W, Pédra M, Chicoulaa B, Escourrou E, Oustric S, Vellas B. RETRACTED: Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care. J Am Med Dir Assoc 2016; 17:782-8. [PMID: 27321868 DOI: 10.1016/j.jamda.2016.05.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/22/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editors-in-Chief. The authors have plagiarized part of a report that had already appeared in Delamaire M-L, Lafortune G. Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries. OECD Health Working Papers No. 54. Paris: Organisation for Economic Co-operation and Development, 2010. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.
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Affiliation(s)
- Bertrand Fougère
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France.
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO
| | - Frédérique Decavel
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Fati Nourhashémi
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Patricia Abele
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO
| | | | - Marilyn Rantz
- Sinclair School of Nursing and Family and Community Medicine, University of Missouri, Columbia, MO
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, Special Administrative Region of the People's Republic of China
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Maryse Pédra
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, France
| | - Emile Escourrou
- Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, France
| | - Stéphane Oustric
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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Ter Maten-Speksnijder AJ, Dwarswaard J, Meurs PL, van Staa A. Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study. J Clin Nurs 2016; 25:3219-3228. [PMID: 27411952 DOI: 10.1111/jocn.13345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions. BACKGROUND Nurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases. DESIGN An ethnographic study. METHODS Episodic participant observations (in total 48 hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures. RESULTS The nurse practitioners perceived the monitoring of patients' treatment as their main professional responsibility. Four monitoring strategies could be distinguished: 'assessing health conditions', 'connecting with patients', 'prioritising treatment in daily living' and 'educating patients'. CONCLUSION While nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients' illness perceptions to the background was not conducive to self-management support. RELEVANCE TO CLINICAL PRACTICE By their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases' treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients' individual needs.
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Affiliation(s)
| | - Jolanda Dwarswaard
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Pauline L Meurs
- iBMG, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - AnneLoes van Staa
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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Leonardo ME, Resick LK, Bingman CA, Strotmeyer S. The Alternatives for Wellness Centers: Drown in Data or Develop a Reasonable Electronic Documentation System. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822303260932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measuring and quantifying the outcomes of care are becoming essential activities for the ongoing operation of nurse-managed health centers. Centers need a data collection system to collect meaningful data that assist with the development of programs and services, measure clinical outcomes, and promote health policy. Accomplishing these objectives is especially difficult in a health and wellness setting designed for an aging population. When tracking the care process over time, it is possible to drown in the data, especially qualitative data. This article describes the experiences of advanced practice nurses as they explored alternatives and devised a system to collect and manage qualitative and quantitative data using the Omaha System in a health and wellness setting for older adults. To be successful, nurse managed health centers and all providers must systematically evaluate their data and information needs as well as available systems and then implement an action plan.
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Affiliation(s)
- Maureen E. Leonardo
- Duquesne University, Pittsburgh, Pennsylvania, Family Medical Associates in Rillton, Pennsylvania
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Hannan J, Brooten D, Youngblut JM, Galindo AM. Comparing mothers' postpartum concerns in two clinical trials 18 years apart. J Am Assoc Nurse Pract 2016; 28:604-611. [PMID: 27273192 DOI: 10.1002/2327-6924.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE To determine if U.S. women's postpartum concerns have changed over time. METHODS Mothers' postpartum concerns were compared in two clinical trials: 1997 (high-risk pregnancy) and 2015 (first-time mothers). Advanced practice nurses (APNs) provided care through 8 weeks postpartum and recorded interactions in clinical logs. Content analysis of logs was used for identifying concerns. RESULTS Ninety-five percent of 58 1997 mothers were African American; 64% of 62 2015 mothers were Hispanic. The number of infant concerns (129 vs. 144) was similar to four of the top five infant concerns; infant feeding was the top concern for both groups. The 1997 mothers were concerned with body changes, birth control, breastfeeding, maternal health problems, and had more concerns about their health (142 vs. 43); the 2015 mothers were concerned with not having help, fatigue, finding things hard. Both groups had postpartum pain concerns and problems accessing mother/infant governmental programs. CONCLUSIONS Mothers' concerns regarding infant care were essentially the same over the two time periods with infant feeding as the top concern. Maternal concerns in common were postpartum pain and needing help accessing government programs. Women who had high-risk pregnancies had more health concerns. IMPLICATIONS FOR PRACTICE Results provide guidance for helping minority mothers in the postpartum period.
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Affiliation(s)
- Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | | | - Ali Marie Galindo
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
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Zhao Y, Kane I, Mao L, Shi S, Wang J, Lin Q, Luo J. The Prevalence of Antenatal Depression and its Related Factors in Chinese Pregnant Women who Present with Obstetrical Complications. Arch Psychiatr Nurs 2016; 30:316-21. [PMID: 27256935 DOI: 10.1016/j.apnu.2015.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The psychological status of Chinese pregnant women who present with obstetrical complications is concerning to Chinese health professionals. This study aimed to investigate the prevalence of antenatal depression and analyzed related risk factors in a population of high-risk Chinese women. DESIGN A large sample size, cross-sectional study. METHODS A total of 842 pregnant women with complications completed the Chinese version of the Postpartum Depression Screen Scale (PDSS) in this cross-sectional study. t-Test, ANOVA and Binary logistic regression tests were used in data analysis of antenatal depression and risk factors. RESULTS The prevalence of major or minor depression in high-risk Chinese pregnant women during antenatal period was 8.3% and 28.9%, respectively. Independent-sample t-test and two-way analysis of variance (ANOVA) indicated significant differences in age, education, occupation and the number of complications (P<0.05). Binary logistic regression analysis indicated a significant negative association between depression and education (P<0.01) with lower educational level (OR: 0.590; 95% CI: 0.424-0.820) associated with a higher risk for depression. A significant positive association was observed between depression and age (P<0.05) with higher age (OR: 1.338; 95% CI: 1.008-1.774) correlated with a higher risk for depression. CONCLUSIONS Women who experienced obstetric complications presented with higher PDSS depression scores. Screening for antenatal depression in high-risk pregnant women to promote early detection of depression and reduce health risks for universal health promotion is recommended.
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Affiliation(s)
- Ying Zhao
- School of Nursing, Fudan University, Shanghai PR China; Psychiatry Department, Fudan University affiliated Huashan Hospital, Shanghai, PR China
| | - Irene Kane
- University of Pittsburgh, School of Nursing, Pittsburgh, PA
| | - Liping Mao
- Fudan University affiliated Women's Hospital, Shanghai, PR China.
| | - Shenxun Shi
- Psychiatry Department, Fudan University affiliated Huashan Hospital, Shanghai, PR China
| | - Jing Wang
- Fudan University affiliated Women's Hospital, Shanghai, PR China
| | - Qiping Lin
- Fudan University affiliated Women's Hospital, Shanghai, PR China.
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China
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Holland DE, Vanderboom CE, Delgado AM, Weiss ME, Monsen KA. Describing pediatric hospital discharge planning care processes using the Omaha System. Appl Nurs Res 2015; 30:24-8. [PMID: 27091248 DOI: 10.1016/j.apnr.2015.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Although discharge planning (DP) is recognized as a critical component of hospital care, national initiatives have focused on older adults, with limited focus on pediatric patients. We aimed to describe patient problems and targeted interventions as documented by social workers or DP nurses providing specialized DP services in a children's hospital. METHODS Text from 67 clinical notes for 28 patients was mapped to a standardized terminology (Omaha System). Data were deductively analyzed. RESULTS A total of 517 phrases were mapped. Eleven of the 42 Omaha System problems were identified. The most frequent problem was health care supervision (297/517; 57.4%). Three Omaha System intervention categories were used (teaching, guidance, and counseling; case management; and surveillance). Intervention targets are varied by role. CONCLUSION The findings provide a rich description of the nature of DP for complex pediatric patients and increase our understanding of the work of DP staff and the influence of the DP practice model.
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Affiliation(s)
- Diane E Holland
- Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, USA, 55905.
| | | | - Adriana M Delgado
- Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, USA, 55905
| | - Marianne E Weiss
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA, 53233
| | - Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA, 55455
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Developing a rural transitional care community case management program using clinical nurse specialists. CLIN NURSE SPEC 2015; 28:147-55. [PMID: 24714432 DOI: 10.1097/nur.0000000000000044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. BACKGROUND As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. RATIONALE Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. DESCRIPTION After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. OUTCOMES The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. CONCLUSION Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. IMPLICATIONS The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.
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American Academy of Nursing: Improving health and health care systems with advanced practice registered nurse practice in acute and critical care settings. Nurs Outlook 2015; 62:366-70. [PMID: 25353040 DOI: 10.1016/j.outlook.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monsen KA, Holland DE, Fung-Houger PW, Vanderboom CE. Seeing the whole person: feasibility of using the Omaha System to describe strengths of older adults with chronic illness. Res Theory Nurs Pract 2015; 28:299-315. [PMID: 25577860 DOI: 10.1891/1541-6577.28.4.299] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A promising strategy for enhancing care and self-management of chronic illness is an integrative, whole-person approach that recognizes and values well-being. Assessment tools are needed that will enable health care professionals to perceive patients as whole persons, with strengths as well as problems. The purpose of this study was to examine the feasibility of using a standardized terminology (the Omaha System) to describe strengths of older adults with chronic illness. The Omaha System assessment currently consists of identifying signs/symptoms for 42 health concepts. Researchers mapped self-reported strengths phrases to Omaha System concepts using existing narratives of 32 older adults with 12-15 comorbid conditions. Results demonstrated the feasibility of describing strengths of patients with chronic illness. Exploratory analysis showed that there were 0-9 strengths per patient, with unique strengths profiles for 30 of 32 patients. Given that older adults with multiple chronic illnesses also have strengths that can be classified and quantified using the Omaha System, there is potential to use the Omaha System as a whole-person assessment tool that enables perception of both problems and strengths. Further research is needed to enhance the Omaha System to formally represent strengths-based as well as a problem-focused perspectives.
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Affiliation(s)
- Karen A Monsen
- University of Minnesota, School of Nursing, Minneapolis, MN 55455, USA.
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Wang F, Li CB, Li S, Li Q. Integrated interventions for improving negative emotions and stress reactions of young women receiving total hysterectomy. Int J Clin Exp Med 2014; 7:331-336. [PMID: 24482729 PMCID: PMC3902281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/15/2013] [Indexed: 06/03/2023]
Abstract
50% of women had obvious abnormal emotions before hysterectomy and hysterectomy can cause strong mental stress reaction. This study was to investigate the impact of psychological health education based integrated interventions on the preoperative negative emotions and stress of patients younger than 45 years receiving total hysterectomy. Forty patients undergoing total hysterectomy were randomly divided into psychological intervention (PI) group and control group (n=20 per group). Patients in PI received peri-operative psychological intervention (supportive psychotherapy, health education, individual depth psychotherapy, family and society supportive care, education on anesthesia and surgery etc.); Interventions were not used in control group. Hamilton Anxiety Scale and Hamilton Depression Rating Scale were used to evaluate patients in two groups on admission (T1) and before surgery (T2; after interventions in PI group). Serum levels of cortisol and IL-6 were detected at T1, T2 and the second day after surgery (T3). Results showed that 1) Patients had obvious anxiety and depression symptoms before and after total hysterectomy. For patients in PI group, the Hamilton Anxiety Scale (HAMA) score decreased from 14.4±5.9 to 9.1±4.2 and the Hamilton Depressing Scale (HAMD) score from 17.8±3.5 to 9.4±6.8 after interventions; 2) In PI group, the serum cortisol was 13.4±3.9 μg/dl at T2 and 14.2±4.8 μg/dl at T3 which were significantly lower than that at T1 (16.6±4.0 μg/dl) and that in the control group at T2 (13.4±3.9/15.5±4.3 μg/dl, t=2.10, P<0.05). Thus, preoperative integrated intervention based on psychological health education can improve peri-operative negative emotions and psychological stress in young patients undergoing hysterectomy.
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Affiliation(s)
- Fen Wang
- Department of Anesthesia, Tenth People’s Hospital Affiliated to Tongji UniversityShanghai 200072, China
| | - Chun-Bo Li
- Shanghai Mental Health Center, Shanghai Jiaotong UniversityShanghai 200030, China
| | - Shenghua Li
- Department of Anesthesia, Jiading Central HospitalShanghai 201800, China
| | - Quan Li
- Department of Anesthesia, Tenth People’s Hospital Affiliated to Tongji UniversityShanghai 200072, China
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Li J, Wang H, Xie H, Mei G, Cai W, Ye J, Zhang J, Ye G, Zhai H. Effects of post-discharge nurse-led telephone supportive care for patients with chronic kidney disease undergoing peritoneal dialysis in China: a randomized controlled trial. Perit Dial Int 2014; 34:278-88. [PMID: 24385331 DOI: 10.3747/pdi.2012.00268] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with end-stage renal failure (ESRF) need integrated health care to maintain a desirable quality of life. Studies suggest that post-discharge nurseled telephone support has a positive effect for patients suffering from chronic diseases. But the post-discharge care is under-developed in mainland China and the effects of post-discharge care on patients with peritoneal dialysis have not been conclusive. AIM The purpose of this study is to test the effectiveness of postdischarge nurse-led telephone support on patients with peritoneal dialysis in mainland China. METHODS A randomized controlled trial was conducted in the medical department of a regional hospital in Guangzhou. 135 patients were recruited, 69 in the study group and 66 in the control group. The control group received routine hospital discharge care. The study group received post-discharge nurse-led telephone support. The quality of life (Kidney Disease Quality of Life Short Form, KDQOL-SF), blood chemistry, complication control, readmission and clinic visit rates were observed at three time intervals: baseline before discharge (T1), 6 (T2) and 12 (T3) weeks after discharge. RESULTS Statistically significant effects were found for symptom/problem, work status, staff encouragement, patient satisfaction and energy/fatigue in KDQOL-SF and 84-day (12-week) clinic visit rates between the two groups. The study group had more significant improvement than the control group for sleep, staff encouragement at both T2 and T3, and pain at T2 and patient satisfaction at T3. No significant differences were observed between the two groups for the baseline measures, other dimensions in KDQOL-SF, blood chemistry, complication control, readmission rates at all time intervals and clinic visit rates at the first two time intervals. CONCLUSIONS Post-discharge nurse-led telephone support for patients undergoing peritoneal dialysis is effective to enhance patients' well-being in the transition from hospital to home in mainland China.
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Affiliation(s)
- Juan Li
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Huizhen Wang
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Hongzhen Xie
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Guiping Mei
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Wenzhi Cai
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Junsheng Ye
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Jianlin Zhang
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Guirong Ye
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
| | - Huimin Zhai
- School of nursing, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Nursing, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China; Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; and Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong 510010, China
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Sadler LS, Slade A, Close N, Webb DL, Simpson T, Fennie K, Mayes LC. Minding the Baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Ment Health J 2013; 34:391-405. [PMID: 24049219 DOI: 10.1002/imhj.21406] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper we focus on the first wave of outcomes in a pilot phase randomized control trial of a home-based intervention for infants and their families, Minding the Baby® (MTB), an interdisciplinary, mentalization-based intervention in which home visiting services are provided by a team that includes a nurse practitioner and a clinical social worker. Families are recruited during mother's pregnancy and continue through the child's second birthday. Analyses revealed that intervention families were more likely to be on track with immunization schedules at 12 months, had lower rates of rapid subsequent childbearing, and were less likely to be referred to child protective services. In addition, mother-infant interactions were less likely to be disrupted at 4 months when mothers were teenagers, and all intervention infants were more likely to be securely attached, and less likely to be disorganized in relation to attachment at one year. Finally, mothers' capacity to reflect on their own and their child's experience improved over the course of the intervention in the most high-risk mothers.
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Affiliation(s)
- Lois S Sadler
- Yale School of Nursing, University of New York ; Yale Child Study Center, University of New York
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Kulakçi H, Emiroğlu ON. Impact of nursing care services on self-efficacy perceptions and healthy lifestyle behaviors of nursing home residents. Res Gerontol Nurs 2013; 6:242-52. [PMID: 23938158 DOI: 10.3928/19404921-20130729-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/03/2013] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the impact of tailored individualized nursing care services on the self-efficacy perceptions and healthy lifestyle behaviors of older adults living in a nursing home in Turkey. This outcomes evaluation research used a quasi-experimental study design in which outcomes evaluations were repeated within time intervals in a single group. The study sample included 30 older adults. Nursing diagnoses and interventions were identified using the Omaha System. The impact of implemented nursing care services was evaluated using the Self-Efficacy Scale and Healthy Life-Style Behaviours Scale II. A total of 3,024 nursing interventions were performed, and self-efficacy perceptions and healthy lifestyle behaviors of older nursing home residents were significantly increased in a positive manner (p < 0.05). The results suggest that nurses should assess self-efficacy perceptions and healthy lifestyle behaviors of older adults and that nursing care services directed at health promotion of older adults should be maintained.
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Looman WS, Presler E, Erickson MM, Garwick AW, Cady RG, Kelly AM, Finkelstein SM. Care coordination for children with complex special health care needs: the value of the advanced practice nurse's enhanced scope of knowledge and practice. J Pediatr Health Care 2013; 27:293-303. [PMID: 22560803 PMCID: PMC3433641 DOI: 10.1016/j.pedhc.2012.03.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 11/15/2022]
Abstract
Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. Existing literature that addresses the relevance of the advanced practice nurse (APN) role as a fit for coordination of care for children with special health care needs (SHCN) is limited. The objective of this article is to describe the value of the APN's enhanced scope of knowledge and practice for relationship-based care coordination in health care homes that serve children with complex SHCN. The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a health care home for children with SHCN.
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Affiliation(s)
- Wendy S Looman
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
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21
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Kilpatrick K, DiCenso A, Bryant-Lukosius D, Ritchie JA, Martin-Misener R, Carter N. Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey. Int J Nurs Stud 2013; 50:1524-36. [PMID: 23548169 DOI: 10.1016/j.ijnurstu.2013.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/15/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical nurse specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for clinical nurse specialists. Previous studies have found that clinical nurse specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of clinical nurse specialists. OBJECTIVE To identify the practice patterns of clinical nurse specialists in Canada. DESIGN A descriptive cross-sectional survey. PARTICIPANTS Self-identified clinical nurse specialists in Canada. METHODS A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified clinical nurse specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis. RESULTS The actual number of clinical nurse specialists in Canada remains unknown. The response rate using the number of registry-identified clinical nurse specialists was 33% (804/2431). Of this number, 608 reported working as a clinical nurse specialist. The response rate for graduate-prepared clinical nurse specialists was 60% (471/782). The practice patterns of clinical nurse specialists varied across clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support clinical nurse specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a clinical nurse specialist and consequently made it difficult to determine the number of clinical nurse specialists in Canada. CONCLUSIONS This is the first national survey of clinical nurse specialists in Canada. A clearer understanding of these roles provides stakeholders with much needed information about clinical nurse specialist practice patterns. Such information can inform decisions about policies, education and organizational supports to effectively utilize this role in healthcare systems. This study emphasizes the need to develop standardized educational requirements, consistent role titles and credentialing mechanisms to facilitate the identification and comparison of clinical nurse specialist roles and role outcomes internationally.
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Affiliation(s)
- Kelley Kilpatrick
- Canadian Centre for Advanced Practice Nursing Research, Faculty of Nursing, Université de Montréal, Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Hôpital Maisonneuve-Rosemont, CSA - RC - Aile bleue - Bureau F121, 5415 boul. l'Assomption, Montréal, QC, Canada H1T 2M4.
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Abstract
Advancing pediatric palliative care is desperately needed to support the physical, emotional, cultural, spiritual, and psychosocial needs of children and families who live with life-threatening illnesses. Although educational resources and standards of practice related to this topic have been developed, dissemination and implementation of programs have been slow to progress. The purpose of this case study is to present the lived experiences of an adolescent with leukemia and his family to illustrate how health care providers may benefit from receiving enhanced palliative and end-of-life care education.
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Smith JE. The advanced practice wound ostomy continence nurse in homecare. HOME HEALTHCARE NURSE 2012; 30:586-595. [PMID: 23131686 DOI: 10.1097/nhh.0b013e3182705d1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Wound ostomy continence (WOC) programs are essential in any healthcare organization, including home care agencies, to provide comprehensive, high-quality care. Advanced practice nurses (APNs) with assessment, diagnostic, and coordination skills are well suited to manage the complex patients being cared for by home care agencies. A number of research studies have assessed the credibility and value of APNs in the home care setting, caring for complex, frail patients. This article describes the role of the APN, and the role of the WOC specialist nurse, comparing similarities and differences. The advanced practice WOC nurse is now essential in the home care setting to manage the care of complex patients.
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Affiliation(s)
- Janet E Smith
- School of Nursing and Health Sciences, La Salle University, 1900 W. Olney Ave., Philadelphia, PA 19141, USA.
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Brooten D, Youngblut JM, Deosires W, Singhala K, Guido-Sanz F. Global considerations in measuring effectiveness of advanced practice nurses. Int J Nurs Stud 2012; 49:906-12. [DOI: 10.1016/j.ijnurstu.2011.10.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 11/28/2022]
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Brooten D, Youngblut JM, Hannan J, Guido-Sanz F, Neff DF, Deoisres W. Health Problems and APN Interventions in Pregnant Women with Diabetes. PACIFIC RIM INTERNATIONAL JOURNAL OF NURSING RESEARCH 2012; 16:85-96. [PMID: 24660041 PMCID: PMC3961487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to compare health problems and advanced practice nursing (APN) interventions in two types of APN care provided to 41 childbearing women with diabetes. The study's design involved content analysis of interaction logs containing the process of APN care during two clinical trials: 1) APN care was added to physician care (n = 22); and, 2) half of physician care was substituted with APN care (n = 19). Women's' health problems and APN interventions were classified using the Omaha System's Problem Scheme and Intervention Scheme. The women, in the study, had a mean age of 30, and were predominantly Black, high school graduates, with a low income. The findings identified 61,004 health problems and 60,980 APN interventions from the interaction logs. APNs provided significantly more interventions antenatally to the women in the substitution group than to those in the additive group. However, the overall categories of problems were the same in both groups. Surveillance and health teaching/counseling were the top APN interventions antenatally and postpartum. Case management interventions were third most common for both groups, while treatments and procedures constituted the least number of APN interventions in each group before and after birth. When APNs shared care more equally with physicians, they intervened differently in type and number of interventions. Their broad range of skills and depth of understanding in clinical practice, health systems, family and personal issues allowed them to intervene early and effectively.
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Affiliation(s)
- Dorothy Brooten
- Florida International University, University Park, 11200SW 8 Street, Miami, FL 33199, USA
| | - Joanne M Youngblut
- Florida International University, University Park, 11200SW 8 Street, Miami, FL 33199. USA
| | - Jean Hannan
- Florida International University, University Park, 11200SW 8 Street, Miami, FL 33199, USA
| | - Frank Guido-Sanz
- Florida International University, University Park, 11200SW 8 Street, Miami, FL 33199, USA
| | - Donna Felber Neff
- University of Florida, College of Nursing HPNP Room 3232; PO Box 100197, Gainesville, FL 32610, USA
| | - Wannee Deoisres
- Burapha University, Faculty of Nursing, 169 Longhard Bangsaen Road, Muang, Chon Buri Province, Thailand
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26
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Hanrahan NP, Delaney KR, Stuart GW. Blueprint for development of the advanced practice psychiatric nurse workforce. Nurs Outlook 2012; 60:91-104. [DOI: 10.1016/j.outlook.2011.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/06/2011] [Accepted: 04/13/2011] [Indexed: 11/30/2022]
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27
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Thompson CW, Monsen KA, Wanamaker K, Augustyniak K, Thompson SL. Using the Omaha System as a Framework to Demonstrate the Value of Nurse Managed Wellness Center Services for Vulnerable Populations. J Community Health Nurs 2012; 29:1-11. [DOI: 10.1080/07370016.2012.645721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Kim MY. Effects of Oncology Clinical Nurse Specialists' Interventions on Nursing-Sensitive Outcomes in South Korea. Clin J Oncol Nurs 2011; 15:E66-74. [DOI: 10.1188/11.onf.e66-e74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV. Nurs Res Pract 2011; 2011:840248. [PMID: 21935499 PMCID: PMC3169337 DOI: 10.1155/2011/840248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/09/2011] [Indexed: 11/17/2022] Open
Abstract
Individuals with serious mental illness have greater risk for contracting HIV, multiple morbidities, and die 25 years younger than the general population. This high need and high cost subgroup face unique barriers to accessing required health care in the current health care system. The effectiveness of an advanced practice nurse model of care management was assessed in a four-year random controlled trial. Results are reported in this paper. In a four-year random controlled trial, a total of 238 community-dwelling individuals with HIV and serious mental illness (SMI) were randomly assigned to an intervention group (n=128) or to a control group (n=110). Over 12 months, the intervention group received care management from advanced practice psychiatric nurse, and the control group received usual care. The intervention group showed significant improvement in depression (P=.012) and the physical component of health-related quality of life (P=.03) from baseline to 12 months. The advanced practice psychiatric nurse intervention is a model of care that holds promise for a higher quality of care and outcomes for this vulnerable population.
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30
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Oddsdóttir EJ, Sveinsdóttir H. The content of the work of clinical nurse specialists described by use of daily activity diaries. J Clin Nurs 2011; 20:1393-404. [DOI: 10.1111/j.1365-2702.2010.03652.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The people of the United States sent a clear message in November 2008 that they wanted a change in the nation's priorities, including healthcare. The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This article addresses this question by examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults. The article concludes with strategies and Web-based resources for nurses to bring aging issues to the healthcare reform debate at both the national and local levels.
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Van Soeren M, Hurlock-Chorostecki C, Reeves S. The role of nurse practitioners in hospital settings: implications for interprofessional practice. J Interprof Care 2010; 25:245-51. [DOI: 10.3109/13561820.2010.539305] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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33
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Hobbie WL, Ogle SK, Reilly M, Ginsberg JP, Rourke M, Ratcliffe S, Deatrick JA. Identifying the educational needs of parents at the completion of their child's cancer therapy. J Pediatr Oncol Nurs 2010; 27:190-5. [PMID: 20562388 DOI: 10.1177/1043454209360778] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For parents of children with cancer, the experience of completing treatment can be a time of celebration and hope as well as anxiety and fear. Previous research has identified the time immediately following completion of therapy as one of the most difficult and anxiety producing periods in parents' trajectory of cancer treatment. A gap in knowledge exists to guide nursing practice regarding parents' educational needs. The purpose of this study was to (a) determine the educational needs of parents as their children completed cancer treatment and (b) assess the feasibility of measuring parental educational needs, anxiety, and family management styles as treatment ends. The results support previous findings that parents are anxious at the end of therapy. Fear of relapse was their primary concern. Although parents desire education at the end of therapy, attention to parental readiness to learn and the individual needs of the patient and family must be considered. In the feasibility portion of this study, parents were able to complete the questionnaires with no negative feedback provided.
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Hanrahan NP, Delaney K, Merwin E. Health care reform and the federal transformation initiatives: capitalizing on the potential of advanced practice psychiatric nurses. Policy Polit Nurs Pract 2010; 11:235-44. [PMID: 21233135 PMCID: PMC3392024 DOI: 10.1177/1527154410390381] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed.
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Affiliation(s)
- Nancy P Hanrahan
- University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
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35
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D'Errico EM, Lewis MA. RN Continuity in Home Health: Does It Make a Difference? HOME HEALTH CARE MANAGEMENT AND PRACTICE 2010. [DOI: 10.1177/1084822309355905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuity of care in home health is valued but poorly understood. This article is about the delivery of nursing care to elderly home health patients and to determine if visits provided by the same RN improve selected “Outcome and Assessment Information Set” outcomes. Functional status, psychological status, and use of emergent care were examined. Cases selected represented individuals aged 65 years and older, with at least one chronic illness and a good prognosis. Patients received four or more visits from the same RN.The clinical and administrative billing records from an initial 60-day period yielded a convenience sample of 887 discharged cases from a suburban, U.S. hospital-based home health agency. Higher levels of RN continuity were associated with a decreased likelihood of neuro/emotional/behavioral issues for patients at discharge. The findings showed no relationship of RN continuity of care to functional status and use of emergent care for the period examined.
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Affiliation(s)
| | - Mary Ann Lewis
- University of California at Los Angeles, Los Angeles, CA, USA
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36
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Westra BL, Oancea C, Savik K, Marek KD. The feasibility of integrating the Omaha system data across home care agencies and vendors. Comput Inform Nurs 2010; 28:162-71. [PMID: 20431359 PMCID: PMC3090219 DOI: 10.1097/ncn.0b013e3181d7812c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Federal and state initiatives are aligning around the goal that by 2014 all Americans will have electronic health records to support access to their health information any time and anywhere. As a key healthcare provider, nursing data must be included to enhance patient safety, effectiveness, and efficiency of care that is patient-centric. The purpose of this study was to test the feasibility of abstracting, integrating, and comparing the effective use of a standardized terminology, the Omaha System, across software vendors and 15 home care agencies. Results showed that the 2900 patients in this study had an average of four problems on care plans, with interventions most frequently addressing surveillance (39%) and teaching (30%). Findings in this study support the feasibility of integrating data across software vendors and agencies as well as the usefulness for describing care provided in home care. However, before exchanging data across systems, data quality issues found in this study need attention. There were missing data for 10.8% of patients as well as concerns about the validity of using the problem rating scale for outcomes. Strategies for effective use of standardized nursing terminologies are recommended.
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Affiliation(s)
- Bonnie L Westra
- School of Nursing, University of Minnesota, Minneapolis, MN, USA.
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37
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Wong FKY, Chow SKY, Chan TMF. Evaluation of a nurse-led disease management programme for chronic kidney disease: A randomized controlled trial. Int J Nurs Stud 2010; 47:268-78. [DOI: 10.1016/j.ijnurstu.2009.07.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/23/2009] [Accepted: 07/05/2009] [Indexed: 01/28/2023]
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38
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Bakerjian D. Care of nursing home residents by advanced practice nurses. A review of the literature. Res Gerontol Nurs 2010; 1:177-85. [PMID: 20077962 DOI: 10.3928/19404921-20080701-04] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The complexity of care in nursing homes has steadily increased during the past several years. Many nursing homes now provide care for both short-stay and long-stay patients who range in age from young to very old. At the same time, there has been a shortage of primary care physicians to provide care while nursing homes have been under intense scrutiny and pressure to improve the quality of care provided. Advanced practice nurses (APNs) are increasingly evident members of the nursing home workforce, providing both primary care to individual residents in collaboration with physicians and consultative services to nursing homes. This article reviews the research that documents the relationship between APNs and improved quality of care and begins a discussion of what constitutes APN best practices in the nursing home setting.
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Affiliation(s)
- Debra Bakerjian
- University of California-San Francisco, 3333 California Street, San Francisco, CA 94118, USA.
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Ford WT, Britting LL. Nonphysician providers in the hospitalist model: a prescription for change and a warning about unintended side effects. J Hosp Med 2010; 5:99-102. [PMID: 20104626 DOI: 10.1002/jhm.556] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- William T Ford
- Section of Hospital Medicine, Cogent Healthcare, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
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Friese CR, Aiken LH. Failure to rescue in the surgical oncology population: implications for nursing and quality improvement. Oncol Nurs Forum 2009; 35:779-85. [PMID: 18765323 DOI: 10.1188/08.onf.779-785] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE/OBJECTIVES To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice. DESIGN Secondary analysis of inpatient claims. SETTING Data obtained from the Pennsylvania Health Care Cost Containment Council were linked with data from the Pennsylvania Cancer Registry. SAMPLE 24,618 patients with solid tumors hospitalized for tumor-directed surgery in 164 acute care hospitals from 1998-1999. METHODS Frequency distributions examined the incidence of each complication, the proportion of patients who died with the complication, and complication frequency by tumor type. Chi-square tests compared the frequency of complications for patients who were admitted routinely or via the emergency department. MAIN RESEARCH VARIABLES 30-day mortality, postoperative complications, and tumor type. FINDINGS The most frequent complication in the sample was gastrointestinal bleeding (13.2%); however, 37.1% of patients who died had respiratory compromise as a complication. Admission through the emergency department was significantly associated with experiencing a complication (71.9% versus 43.9%). CONCLUSIONS Treatable but serious postoperative complications are frequent and can be fatal in the surgical oncology population. Complication frequency and fatality vary significantly by cancer type. IMPLICATIONS FOR NURSING The complications studied are detectable by nurses and can be managed successfully with timely intervention. Recognition of complications at an early stage and evidence-based management may assist nurses in patient rescue and, ultimately, improve quality of care.
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ONISHI MAMI, SASAKI MINAKO, NAGATA AYAKO, KANDA KATSUYA. Development of nurses with specialties: the nurse administrators’ perspective. J Nurs Manag 2008; 16:795-803. [DOI: 10.1111/j.1365-2834.2008.00882.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Acute care nurse practitioner: an advanced practice role for RN first assistants. AORN J 2008; 87:1205-15. [PMID: 18549834 DOI: 10.1016/j.aorn.2007.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 07/25/2007] [Accepted: 07/26/2007] [Indexed: 11/21/2022]
Abstract
Acute care nurse practitioners (ACNPs) are advanced practice RNs who are educationally prepared to provide advanced nursing care to patients with complex acute, critical, and chronic illness. The education of advanced practice nurses should prepare them for the setting in which they practice; ACNPs are well prepared for hospital and specialty practice, particularly if they have experience as RN first assistants (RNFAs). This article provides a brief overview of the ACNP opportunity for RNFAs and the importance of additional training for ACNPs without OR experience who may be first assisting.
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Chow SKY, Wong FKY, Chan TMF, Chung LYF, Chang KKP, Lee RPL. Community nursing services for postdischarge chronically ill patients. J Clin Nurs 2008; 17:260-71. [DOI: 10.1111/j.1365-2702.2007.02231.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Conn VS, Cooper PS, Ruppar TM, Russell CL. Searching for the Intervention in Intervention Research Reports. J Nurs Scholarsh 2008; 40:52-9. [DOI: 10.1111/j.1547-5069.2007.00206.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rose LE, Gerson L, Carbo C. Transitional care for seriously mentally ill persons: a pilot study. Arch Psychiatr Nurs 2007; 21:297-308. [PMID: 18037440 DOI: 10.1016/j.apnu.2007.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/01/2007] [Accepted: 06/29/2007] [Indexed: 01/08/2023]
Abstract
This article reports the results of a pilot study of a nurse-based in-home transitional care intervention for seriously mentally ill persons. The goals of the intervention were to address the lack of continuity of care in existing programs and to meet the immediate postdischarge needs of severely mentally ill persons. This article focuses primarily on the applicability and feasibility of the intervention for this population, given the challenges of engaging seriously mentally ill patients in a community-based protocol and the complexity of their illnesses. Factors that are important to community adjustment postdischarge were identified: caregiver concerns and health status impeding illness management, lack of structure/involvement in daily activities, structural and functional factors affecting adherence, and presence of symptoms after discharge. Use of an advanced practice nurse to provide transitional care can offer an alternative to patients who might otherwise be left poorly treated or untreated in the community setting.
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Affiliation(s)
- Linda E Rose
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
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Affiliation(s)
- Jill H Anderson
- Clinical Education and Research, a Saint Alphonsus Regional Medical Center, Boise, Idaho, USA
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Lein C, Wills CE. Using patient-centered interviewing skills to manage complex patient encounters in primary care. ACTA ACUST UNITED AC 2007; 19:215-20. [PMID: 17489953 DOI: 10.1111/j.1745-7599.2007.00217.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe effective and efficient patient-centered interviewing strategies to enhance the management of complex primary care patient encounters. DATA SOURCES Research literature and applied case study analysis. CONCLUSIONS Patient-centered interviewing can enhance effectiveness of care in complex patient encounters. A relatively small investment of time and energy has positive yields in regard to improvements in longer term physiological status, treatment adherence, quality of life, patient-provider working relationship, and patient and nurse practitioner satisfaction. IMPLICATIONS FOR PRACTICE Use of patient-centered interviewing strategies can enhance effectiveness of patient care processes and outcomes while retaining efficiency of patient management.
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Affiliation(s)
- Catherine Lein
- Michigan State University, College of Nursing, East Lansing, Michigan 48825, USA.
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