Nurse-managed Center Research Articles

Influence of lifestyle, health behavior, and health indices on the health status of underserved adults

To examine how lifestyle, health behavior, and health indices best predict health status in underserved adults. Eighty-four underserved adults from a nurse-managed center completed an investigator-developed instrument to measure lifestyle, health behavior, and health indices. The SF-12 Health Survey measured general (SF-1), physical (PCS), and mental (MCS) health status. The majority of the sample was female (64%). Sixty-three percent were at or below 200% of the federal poverty level. For nonsmokers, five independent variables accounted for 47.1% of the variance in SF1 (p < .000), 33.5% in PCS-12 scores (p < .001), and 23.2% in MCS-12 scores (p = .017). For smokers, six variables accounted for 48.7% of the variance in SF1 (p = .024), 41.7% in PCS-12 scores (p = .067), and 25.4% in MCS-12 scores (p = .378). Findings provide partial support for the impact of lifestyle and health behaviors on health status outcomes. Focusing concurrent interventions on improving multiple behaviors may have the greatest impact on health status outcomes.

Developing a Virtual Nurses’ Station for Community-Based Nurses

Nurses who work throughout the community need a nurses' station, just as nurses who work in a hospital. The nurses' station is the area where communication, information sharing, and documentation occur. This article describes how a virtual nurses' station was created using Blackboard technology to meet the needs of nurses who are scattered throughout a geographic area. These nurses work in several urban neighborhoods to conduct the outreach services offered through an academic nurse-managed wellness center to community-dwelling older adults. Results have been positive as the virtual nurses' station provides the nurses an area to exchange data and information, print patient health care information, and access nursing policies. Satisfaction surveys from the nurses give valuable input on the design and use of the virtual nurses' station.

A journey to become a federally qualified health center

Since 1998, Integrated Health Care (IHC), an academic nurse-managed center of the University of Illinois at Chicago College of Nursing, has delivered primary and mental health care to people with serious and persistent mental illness who are enrolled in psychosocial rehabilitation. Federal guidelines and experiences of the steering group. This article reports our journey of transformation to a achieve the status of a Federally Qualified Health Center (FQHC). Nurse-managed clinics (NMCs) have become important in the U.S. healthcare system with well documented positive impact. However, financial issues have placed may NMCs at risk for closure. Achieving FQHC status is seen as a viable option to increase revenue and therefore financial stability. This discussion of the benefits of FQHC status, an overview of some common compliance issues with FQHC requirements, and the report of lessons learned along the way in meeting FQHC standards that we encountered can provide support and guidance for other NMCs in similar situations.

The Retired Nurses Working in Neighborhoods (RN+WIN) Program: An Approach Toward Sustainability of an Academic Nurse—Managed Wellness Center

Obtaining resources for sustainability of academic nursing centers is an ongoing challenge. Academic wellness centers face challenges related to the limited availability of insurance to meet demand and resources for state and local contracts or fee for service. Traditionally, state and local contracts and fee-for-service insurance plans do not cover preventive or wellness-related health services. In addition, third party reimbursement for wellness, disease prevention and health promotion, and health education services may be limited because of Current Procedural Terminology codes. An approach toward sustainability of the Duquesne University School of Nursing Nurse-Managed Wellness Center was to build on the human resources of volunteer retired nurses residing in the neighboring communities of the university.This article describes the RN+WIN program as a creative approach toward sustainability of an academic nurse—managed wellness center.

WOW Specialty Home Care Service for Individuals With Serious Mental Illness

Integrated Health Care (IHC) is a nurse-managed center of the College of Nursing, University of Illinois at Chicago through which faculty nurse practitioners and clinical nurse specialists provide primary and mental healthcare services for people with serious mental illness in partnership with Thresholds, the leading freestanding psychiatric rehabilitation agency in Illinois with locations throughout metropolitan Chicago.This article describes a new project to increase access to IHC services and improve health outcomes for the most vulnerable, hard-to-reach Thresholds clients (called members) through an innovative combination of strategies to outreach beyond IHC's three clinic locations, including: house calls, group visits, and telemonitoring, IHC Without Walls (IHC WOW).As an academic nursing practice, we view IHC WOW as an opportunity to integrate teaching and evidence-based practice; accordingly our objectives include expansion of novice and advanced practice experiential learning within this innovative practice domain.

A 10-Year Review of Four Academic Nurse-Managed Centers: Challenges and Survival Strategies

Since 1985, there has been rapid growth in nurse-managed health centers (NMHCs). Many were established by academic schools of nursing, and several have closed. The Independence Foundation undertook this study to identify the challenges and survival strategies employed by four academic nurse-managed center grantees during a 10-year period. Data from Foundation records, interviews with directors and staff from the centers and the National Nursing Centers Consortium, a focus group with center founders, and field notes were analyzed for themes related to the centers' challenges and survival strategies. Although the centers faced many challenges from the sociopolitical environment, the community, and their parent organizations, the most difficult challenge was achieving financial sustainability, which was attainable only by obtaining cost-based reimbursement. Because of existing health policies, that was possible only through organizational restructuring and affiliation with an existing federally qualified health center. The future of nursing centers depends upon favorable health policies, data documenting centers' effectiveness, and adequate preparation of the next generation of nursing center directors and practitioners.

Evaluating the Effect of Teaching Modules on Underserved Clients’ Perceived Health

Underserved individuals need comprehensive health care. Educational resources that meet health care needs can promote wellness. This descriptive study evaluated effects of preferred teaching modules on perceived health of underserved clients of a nurse-managed center. Participants (N = 101) were between 19 and 61 (M = 38.7); the majority was female (68.3%) with a high-school education (M = 12.17). Most participants (65%) identified health education as very important; 92% used at least one teaching module. Age, gender, and education were not related to importance of health education. Use of various teaching modules was positively correlated with perceived improved health (p < .05). Participants who used a combination of videos and pamphlets reported the greatest improvement (p < .000).

Nurse Managed Center: Access to Primary Health Care for Urban Native Americans

Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A sample of 334 participant's patient data were abstracted from a computerized clinical data set and coded based on the Omaha Classification System. The majority were over 40 years of age, were female, were single, completed high school, and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems, and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms. The NMC was an accessible source of primary health care for urban Native Americans in northeastern Ohio.

Nurse Managed Center: Access to Primary Health Care for Urban Native Americans

Abstract Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A sample of 334 participant's patient data were abstracted from a computerized clinical data set and coded based on the Omaha Classification System. The majority were over 40 years of age, were female, were single, completed high school, and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems, and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms. The NMC was an accessible source of primary health care for urban Native Americans in northeastern Ohio.

Integrated Primary and Mental Health Care: Evaluating a Nurse-Managed Center for Clients with Serious and Persistent Mental Illness

Nurse-managed centers have been at the forefront of providing ambulatory care alternatives for underserved populations lacking access to care. Following this model, the Center for Integrated Health Care of the College of Nursing at the University of Illinois in Chicago delivers primary and mental health care services to a population of people with serious and persistent mental illness. The authors' experience illustrates the many rewards and challenges that nurse-managed centers face. This article describes their center's model of integrated care, examines selected performance indicators, and discusses the implications, opportunities, and challenges ahead.

Health Concerns and Learning Styles of Underserved and Uninsured Clients at a Nurse Managed Center

The medically underserved and uninsured often seek care for immediate health concerns rather than use health promotion activities. To facilitate health promotion activities, it is important to understand the health concerns and learning styles of these underserved clients. The purpose of this descriptive study was to assess specific health concerns and identify learning styles of clients seeking care at a nurse managed center. Eighty-two participants completed the Hilltop Health Questionnaire, a self-report instrument developed by the research team. Top reasons for seeking care included upper respiratory infections (17%), routine physical (17%), medication refill (12%), and low back pain (11%). Preference for learning style included hands-on instruction (82%), reading (63%), and listening (59%). These data were used to obtain or customize teaching modules based on the clients' health concerns and preferred style of learning. Continued emphasis should be placed on health education that engages the underserved and uninsured in their care and health promotion activities.

Health Concerns and Learning Styles of Underserved and Uninsured Clients at a Nurse Managed Center

The medically underserved and uninsured often seek care for immediate health concerns rather than use health promotion activities. To facilitate health promotion activities, it is important to understand the health concerns and learning styles of these underserved clients. The purpose of this descriptive study was to assess specific health concerns and identify learning styles of clients seeking care at a nurse managed center. Eighty-two participants completed the Hilltop Health Questionnaire, a self-report instrument developed by the research team. Top reasons for seeking care included upper respiratory infections (17%), routine physical (17%), medication refill (12%), and low back pain (11%). Preference for learning style included hands-on instruction (82%), reading (63%), and listening (59%). These data were used to obtain or customize teaching modules based on the clients' health concerns and preferred style of learning. Continued emphasis should be placed on health education that engages the underserved and uninsured in their care and health promotion activities.

Life Situations Of Elderly People With Heart Disease: The Impact Of Self-Efficacy On Self-Care

A number of factors are associated with higher readmission rates, disabilities, and morbidity among elderly people with heart disease. There are few studies that have been done on self-efficacy among these individuals. The significance of this study was the identification of this phenomenon as a prognostic factor that could be related to patient outcomes. The researcher of this study analyzed data to identify areas where self-confidence lacks among this population; as a factor that might put patients at risk for readmission. The Cardiac Self-Efficacy Questionnaire was used to measure confidence levels of 20 elderly people, between the ages of 65 and 101 with heart disease. This instrument was administered to those individuals who reside at the Chai House, a senior residential living facility in Northern California. Most of the subjects also visit the nurse-managed center there. The study provided evidence that more attention needs to be focused on increasing self-efficacy around issues related to self-care measures.

Quality Outcome Measures at an Academic Rural Nurse-Managed Center: A Core Safety Net Provider

As the number of medically underserved people continues to swell, core safety net providers, such as nursing centers, are finding it increasingly difficult to provide quality care and remain financially viable. The purpose of this article is to highlight the successful implementation of a quality improvement plan at one rural nursing center. Outcome measurement has been conducted since 1994 in several areas, including client, nursing, and student satisfaction, as well as a variety of measures to evaluate access to health care and its effectiveness in improving client health. The need for nursing centers to measure and publish quality outcome data is discussed, including recommendations for national health policy initiatives to support nursing centers as one of the few options remaining for the underserved in our nation.

Academic-Based Nurse-Managed Centers

A school of nursing that is planning an academic-based nurse-managed center must consider the many implications of this action. It requires a long-term commitment to the community and to the individual clients served, and time, energy, and consistent funding will be needed to maintain viability. Six key questions that must be answered are explored.

Advancing the role of clinical nurse specialist in rural family health research.

For the clinical nurse specialist (CNS), perhaps the least implemented role is researcher. This is especially true of CNS research pertaining to rural family health. To be effective in this area the CNS must recognize the various definitions of rural, family, and family health. In addition, the impediments to CNS research in rural family health must be addressed. In this article, these issues are discussed, and the nurse-managed center is proposed as an ideal setting for conducting research into rural family health.

Starting a nurse-managed center for older adults: The needs assessment process: Nurse-managed centers work well in the new health care environment. The challenge is to determine the type of project that is feasible and develop strategies to implement services

Nursing centers can be a vital part of the plan to meet the health needs of the coming "age wave." Nurses, who provide both the care for chronic illness and the means for preventing the onset of chronic disability, are in key positions to influence the evolving health care system to create new systems of community-based care. The time for NMCs is, perhaps, now or never. Conducting a thorough needs assessment is the first important step.

Group Intervention

Nurse-facilitated, long-term group intervention provides a healing environment for adult survivors of incest. In this article, the healing journey of the group process is discussed as two clinical specialist nurse facilitators share their experiences of facilitating long-term incest groups for the past 5 years at a nurse-managed center for practice in the college of nursing at a large midwestern university. The group intervention, which consists of 51 sessions 1 1/2 hours in length, is discussed in depth. The three phases of the group and the tasks of each are developed in detail in relation to the mind-body-spirit healing that occurs. Use of clinical vignettes elaborates the group experiences and the healing evolution of the group members.

Authentic caring: The sensible answer for clients and staff dealing with HIV/AIDS

The Denver Nursing Project in Human Caring is a nurse-managed outpatient center providing integrated care and services for persons living with HIV/AIDS, their family members, and friends. The center is collaboratively sponsored by three Denver hospitals and the University of Colorado School of Nursing. Programs and services of the center are based on Watson's theory of human care nursing. The ongoing challenge to operationalize authentic caring has resulted in growth and satisfaction for both clients and staff. In addition, the center has documented its cost effectiveness for the participating institutions.

Nursing care partnerships at the Denver Nursing Project in Human Caring: an application and extension of caring theory in practice.

Jean Watson's theory of nursing as the art and science of human caring provides the framework for practice at the Denver Nursing Project in Human Caring, a nurse-managed center for people living with HIV/AIDS. The purpose of this article is to describe the development, implementation, and evaluation of a new model of nursing practice at the Caring Center, called nursing care partnerships. Client and nurse narrative accounts are presented as a means of grounding the reader in the care partners' relationships that are formed during the journey of HIV/AIDS.