Relationships Between Processes and Outcomes of Nurse Practitioners in Acute Care
School of Nursing, Ryerson University, Toronto, Ontario M5B 2K3, Canada. Journal of nursing care quality
(Impact Factor: 1.39).
08/2009; 25(1):31-8. DOI: 10.1097/NCQ.0b013e3181b1f41e
This nonexperimental repeated-measure study examined the relationships between processes (coordination of care, and provision of counseling and education) and outcomes (symptom resolution, functional status, and satisfaction with care) expected of acute care nurse practitioners (ACNPs). The data were obtained from 320 patients admitted to medical, surgical, and cardiac units. The results indicated positive association between the process and outcome variables, providing initial evidence delineating care processes of ACNPs that contribute to the achievement of nursing-sensitive outcomes.
Available from: Christina Hurlock-Chorostecki
- "Primary NP research studies were reexamined for inclusion of the identified key IP terms and the manner in which the terms were employed. Less than half the research studies (six research studies, eight articles) contained key IP terms within their findings or discussions (Searle, 2008; van Soeren et al., 2009; 2011; Sidani & Doran, 2010; Desborough, 2012; Kilpatrick et al., 2012a,b; Williamson et al., 2012). Six of the 12 identified IP terms used were: communication, collaboration , shared responsibility, coordination, integration, and leadership (Table 3). "
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ABSTRACT: This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty-nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital-based nurse practitioner role.
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ABSTRACT: In many countries, acute care nurse practitioners contribute to patient care through an expanded scope of practice that includes nursing and medical activities. There have been calls across nations to establish better understanding of how nurse practitioners enact their roles in healthcare teams. The 2006 introduction of cardiology nurse practitioners in Quebec, Canada provides an opportunity to examine this process more closely.
The purpose of the study is to understand how nurse practitioners enact the medical and expanded nursing portions of their role in healthcare teams.
A descriptive multiple-case study design was used.
The study was conducted in two university-affiliated teaching hospitals in Quebec.
Data were collected from March 2009 to May 2009. Data sources included interviews (N=59), field notes, documents, and a time and motion study (N=108 h 53 min) of nurse practitioner activities using a validated observation tool.
The interviews were conducted individually or in groups. Content analysis was used to analyse the qualitative data. Descriptive statistics were generated for the time and motion study.
The clinical role component, including nursing and medical activities, occupied the largest portion of the nurse practitioners' work time. The pace of nurse practitioner work activities was faster in the first half of the workday in response to patient care demands. The enacted nurse practitioner scope of practice was sensitive to the local context, and the needs of team members, patients and families. Nursing and medical leadership, and the transfer of prescriptive authority and decision-making autonomy affected how nurse practitioners enacted the medical and expanded nursing portions of their roles. Participants believed the pace of work influenced the nurse practitioners' ability to develop relationships with team members, and enact all the components of their role.
The practitioners' scope of practice changed in response to pressures inside and outside healthcare teams or a lack of healthcare system structures. The study findings appear to be applicable to nurse practitioners working in other specialties, and in other countries. Future research needs to examine how the pace of work affects the nurse practitioners' ability to provide care.
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ABSTRACT: Aim. This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness.
Background. Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team structures and processes to desirable outcomes is needed.
Data sources. Literature was obtained by searching CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and Google Scholar from 1985–2010. A descriptive multiple-case study was completed from March 2009–May 2009.
Discussion. A new conceptual framework describing how role enactment and boundary work affect perceptions of team effectiveness was developed by combining theoretical and empirical sources. The framework proposes proximal indicators used by team members to assess their team’s performance.
Implications for nursing. The framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that reflect the contributions of all providers to quality patient care, and explore the patients’ and families’ perceptions of team effectiveness following the introduction of acute care nurse practitioners.
Conclusion. The new framework can guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in healthcare teams.
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