Measuring advanced practice nursing outcomes

A novel, intensive home-visiting intervention for runaway, sexually exploited girls

PURPOSE

Few studies have examined interventions that help adolescents who run away. This study both describes a home-visiting intervention program for young, sexually assaulted runaways (10-14 years old) and provides preliminary outcomes from the first 20 female participants.

DESIGN AND METHODS

Using a strengths-based approach, advanced practice nurses provided frequent home and school visits and case management, and assisted girls to access an empowerment group over a 1-year period.

RESULTS

Teens' risk behaviors decreased, including truancy, runaway episodes, sexually transmitted infections, and substance use.

CONCLUSIONS

Preliminary results suggest that this is an effective intervention for reducing risk behaviors and helping younger runaways reconnect to school and family.

PRACTICE IMPLICATIONS

Client-centered interventions in community settings can address the complex health needs of vulnerable young runaways.

Family caregiving of persons living with HIV/AIDS in Thailand: Caregiver burden, an outcome measure

The present paper provides an initial picture of HIV/AIDS-affected families. It is evident that families play a major role of support for HIV/AIDS patients in Thai society. Caregiver burden is one of the patient-related outcomes, which is the most common outcome measure in caregiver research. The demands on the family caregivers of these patients are enormous and need to be addressed. The determinants that are associated with caregiver burden such as caregiver characteristics, patient characteristics and social stigma are important for nurses to minimize the burden of care so that appropriate interventions can be developed for persons with HIV/AIDS and family members who share the work of managing their care at home.

Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

• Background Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.

• Objective To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.

• Methods Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses).

• Results Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for “long-stay” patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners’ continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols.

• Conclusion Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner’s role as medically oriented, the themes reflect a clear nursing focus.

Traditional versus telenursing outpatient management of patients with cancer with new ostomies

PURPOSE/OBJECTIVES

To measure the impact of telenursing on patients discharged with ostomies resulting from cancer treatment.

DESIGN

Quasi-experimental design with surveys.

SETTING

Large tertiary care center in the southwestern United States.

SAMPLE

28 patients with cancer in two groups: traditional home health and home health plus telenursing.

METHODS

Recorded the number of home health and telenursing contacts, dates when ostomy self-care needs were met, supplies used, and distance traveled. Patients completed a satisfaction survey and Maklebusts Ostomy Adjustment Scale.

MAIN RESEARCH VARIABLES

Type of care, costs, patient satisfaction, ostomy adjustment, and time to achieve ostomy self-care.

FINDINGS

Telenursing patients indicated higher satisfaction. The home health group averaged one more home health visit per patient (telenursing mean= three visits). Overall costs for both types of visits were about equal. The home health group used an average of four more pouches per patient, with increased cost of 52 dollars per patient. Telenursing patients believed that nurses had increased understanding of their problems, and they were more comfortable with what nurses told them about ostomy. Telenursing participants believed that telenursing made care more accessible; they preferred telemedicine rather than waiting for face-to-face visits but still believed that face-to-face visits were best.

CONCLUSIONS

Combining traditional home health and telenursing is feasible for supporting discharged patients with new ostomies and enhances traditional home health, resulting in increased satisfaction overall.

IMPLICATIONS FOR NURSING

Oncology nurses should develop telenursing programs that include patient and family education regarding oncology issues.

Using outcomes research to validate the advanced practice nursing role administratively

The health care system has been forced to respond to the demand for changes in care provision. The changes have produced an opportunity for APNs to become a partner in care in the ICU. With the new opportunities APNs have been challenged to quantify the quality and fiscal effectiveness of their practices in the critical care arena. Administrators have a vested interest in the success of the organization, which includes the concepts of fiscal viability and quality care and patient and family satisfaction. There are data available to help formulate the rational argument for the inclusion of APNs in critical care. By using the data APNs can prove that their presence has a positive impact on the quality and financial outcomes of care. APNs can have a positive impact on the organization in all of the ways that are important to the administration. They can transform the current practice and improve the quality of the care. In presenting the outcome data of the APN role to administrators, APNs can be successful in gaining support for their role. APNs are vital components of the healthcare system and gaining recognition of the true value of the role is key to ensuring the ability of APNs to meet today's healthcare challenges for the improvement of patient care.

What advanced practice nursing outcomes research is out there?

With a traditional focus on primary care or selected patient populations, advanced practice nurses (APNs) are forging new roles in a variety of practice settings, including acute and critical care. APNs have become important members of the critical care team, yet the impact of their care on acute and critically ill patients has not been well studied. This article presents an overview of the research currently available on outcomes of APN practice for acute and critically ill patients. The findings from these studies are discussed and implications for the future of APN outcomes research are provided.

Challenges of outcomes research for nurse practitioners

PURPOSE

To describe the numerous methodological challenges nurse practitioners (NPs) face in designing and conducting outcomes research and provide practical tips to implement an outcomes study within an institution.

DATA SOURCES

Review of world wide scientific literature on outcomes research.

CONCLUSIONS

Nurse practitioners must be aware of the challenges of conducting outcomes research. Challenges associated with variable definition, designing outcomes studies, use of data sets, and instrument development and selection must be understood prior to undertaking an outcome study.

IMPLICATIONS FOR PRACTICE

Valuable studies have laid a foundation for evidence of quality care provision by NPs. Now is the time to measure patient outcomes of the NP care longitudinally over significant periods of time.

Support for evidence-based practice

OBJECTIVES

To discuss examples of the process for evidence-based practice (EBP) and suggest helpful mechanisms for its support.

DATA SOURCES

Published review and research articles, textbooks, guidelines, and web sites.

CONCLUSIONS

Evidence-based practice requires a step by step process. Obtaining resources for EBP is essential to identifying and implementing and/or sustaining clinical care based on the best evidence available.

IMPLICATIONS FOR NURSING PRACTICE

Finding resources to conduct EBP activities is one of the more challenging aspects of this approach to maintaining and improving quality of clinical care. However, nurses have found creative ways to obtain needed resources to implement EBP.

Comprehensive trauma patient care by nonphysician providers

Nonphysician providers are being increasingly used to care for trauma patients. As these complex patients recover, they require meticulous medical management and time-consuming psychosocial care. A retrospective evaluation of a unique patient care service staffed by nonphysician providers is presented. The Intermediate Care Service is designed to facilitate the management and long-term placement of trauma patients who no longer require intensive care while recovering from their injuries. The new diagnoses, physician order changes, and disposition of 93 patients cared for during a 6-month period are described. Most patients were admitted with neurologic injury. The most common new diagnosis was constipation; the most frequent new orders related to medications, including bowel management, and rehabilitation consultations. All patients were discharged from the hospital. The Intermediate Care Service represents a unique and valuable model for the collaborative management of complex trauma patients.