Perceptions of senior residents about a community-based nursing center

HIV-infected women's relationships with their health care providers in the rural deep south: an exploratory study

Through this qualitative study we explored the patient/provider relationships of rural HIV-infected women. Thirty-nine women from rural Alabama were recruited to participate in one of four focus groups. The focus groups were audiorecorded, and the participants were asked to complete surveys measuring patient/provider trust. The verbatim-transcribed audio recordings were analyzed using content analysis. The participants' descriptions of their relationships with health care providers were represented by three major thematic categories: caring, informative, and competent. These findings provide a foundation for further research on the role of patient/provider relationships in the health outcomes of HIV disease in rural, resource-poor settings.

The validation of a new measure quantifying the social quality of life of ethnically diverse older women: two cross-sectional studies

BACKGROUND

To our knowledge, the available psychometric literature does not include an instrument for the quantification of social quality of life among older women from diverse ethnic backgrounds. To address the need for a tool of this kind, we conducted two studies to assess the initial reliability and validity of a new instrument. The latter was created specifically to quantify the contribution of a) social networks and resources (e.g., family, friends, and community) as well as b) one's perceived power and respect within family and community to subjective well-being in non-clinical, ethnically diverse populations of older women.

METHODS

In Study 1, we recruited a cross-sectional sample of primarily non-European-American older women (N = 220) at a variety of community locations. Participants were administered the following: a short screener for dementia; a demographic list; an initial pool of 50 items from which the final items of the new Older Women's Social Quality of Life Inventory (OWSQLI) were to be chosen (based on a statistical criterion to apply to the factor analysis findings); the Single Item Measure of Social Support (SIMSS); and the Medical Outcome Study 36-item Short-Form Health Survey (MOS SF-36). Study 2 was conducted on a second independent sample of ethnically diverse older women. The same recruitment strategies, procedures, and instruments as those of Study 1 were utilized in Study 2, whose sample was comprised of 241 older women with mostly non-European-American ethnic status.

RESULTS

In Study 1, exploratory factor analysis of the OWSQLI obtained robust findings: the total variance explained by one single factor with the final selection of 22 items was over 44%. The OWSQLI demonstrated strong internal consistency (α = .92, p < .001), adequate criterion validity with the SIMSS (r = .33; p < .01), and (as expected) moderate concurrent validity with the MOS SF-36 for both physical (r = .21; p < .01) and mental (r = .26; p < .01) quality of life. In order to confirm the validity of the 22-item OWSQLI scale that emerged from Study 1 analyses, we replicated those analyses in Study 2, although using confirmatory factor analysis. The total variance accounted for by one factor was about 42%, again quite high and indicative of a strong single-factor solution. Study 2 data analyses yielded the same strong reliability findings (i.e., α = .92, p < .001). The 22-item OWSQLI was correlated with the SIMSS (r = .27, p < .001) in the expected direction. Finally, correlations with the MOS SF- 36 demonstrated moderate concurrent validity for physical (r = .14; p < .01) and mental (r = .18; p < .01) quality of life, as expected.

CONCLUSIONS

The findings of these two studies highlight the potential for our new tool to provide a valid measure of older women's social quality of life, yet they require duplication in longitudinal research. Interested clinicians should consider using the OWSQLI in their assessment battery to identify older women's areas of lower versus higher social quality of life, and should establish the maximization of patients' social quality of life as an important therapeutic goal, as this variable is significantly related to both physical and mental health.

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.

Impact of academic nurse-managed centers on communities served

PURPOSE

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.

DATA SOURCES

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.

CONCLUSIONS

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.

IMPLICATIONS FOR PRACTICE

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.

Establishing a definition for a nurse-led clinic: structure, process, and outcome

AIM

This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome.

BACKGROUND

Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service.

METHODS

This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003.

RESULTS

The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses.

CONCLUSIONS

A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework.

The Midwest Nursing Centers Consortium Research Network: translating research into practice

Community nursing centers (CNCs) serve the health needs of culturally diverse populations that are often marginalized and likely to experience disparities in health. CNCs utilize innovative models of primary health care that blend traditional medical management with nursing case management and community-based health promotion strategies. This article describes the mission and activities of the Midwest Nursing Centers Consortium Research Network (MNCCRN), a practice-based research network (PBRN) funded by the Agency for Healthcare Research and Quality, and is one of only two federally funded nonphysician primary care PBRNs and the only PBRN in the United States comprising exclusively CNCs. The MNCCRN utilizes Advanced Practice Nurses to deliver primary health care with a particular emphasis on reducing health disparities. The MNCCRN has successfully established a multisite, multistate collaboration for community-based participatory research that will ultimately inform practice, education, and health policy.

Perceptions of a senior citizens' Wellness Center. The community's voice

Health promotion encompasses an important role in the nursing care of all individuals across the life span. The literature indicates senior citizens tend to be the age group most actively involved in health promotion activities. Not only do senior citizens, as an age group, participate more frequently in health promotion activities, but also they tend to seek out health promotion opportunities. A center for community residing senior citizens, funded by the provincial health department for 4 years, was initiated to promote health and wellness among the senior citizens and to delay the onset of disability. To evaluate the outcomes of the Wellness Center, the qualitative methodology of this study used the focus group approach. The participants in the focus groups comprised health professionals and community groups with some involvement with the Wellness Center. In their discussions, participants identified the Center as providing health promotion services different from those currently existing in the health care system. The participants agreed the Center was essential to promote healthy lifestyles for senior citizens.

Using focus groups in rehabilitation nursing

The purpose of this paper is to describe the research method of focus groups and give an example of how it could be used to advance rehabilitation nursing in the area of poststroke adaptation or recovery. Stroke is a leading cause of death and disability in elderly Americans. Although much is known about the physical effects and treatments of stroke, little has been published on the adaptive behaviors or recovery process of stroke survivors. The focus-group technique can provide an "insider's" view of the adaptive behaviors of stroke survivors and is a cost-effective way to generate rich qualitative data to guide nursing practice.

Contrasting two approaches in a community-based nursing practice with older adults: the medical model and Parse's nursing theory

This article contrasts the assumptions and concepts of two distinct approaches, the medical model and Parse's human becoming theory, as applied in a nurse-managed capitated community healthcare program for older adults. Many nurses incorporate aspects of the medical model into their practice without fully appreciating the implications or being aware of alternative perspectives. Within capitated health programs a nursing practice based on a nursing theory which emphasizes an intersubjective dialogue with older adults as they move toward different meanings and free choice is seen as more likely to be associated with greater satisfaction and reduced healthcare expenditures than a nursing approach based on the medical model, which relies on the objectification of human experience. Nurses can best balance the problem-focused orientation of a medical model dominated healthcare system by adopting an approach committed to recognizing that persons are the coauthors of their existence.

A blending of health strategies in a community-based nursing center

In today's changing healthcare climate, there is a need for a paradigm shift from a goal-driven model of care to a resource-driven model of care. This proposal describes a nursing center model that attempts to create a framework involving the community in determining the priority of its healthcare needs. Although it is desirable to offer all services to all people, it is apparent that costs will play a major role in determining service availability. Participation, support, and cost-effective outcomes are likely to be greater if residents of the community are involved in the services and programs provided. The advanced practice nurse (APN) is well suited to assist communities in determining priorities and meeting health needs in a cost-effective manner. The proposal submitted is based on a theoretical foundation that articulates a nursing framework and includes specific examples of services provided. It is flexible and can be adapted to any community. Modern scientific care, alternative therapies, education, and programs specific to the community's needs are also discussed. The presentation offers a nursing care delivery model in the community and discusses phases of implementation that have been initiated.