Nurse Practitioner Project Research Articles

Australian research investigating the role of nurse practitioners: A view from implementation science

Summary The catalyst for the paper was a rapid review of the literature which identified Australian research on nurse practitioners. This paper reports on those studies investigating individual nurse practitioner roles, framed in terms of the implementation science literature and three stages of implementation: exploration and adoption of the role, initial implementation of the role, and full operation of the role. Database searching of the peer-reviewed literature was supplemented with searching relevant web sites. Most studies focused on certain aspects of the nurse practitioner role rather than undertaking a comprehensive evaluation. There was no consistency in the way the roles were described, making it difficult to compare what may be similar roles in different studies. The research generally treats the nurse practitioner role as the independent variable, rather than the care provided by the nurse practitioner. The concept of implementation fidelity was absent from all studies, except for one which addressed the issue indirectly. Many studies included little contextual information, making it difficult to judge the role of context in influencing both implementation and patient outcomes and establish plausible links between the activities of the nurse practitioners and patient outcomes. Based on the findings, a checklist is recommended for use in future studies which would enhance the ability to make judgements about implementing nurse practitioner models of care; facilitate comparison of similar roles and increase the capacity to make informed decisions about the prospects for wider implementation of nurse practitioner roles or models of care.

Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers

The final phase of a three phase study analysing the implementation and impact of the nurse practitioner role in Australia (the Australian Nurse Practitioner Project or AUSPRAC) was undertaken in 2009, requiring nurse telephone interviewers to gather information about health outcomes directly from patients and their treating nurse practitioners. A team of several registered nurses was recruited and trained as telephone interviewers. The aim of this paper is to report on development and evaluation of the training process for telephone interviewers. The training process involved planning the content and methods to be used in the training session; delivering the session; testing skills and understanding of interviewers post-training; collecting and analysing data to determine the degree to which the training process was successful in meeting objectives and post-training follow-up. All aspects of the training process were informed by established educational principles. Interrater reliability between interviewers was high for well-validated sections of the survey instrument resulting in 100% agreement between interviewers. Other sections with unvalidated questions showed lower agreement (between 75% and 90%). Overall the agreement between interviewers was 92%. Each interviewer was also measured against a specifically developed master script or gold standard and for this each interviewer achieved a percentage of correct answers of 94.7% or better. This equated to a Kappa value of 0.92 or better. The telephone interviewer training process was very effective and achieved high interrater reliability. We argue that the high reliability was due to the use of well validated instruments and the carefully planned programme based on established educational principles. There is limited published literature on how to successfully operationalise educational principles and tailor them for specific research studies; this report addresses this knowledge gap.

The post-infarction nurse practitioner project: A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population.

To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). Observational study. Acute coronary care unit in a teaching hospital. We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. Time to first event analysis of death from all causes or repeat myocardial infarction. 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).

The Kids Into Health Careers (KIHC) Initiative: Innovative Approaches to Help Solve the Nursing Shortage

In 2001, the Northern Illinois University School of Nursing was awarded a grant from the Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, to enhance the School's advanced practice nursing program. As a recipient of this grant, the School of Nursing was required to incorporate activities to meet the goals of the "Kids Into Health Careers (KIHC) Initiative" to encourage children into health care careers. This article describes the strategies developed by the School of Nursing to meet the KIHC goals and encourage children, especially those from minorities, into health care careers. The School's approach was multifaceted and included collaboration with a variety of community organizations and groups. While there is a tremendous amount of work to be accomplished in encouraging middle and high school students to consider nursing as a career, creative strategies through which nurses take an active role in helping resolve the problem are suggested.

Clinical education in managed care for advanced practice nurses: A case example

Managed care is a major component in the current practice environment of advanced practice nurses (APNs). Professional nursing organizations are incorporating managed care concepts into their requirements for nursing curriculum. Partnerships for Quality Education (PQE) was developed to foster partnerships designed to incorporate managed care skills into clinician education. This paper describes how one PQE-funded nurse practitioner project joined with a federally qualified community health center (FQCHC) to provide a foundation in managed care theory and practice to nursing students, clinicians, and other support staff.

Development, reliability and validity of an instrument measuring the attitudes and knowledge of Emergency Department staff regarding the Emergency Nurse Practitioner role

The Emergency Department (ED) at The Northern Hospital is currently participating in the Victorian Department of Human Services funded Emergency Nurse Practitioner Project. This project aims to develop, implement and evaluate the Emergency Nurse Practitioner role in Victorian EDs. This led to a need to develop a specific data collection tool called The Northern Emergency Nurse Practitioner Staff Survey to examine the knowledge and attitudes of ED medical and nursing staff. This paper describes the development of The Northern Emergency Nurse Practitioner Staff Survey and presents the results of reliability and validity studies. Twenty-five items were developed and piloted on a sample of 58 ED medical and nursing staff. Content and face validity were established by expert panel review. Reliability was established by tests of unidimensionality, exploratory factor analysis and internal consistency. Four items were discarded because of low item to total correlation. Exploratory factor analysis of the remaining items revealed five factors with eigenvalues >1 and acceptable correlation coefficients that explained 76.7% of the variance. Cronbach's coefficent alpha for these items was 0.926 indicating a high degree of internal consistency. The factors were titled to reflect the content domain of the items in each factor and the factors arranged in a logical sequence to form the final version of The Northern Emergency Nurse Practitioner Survey.

An overview of the role and functions of a psychiatric consultation liaison nurse: an Australian perspective.

The role of the psychiatric consultation liaison nurse (PCLN) has increased substantially in popularity over the last few years. Despite the growth of this position, a paucity of literature regarding the role, functions and effectiveness of psychiatric consultation liaison nursing continues to exist. The current study was undertaken as part of the Victorian Nurse Practitioner Project. A significant aspect of this study concerned collection of data on the activities of the PCLN. This approach enabled an extensive and detailed profile of the PCLN to be formulated. The findings indicate that the PCLN provided a service to nursing, medicine and allied health in relation to patients experiencing mental health problems in the general hospital setting. Patients referred to the PCLN presented varied clinical features in terms of medical, surgical and mental health disorders. The PCLN performed a range of interventions. The results of this study make a significant contribution to address the current paucity of literature.

The South Australian Nurse Practitioner Project: A Midwife'S Perspective On A New Initiative

Midwifery education in Australia is currently the focus of intense debate both within and outside the field of midwifery. Proposed changes arsing from these debates centre principally around the issue of midwifery as a separate profession from nursing. This paper describes a case in point as to how changes in attitude and practice are occurring. As a midwife representing the Australian College of Midwives Inc.- SA Branch (ACMI-SA) on the Advisory Committee of the South Australian Nurse Practitioner Project, I provide an insight into some of the debates around midwifery and its relationship with this project. ACMI was a member of the Ministerial Advisory Committee established following the initiative of the Executive of the Department of Human Services (DHS) (formerly the South Australian Health Commission) in forming the Nurse Practitioner Project. The Terms of Reference for this committee included the development of an operational framework for the development and implementation of the Nurse Practitioner role in South Australia. A collaborative approach was seen as essential to enable nurses to best serve their communities by functioning at an advanced level of practice. The ACMI and midwives generally fully support the Nurse Practitioner Project for nurses. By Jennifer Pauline Byrne.

Relocation to a new environment: decisional control and the move to a nursing home.

Bivariate and multivariate analyses were used to study the effect of deciding to move and wanting to move to a nursing home on the initial reactions of 502 elderly residents to their new environment. Data used in the analysis were taken from the Geriatric Nurse Practitioner Project in which residents were interviewed within one month of admission. Three scales were used to measure initial reaction: participation in nursing home activities, satisfaction with services, and social interaction. Covariates used to control for differences between groups were age, activities of daily living score, cognitive score, and affective status score. Bivariate relationships were found between the independent variables, deciding to move and wanting to move, and two measures, satisfaction with services and participation in nursing home activities. Multivariate analysis suggests that the two variables independently influence satisfaction and participation. Implications for practice and further research are discussed.

One nurse's view of pediatric nurse practitioners

Involvement in and reflections upon nine years of change in nursing and health care provide the framework for this commentary on the article, "Nurse Practitioners for Children—Past and Future" by McAtee and Silver.1 My earlier association with Silver as a co-director of the first pediatric nurse practitioner project at the University of Colorado makes these comments, hopefully, like conversations and challenges between colleagues. My remarks address those issues concerned with establishing priorities in the preparation of teacher-practitioners, the development of interdisciplinary collaboration, the need for studies of effectiveness of nurse practitioners, and an opinion on the recommendation to prepare "assistant nurse practitioners."

The Two Languages of Nursing and Medicine

MS. LYNAUGH (St. Mary's, Rochester, N.Y.; B.S., M.S., University of Rochester) and DR. BATES (M.D.. Cornell University) are co-directors of the medical nurse practitioner project at the University of Rochester, where they are on the faculties, respectively, of the school of nursing and school of medicine. The study on which this article is based was supported in part by Grant #NU-09737-01, USPHS Division of Nursing and by the Rochester Regional Medical Program.

The Two Languages of Nursing and Medicine

MS. LYNAUGH (St. Mary's, Rochester, N.Y.; B.S., M.S., University of Rochester) and DR. BATES (M.D.. Cornell University) are co-directors of the medical nurse practitioner project at the University of Rochester, where they are on the faculties, respectively, of the school of nursing and school of medicine. The study on which this article is based was supported in part by Grant #NU-09737-01, USPHS Division of Nursing and by the Rochester Regional Medical Program.