Nurse-managed Centers Research Articles

Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health

Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.

Test of an interprofessional collaborative practice model to improve obesity-related health outcomes in Michigan

Abstract The purpose of the study was to test the effectiveness of an interprofessional collaborative practice (IPCP) education program on clinicians' and students' knowledge and attitudes toward IPCP and to determine the effectiveness of an IPCP weight loss program in two nurse-managed centers. The study team used the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborative practice education program that consists of online learning modules followed by daily huddles and collaborative care planning. The obesity intervention program was implemented by faculty and staff practitioners and students in two clinics with very different patient populations (community residents and college students). Staff/faculty practitioners and students demonstrated statistically significant knowledge gains as a result of online learning modules (Introduction to IPE p .05). The study demonstrated the potential of an IPCP program to affect weight loss in two populations.

Lessons in Retrospect

Baccalaureate community health education often includes clinical practice in home care agencies. Complexity with securing home care agency practice sites has led to the proliferation of alternative models for community health clinical. Nurse-managed wellness centers (NMWCs) are one such alternative that provides robust clinical experience for students and valuable home health services for vulnerable population groups. Despite anecdotal evidence of the value of the NMWC home care service, sustainability was dependent on the ability to report outcomes. An effort to quantify emergency department and hospital cost and utilization outcomes was unsuccessful. This resulted in failure to obtain financial support, and NMWC services were terminated in one community. In retrospect, the NMWC model was identified as having potential for integration into home care agency services.

Transforming Practice through Embracing Caring In Nurse-Managed Centers

Caring is a complex and multidimensional concept. The quality of interaction in patient care encounters is affected by philosophical beliefs that shape practice design, delivery, and structural aspects of the practice environment. Florida Atlantic University’s Christine E. Lynn College of Nursing operates two nurse-managed centers that address diabetes and Alzheimer’s disease care; these play a critical role in the reduction of cost of care. In this article, we demonstrate the impact of following a caring philosophy in our centers through intersubjective, interobjective, interior and exterior individual, and collective measures. A philosophy of caring in action allows these centers to become places where the beauty and mystery of the human life experience is lived, studied, and researched.

Transforming Practice through Embracing Caring In Nurse-Managed Centers

Caring is a complex and multidimensional concept. The quality of interaction in patient care encounters is affected by philosophical beliefs that shape practice design, delivery, and structural aspects of the practice environment. Florida Atlantic University's Christine E. Lynn College of Nursing operates two nurse-managed centers that address diabetes and Alzheimer's disease care; these play a critical role in the reduction of cost of care. In this article, we demonstrate the impact of following a caring philosophy in our centers through intersubjective, interobjective, interior and exterior individual, and collective measures. A philosophy of caring in action allows these centers to become places where the beauty and mystery of the human life experience is lived, studied, and researched.

Meeting Baccalaureate Public/Community Health Nursing Education Competencies in Nurse-Managed Wellness Centers

The purpose of this article is to describe how community health competencies for baccalaureate nursing education have been met by locating clinical experiences in nurse-managed wellness centers. Such centers are an ideal setting for students to integrate theoretical concepts into clinical practice while building on previous learning. Students are able to develop skills in community health nursing practice at individual, family, and population level. In addition, the practice setting provides other advantages. Clients who represent a vulnerable population group receive valuable health services. Students gain learning opportunities that are broader than community health competencies, and faculty are provided clinical practice, research, and scholarship opportunities. The challenges to year-round sustainability of nurse-managed centers are burdensome; however, the benefits outweigh the difficulty of those challenges.

Family-centered Health Care/Medical Home: APN Roles in Shaping New Care Models

www.jpedhc.org The Patient Protection and Affordable Care Act (PPACA) of 2010 is the legislation that created the foundation for reformof theU.S. health care system.The legislation established and funds diverse policies and projects to realign the financial incentives in the current health care insurance market. It encourages efficiency and quality and directs funds toward prevention and population health. Many regulations and rules from the legislation are currently being formulated to translate the law’s provisions into actual changes in health care practices and processes (Table 1). The law includes much for advanced practice nurses (APNs) to celebrate, such as funding for nursemanaged centers and increased nurse education loans and grants. Care innovations, a provision in the health care reform legislation, have significant potential for enhancing APN practice even though physician-exclusive language in the legislation resulted in nurse practitioners (NPs) not being fully included in key provisions of the care innovations reforms. This article focuses on one of the care innovations strongly supported in the PPACA, the health care/medical home. It provides background on the health care/medical home model, the importance of family-focused caremodels, and suggestions for possible partnership for APNs to forge with family advocacy groups to improve access and quality and to strengthen the position of NPs in the newmodels of health care delivery.

Providing Health Care and Education to Migrant Farmworkers in Nurse-Managed Centers

Abstract Hispanic migrant and seasonal farmworkers with health problems pose special challenges to the practice of nursing because of their transient lifestyles, poverty, lack of resources, and occupational risks in fields and factories. Chronic conditions such as diabetes, hypertension, and arthritis are prevalent while quality health care is often limited. Migrant Health Service, Inc. was established to address health needs of migrant farmworkers and their families when they travel to Minnesota and North Dakota during the summer months. Currently, 10 seasonal satellite nurse-managed centers and two mobile units operate two to five months each year using a voucher system that provides financial support for clients when they are referred to health care providers in the community. A priority for seasonal nurses is to provide health care and education in a culturally sensitive manner to promote self-care and empowerment of migrant farmworkers. Nurses are assisted by bilingual health outreach workers who hel...

The Omaha System and Quality Measurement in Academic Nurse-Managed Centers: Ten Steps for Implementation

Measuring and describing client problems, nursing interventions, and outcomes is a challenge in nursing care. This study reviews the literature about the use of the Omaha System and describes the steps used to introduce and implement the Omaha System as a documentation and outcome measurement system in academic nurse-managed centers. The goal of the article is to provide a guide for nurse educators to develop and implement a quality measurement system that can be used in clinical settings by undergraduate students. The Omaha System is a strategy to introduce and incorporate evidence-based practice in the undergraduate nursing clinical experience.

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.

Characteristics of schools of nursing operating academic nurse-managed centers

Academic nurse-managed centers (ANMCs) can be important sites for addressing the tripartite mission of the academy. Yet, limited information about numbers of ANMCs and the schools sponsoring them is available. This paper presents an update on schools of nursing (SONs) operating ANMCs. A survey was sent to 683 deans and directors of baccalaureate and higher-degree SONs, with 565 responding (response rate: 83%). Ninety-two SONs indicated they had one or more ANMCs. The largest percentage of the SONs with ANMCs were classified as doctoral/research-intensive or extensive universities, a proportion much higher than the national percent of SONs in this category. Schools of Nursing were financially supporting centers at a lower percentage of actual costs than was reported in earlier studies, although grants continue to be a major source of funding. Academic nurse-managed centers are likely to be supported by SONs with substantial research, practice, faculty, and student resources. Overall, the national number of ANMCs seems stationary over the past two decades.

Impact of academic nurse‐managed centers on communities served

This paper presents findings from six community focus groups that addressed the impact of academic nurse-managed centers (ANMCs) on the overall community being served as well as the quality of care provided in the centers. Experts in focus group methodology from a public health institute conducted the six focus groups at ANMCs from four universities in the Midwest. Discussions were guided by nine questions presented to each group. All groups were tape-recorded and transcribed. A total of 37 participants were recruited from the ANMCs and included patients and families, advisory board members, and local community organizations. Four themes were identified across the six focus groups: valuing patient-centered care, which included two subthemes-continuous specific provider and specific aspects of care; quality of care; increasing access to care/addressing the safety net; and evidence of outreach. Findings from these focus groups verify that community members do "get it" in terms of the unique aspects of ANMCs. Participants were able to articulate the differences between nurse-managed care and other types of ambulatory primary care. The unique strengths of nurse practitioners were repeatedly articulated as well as the centers' outreach into the community.

Clients Served and Services Provided by Academic Nurse-Managed Centers

Currently, no national database for academic nurse-managed centers (ANMCs) exists. These primary care services remain somewhat invisible in the policy and reimbursement areas of the American primary care system and, consequently, are undersupported. The purpose of this article is to describe client and service data from a national study of ANMCs. A cross-sectional survey design was used to collect data from ANMC directors. Usable data were received from 64 centers. ANMCs in the sample were relatively small in terms of patients and volume. Client and service profiles demonstrated variation, which seemed to be reflective of needs relative to populations and communities served. Nearly half of the ANMCs responding served clients of all ages, with services representing the breadth of primary care (i.e., health maintenance and management of minor acute and common chronic illnesses). Evidence of community-focused care was also noted. The reported use of standardized nursing language was low. Standardized medical taxonomies were more commonly used, with International Classification of Diseases, Ninth Revision being the most common. ANMCs provide a small but substantial amount of primary care services in communities served. Findings indicated a need for ANMCs to improve the documentation of their contributions through the use of standardized taxonomies to provide aggregated reporting for policy and research purposes.

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.

The Nurse-Managed Health Center Safety Net: a Policy Solution to Reducing Health Disparities

Nurse-managed health centers are critical safety net providers. Increasing support of these centers is a promising strategy for the federal government to reduce health disparities. To continue as safety net providers, nurse-managed health centers need to receive equal compensation as other federally funded providers. Ultimately, the long-term sustainability of nurse-managed centers rests on prospective payments or similar federally mandated funding mechanisms.

Measuring Quality in Nurse-Managed Centers Using HEDIS Measures

Nurse-managed centers (NMCs) provide viable options for primary healthcare and contribute substantially to filling access gaps for vulnerable populations. The purposes of this paper are to (a) describe a pilot application and adaptation of eight Health Plan Employer Data and Information Set (HEDIS) measures to six NMCs, (b) report the findings from the quality assessments, and (c) compare findings to national HEDIS data. The eight quality assessment areas are asthma, cervical cancer screening, childhood immunizations, depression, diabetes, hypertension, mammography screening, and smoking cessation. The NMCs achieved or exceeded HEDIS 50th percentile levels in a number of important clinical areas, but did not attain the 50th percentile level in others. Thus, HEDIS measures are relevant for the assessment of care quality and provide useful data for quality improvement in NMCs.

The Safety Net: Academic Nurse-Managed Centers’ Role

This article reports on a study conducted in 2001 that examined the role of four schools of nursing (SONs) in Michigan and their challenges in serving the safety net population through primary care nurse-managed centers (NMCs). The NMCs are described and compared to community health centers (CHCs) in terms of patient mix, funding sources, and contributions SONs make as a substitute resource for federal funding to the NMCs. NMCs are frequently invisible providers in the health system, yet they serve high-need populations. Similarities and differences between NMCs and CHCs are discussed as well as the unique challenges faced by NMCs and their SONs as the result of policies that sometimes limit NMCs ability to serve safety net populations.

Nurse-Managed Centers: Increasing Access to Health Care

Nurse-Managed Centers: Increasing Access to Health Care

Developing the academic nursing practice in the midst of new realities in higher education.

The academic nursing practice has a role in replenishing the diminished resources that confront higher education and, if well conceived and managed, is a viable option to support existing academic program stability and growth. An alternative model for defining the academic practice--beyond traditional nurse-managed centers--is presented in this article. The cohesive interconnection of the education, research, and practice missions is addressed with examples of how each contributes to a variety of communities of interest and expands professional nursing roles through innovative care model testing and development. With effective business planning and infrastructure support, faculty practice plans can evolve to a second generation, with heightened societal accountability for service, academic, and collaborative research outcomes.

Toward national comparable nurse practitioner data: proposed data elements, rationale, and methods

Federal funds have supported Nurse Practitioner (NP) education and the establishment of nurse-managed centers. Yet, important questions are raised about the quality and appropriate scope of NP care. Few NP-patient encounters are documented in the largest national surveys of ambulatory care, sponsored by the National Center for Health Statistics, due to sampling frames that are based on physician practices. In addition, these national surveys lack essential outcome indicators, therefore limiting their data to descriptions of patient demographics and practice patterns. Informatics principles are applied to a proposed expansion of the National Ambulatory Medical Care Survey. Its sample would include nurse-managed centers and its variables would include quality outcome and process indicators in standardized language that are nurse-sensitive and that reflect national priorities for action on health care quality. Variables for inclusion in a draft pilot instrument are identified.