Nurse-managed Clinic Research Articles

The School-Based Clinic Family Nurse

The School-based Clinic is located in a New York City public elementary school with a small magnet junior high. This nurse-managed clinic has two components, the Child Health Care Center and the Family Center, of which I am the coordinator. The Family Center was established to provide services to parents and children in order to prevent the development of behavioral disorders in children.

Patient Waiting Times In A Nurse Managed Clinic

This study evaluates the waiting times experienced by patients in a primary care nurse managed clinic in a large southern metropolitan area over a two week period of time in October and two week period in December of 1995. The waiting times include: waiting room, examination room, time spent with the nurse practitioner, and total elapsed time in clinic. Subjects included all patients who had scheduled appointments with the nurse practitioners during the study period. The patient groups served by this primary care clinic are adults who are students or employees of a university and private patients who are members of managed care organizations.The mean time interval from arrival in clinic to being placed in an examination room was 13.75 minutes. The nurse practitioners spent an average of 22.8 minutes with each patient and the patients were in and out of clinic in 49.05 minutes.This is the first study to document waiting times specifically in a nurse managed clinic.It is significant in that it documents that a nurse managed clinic waiting times and provider care times are dramatically better than national norms for clinics other than those managed by nurse practitioners.

Establishing outreach health services for homeless persons: an emerging role for nurse managers.

Nurse-managed clinics can be an effective strategy for addressing the health care needs of homeless and indigent populations. The role of the nurse manager in the establishment of a clinic involves community leadership--specifically, it involves addressing strategic planning, financial and manpower issues. The collaborative relationship of nurse managers, educators, and the community laid the groundwork for accessible and affordable health care for the homeless and indigent of one northwest Georgia community. Specific tools and strategies are presented.

Utilization of an academic nursing center.

Academic nursing centers, or nurse-managed clinics, are relatively new health care delivery systems. Little information exists as to the demographic characteristics of individuals who use academic nursing centers for health care. Moreover, little is found in the literature about the types of conditions diagnosed and the procedures and tests performed at academic nursing centers. Based on one academic nursing center, this project showed that 3,263 persons received care during an 8-month period. The types of conditions diagnosed and the demographic characteristics of individuals cared for are described. The procedures and diagnostic tests performed are identified. These data have important implications for marketing, predicting resources, and meeting the educational component of the academic nursing center.

Intrapreneurial Nursing: The Comprehensive Lower Extremity Assessment Form

The Comprehensive Lower Extremity Assessment Form was developed in response to the need for a screening tool in a nurse-managed foot care clinic. It differs from other such tools because it includes clinical measures that identify the potential for foot pathology. The Comprehensive Lower Extremity Assessment Form also serves as an assessment teaching guide in a foot care course and is included as part of a home-study program. The authors demonstrate how the Comprehensive Lower Extremity Assessment Form has generated revenue as part of an intrapreneurial outgrowth of their foot clinic and provides a comprehensive approach to lower extremity assessment. The form can be tailored to meet the needs of the advanced practice nurse, the clinical setting, or patient population.

Nurse Management of Posttransplant Hypertension in Liver Transplant Patients

Hypertension develops soon after organ transplantation using cyclosporine- or FK506-based immunosuppression. Sustained rises in blood pressure require intervention to reduce the risk of intracranial bleeding and other cardiovascular complications. Antihypertensive treatment is complicated by reduced renal function and potential interference with absorption and/or metabolism of cyclosporine or FK506. To manage early and long-term hypertension related to immunosuppression with cyclosporine or FK506 and prednisone following orthotopic liver transplantation, a comprehensive nurse-managed hypertension clinic was developed. Blood pressure, heart rate, and antihypertensive and immunosuppressive regimens were evaluated according to a standard protocol at 1, 4, 12, 24, and 36 months after orthotopic liver transplantation. Data indicate that posttransplantation hypertension develops within the first months after orthotopic liver transplantation and persists indefinitely. If comprehensively managed by the hypertension nurse-clinician, the percentage of controlled hypertension patients can increase over time.

Anticoagulant Clinic Warfarin Adherence Rates and Assessment

Objective: To identify warfarin medication-taking patterns and the relationship between adherence and international normalized ratio (INR). Design: Two-month, single-blind, observational cohort. Setting: Veterans Affairs Medical Center ambulatory care clinics. Patients: Twenty-three veteran outpatients followed in a nurse-managed anticoagulation clinic were enrolled by consecutive sample. Patients were excluded if they used a medication reminder device, were scheduled to have warfarin discontinued within the next 2 months, or had been receiving warfarin less than 1 month. Twenty patients were evaluable. Intervention: All study patients received warfarin in a vial with an electronic medication-event monitoring system (MEMS) device. Patients were not told that adherence was being monitored. Main Outcome Measure: Mean and preclinic warfarin adherence, dosage changes, and INR values were tabulated. Results: Thirty-five percent of the patients were nonadherent with warfarin therapy. Mean and preclinic warfarin adherence rates were 86% and 90%, respectively. Medication-taking behavior was underestimated in 75% of patients. Dosage changes were more common in nonadherent patients. There was not a significant correlation between INR and adherence. Conclusions: MEMS adherence data could have changed pharmacologic management in select patients.

The effect of a nurse-managed CHF clinic on patient readmission and length of stay.

Hospital readmission for exacerbation of symptoms of Congestive Heart Failure (CHF) is a major home healthcare problem and expense. To address this problem and curb the increasing expense and patient lifestyle disruption, a group of staff nurses at the Medical University of South Carolina Medical Center developed a nurse-managed clinic to follow all patients with CHF after discharge. Within 6 months of the clinic's operation, readmissions of these patients decreased by 4%, and the length of stay decreased by 1.6 days.

A National Profile of Nursing Centers

Escalating costs of health care and decreasing accessibility to care are growing dilemmas in America. Primary care is being delivered in nurse-managed clinics, or nursing centers, by nurses qualified for advanced nursing practice. The purpose of this study was to build a profile of the structure and function of nursing centers, noting major differences between those that are academic-based and those that are not. Questionnaires were developed and mailed to 234 subjects/agencies in every major region of the United States. Responses were tabulated and percentages were calculated to make comparisons and build a profile of nursing centers, based on the following factors identified in the literature and by nurse experts: (a) funding and fees, (b) organizational structure, (c) time elements, (d) demographics, (e) services, (f) qualifications and categories of staff, (g) functions of staff (h) research endeavors, (i) major barriers, and (j) major sources of support.

New Treatment for Scabies?

Robert T. Smithing, M.S.N., R.N.C., is a family nurse practitioner and clinical director of Health Connections, a Kent, Wash., nurse-managed clinic. Madeline D. Wiley, M.S.N., R.N.C., is a family nurse practitioner and administrative director of Health Connections, Kent, Wash.

Staying connected: the core of facilitating health care for homeless persons.

A grounded theory study explored the ways nurses and others in nurse-managed shelter clinics facilitate health care for homeless persons. Analysis of in-depth interview and participant observation data yielded a core category, "staying connected," that represents the essence of what the staff do to facilitate care for homeless persons. The three most important aspects of "staying connected" are the links that nurses establish with the homeless patient, the connections nurses establish in the form of networks with other providers, and facilitation of the homeless person's connections with the health care system. The nurses' descriptions of "staying connected" demonstrate the barriers to facilitating health care and the breakdowns that occur while trying to facilitate care for homeless persons. The barriers include lack of health insurance, insensitivity of health care providers towards homeless persons, stigmatization, cultural barriers, and communication breakdowns. Homeless persons are socially, economically, and politically vulnerable in the American health care system. Nurses have a powerful influence, both macro- and micro-socially, in facilitation of care for this population.

Nurse-managed clinics: a blueprint for success using the Covey framework.

This article describes the process from inception to successful operation of a university-based nurse managed clinic. The article includes information regarding the planning process, method of financing, political strategies for gaining approval, and on-going development of services. Covey's seven habits of highly effective people are used as a framework on which the development and evolution of the clinic are based. The habits are illustrated by relating how services/operation were enhanced and barriers and obstacles were overcome.

Enhanced role opportunities available to the CNS/nurse practitioner.

Role possibilities that could result from the proposed CNS-nurse practitioner merger into an advanced practice nurse role are examined in this article. A brief history of the movement to merge the two roles is reviewed, followed by a review of arguments for and against merging. Role opportunities are explored for nurses with advanced practice preparation, including case management, expanded roles in acute care, practice in nurse-managed clinics, and collaborative private practice.

Types of health problems and satisfaction with services in a rural nurse-managed clinic.

The purpose of this study was to investigate the satisfaction of clients with care provided in a rural nurse-managed health center by family nurse practitioners and to describe common health problems for which family nurse practitioner services were sought. The results indicated that of the 2,106 visits from a case load of 1,350 clients, acute health problems were the most common (95.7%), and chronic health problems were the least common (3.9%). Respiratory and ear infections were the most frequent acute illness (55%), and hypertension (29%), respiratory (27%), and musculoskeletal complaints (27%) were the most frequent chronic conditions. Children up to 6 years of age constituted the largest client population (30%), followed by young adults (23%). Older adults were the smallest numbers of clients (3%). Client satisfaction with nurse practitioner-managed care was highly rated by 97% (n = 101) of the subjects in a random sample telephone survey. The results suggested that family nurse practitioners were providing effective and satisfactory healthcare for this rural community. Issues for further investigation are also discussed.

Nurse-managed Clinics Provide Access and Improved Health Care

With the closing of hospitals, communities must work together to provide access to health care. This article reports on the development of a prenatal nurse-managed clinic, and its expansion to include a birth center, well-child/sick-child clinic, teen-pregnancy program and family planning clinic. The staff includes four certified nurse midwives, five pediatric nurse practitioners, a bilingual certified clinical nurse specialist and a bilingual social worker. Through the innovative management of these professionals, the incidences of low-birth-weight infants and pregnancy-induced hypertension have decreased. Since 1988 when the clinic first opened, first trimester enrollment has increased from 12 percent to 25 percent and third trimester enrollment has decreased from 44 percent to 21 percent because clients go to the clinic earlier. At the largest emergency room in the county, visits by Medicaid recipients under six years of age have decreased 27 percent from the time the pediatric clinic opened.

Living arrangements, visit patterns, and health problems in a nurse-managed clinic for the homeless.

The purpose of this article is to describe living arrangements, clinic visit patterns, and health problems of clients by age and gender in a nurse-managed clinic serving the homeless. The conceptual framework for this project was derived from a nursing perspective of community health. The problem classification scheme used included four domains of community health practice: environmental, psychosocial, physiological, and health-related behavior. Data were collected during each visit to a nurse-managed health clinic for the homeless for 18 months. The findings indicate that living arrangements and visit patterns vary by age and gender. Health problems associated with integument and income were identified as primary and secondary problems across all age groups. Six other health problems were shared across all age and gender groups as either primary or secondary: circulation, respiration, pain, nutrition, communication, and prescription medication. Substance misuse was not a primary problem noted by clients, but was commonly a secondary problem. Genitourinary problems were noted primarily to be problems of younger women. Implications for planning nursing services for the homeless are discussed.

Client Satisfaction With a Nurse-Managed Clinic

To survive and thrive in today's competitive health-care market, health-care providers must evaluate outcomes of their services, including client satisfaction, then use this information to set standards. In the past, standards of care for the elderly were based on tradition rather than evaluation of their effect on outcomes (Thorsland, 1986). There are, therefore, few guidelines for evaluating outcomes of care in any setting and almost none for care of the elderly in nurse-managed centers. As a first step in evaluating client satisfaction in a nurse-managed clinic a focus group discussion was conducted with nine clients of the Nurse Education Link to Aged (NELA) Wellness Center. The focus group participants indicated that the Center had done an excellent job of meeting physical and emotional health needs of clients. Participants especially liked the location of the clinic in the apartment building where they live. Additional services requested by participants included programs for coping with depression and stress, alcoholism, and arthritis, and for increasing social interaction between men and women.

Research connections

Studies are reviewed that describe a nurse-managed clinic for treating hypercholesterolemia and two large drug trials that demonstrated a lowered risk of coronary artery disease associated with antilipid therapy.

The Homeless: Social Isolates

Within the last 10 years, homelessness has emerged as one of the leading social problems in the United States. This article contains the findings of a descriptive study of the characteristics and health status of a homeless population in a southeastern city. The homeless population is of interest to nurses because it is representative of a specific disadvantaged group, seriously at risk for a myriad of physical and mental problems. The theoretical model, Social Disaffiliation, can serve as a basis for intervention with a variety of underserved or unserved population groups and the data presented provide opportunities for designing nursing intervention strategies. The study was conceived as a way to gather empirical evidence about the specific health-care needs of the community's homeless, to generate a data base on which to estimate that need, and to use the findings to support the establishment of an innovative practice model, a nurse-managed clinic. The literature suggests that on-site clinics, located in emergency shelters, are effective approaches to providing acceptable and accessible health care to the homeless. Nurses are well prepared to be a key part of the solution to one of the most serious problems facing health care in the U.S. today.

A Nurse-Managed Multiple Sclerosis Clinic: Improved Quality of Life for Persons with MS

Multiple sclerosis (MS) is a complex disease, the symptoms of which may wax and wane on a daily basis. Conventional treatment for MS patients may involve numerous trips to a variety of clinics, physicians, and rehabilitation settings. This article describes a nurse-managed MS clinic which employs an interdisciplinary and holistic approach to treatment of MS patients with the goal of improving their quality of life and coordinating their health care. In this article, the services of the clinic are described, emphasizing the roles of the nurse practitioner (clinic manager), rehabilitation nurse specialist, and nursing director of the hospital-based home care program. A case study example of the interdisciplinary nature of this clinic's program with one MS patient is included.