Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.
OBJECTIVE: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting. DESIGN: Systematic review of randomised controlled trials and prospective observational studies. DATA SOURCES: Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies. INCLUDED STUDIES: Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care. RESULTS: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations. CONCLUSION: Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care. (+info)
The synergy model and the role of clinical nurse specialists in a multihospital system.
The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses' responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients' outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients' outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice. (+info)
Reciprocity for patients with head and neck cancer participating in an instrument development project.
PURPOSE/OBJECTIVES: To examine reciprocity (i.e., a mutual exchange of benefit) in study participation via a thematic analysis of field notes on study participation from a parent psychometric study. DESIGN: Qualitative. SETTING: Head and neck surgery clinic in an urban tertiary hospital. SAMPLE: Seven patients with head and neck cancer recruited to participate in an instrument development project. METHODS: Symbolic interactionism was employed to frame the examination of field notes from observations and interactions with patients, as well as participant notes accompanying returned retest questionnaires. Analysis relied on the constant comparative technique at the levels of open and axial coding. MAIN RESEARCH VARIABLES: Participation in an instrument development project. FINDINGS: Four content themes emerged in the analysis: Willingness to Help, Reassurance That the Deficits Patients Experience Are Common, Participation Provides Social Contact, and Confirmation of Clinically Significant Findings. A process theme, Unveiling the Experience, integrated the content themes in relation to participation itself. The role of the study nurse appears to be pivotal in this process. CONCLUSIONS: A notion of reciprocity in research participation is apparent. The role of the study nurse is an important element in the process of reciprocity. This role should be explored to enhance study participation. IMPLICATIONS FOR NURSING: Implications, particularly for clinical trial nurses, include recasting the benefits of participating in research, better addressing preparation for patients scheduled to receive treatment for head and neck cancer, and exploring and enhancing the role of the study nurse. (+info)
Online exclusive: a model of health behavior to guide studies of childhood cancer survivors.
PURPOSE/OBJECTIVES: To describe the Interaction Model of Client Health Behavior (IMCHB) and its application to health promotion in childhood cancer survivors. DATA SOURCES: Periodical literature about cancer survivors, health behavior models, and the IMCHB. DATA SYNTHESIS: Childhood cancer survivors are at risk for various late complications of treatment. The primary goal of intervention is the modification of health-related behavior. Conceptual models that extend beyond health beliefs are needed to guide explanatory and intervention studies in this group. CONCLUSIONS: The IMCHB identifies background, cognitive, affective, motivational, and contextual variables that explain health-related behaviors. The model defines the interactive and collective contributions of a survivor, family, and provider to adherence to protocols, reduction of risk behavior, and promotion of health-protective behavior. IMPLICATIONS FOR NURSING: This model may identify new determinants of health-related behavior that can be targeted by specific inter- or intrapersonal interventions to protect the health of childhood cancer survivors and reduce their risk of late sequelae. (+info)
Evaluation of two calcium alginate dressings in the management of venous ulcers.
Calcium alginate dressings facilitate the management of highly exudating wounds such as venous ulcers. To evaluate and compare the performance of two calcium alginate dressings in the management of venous ulcers, a prospective, randomized, controlled clinical study was conducted among 19 outpatients at two wound clinics in California. Ten patients (53%) were treated with Alginate A and nine patients (47%) with Alginate B. Dressings were changed weekly and patients were followed for a maximum of 6 weeks or until the venous ulcer no longer required the use of an alginate dressing. At each dressing change, the wound was assessed and dressing performance evaluated. Absorbency of exudate, patient comfort during wear, ease of removal, adherence to wound bed, dressing residue following initial irrigation, patient comfort during removal, ease of application, and conformability were assessed. Patients using Alginate A experienced significantly less foul odor (P = 0.02) and less denuded skin (P = 0.04) than Alginate B at follow-up wound assessments. With the exception of conformability, Alginate A was rated significantly better than Alginate B (P less than or equal to 0.05) in all dressing performance assessments. No significant healing differences were observed. As the different performance characteristics of various calcium alginate dressings become more obvious in clinical practice, further study is warranted to determine their optimal effectiveness. (+info)
Preparing the wound for healing: the effect of activated polyacrylate dressing on debridement.
Activated polyacrylate dressings facilitate wound debridement by retaining moisture while attracting and retaining proteins and bacteria. A 55-patient retrospective study was conducted to quantify the effect of this dressing on debridement of chronic wounds in clinical practice. All patients attended one of four outpatient wound clinics between June 1, 2001 and February 10, 2002 and received treatment with the polyacrylate dressing for an average of 3.9 weeks (SD 4.1). During that time, the rate of wound necrotic tissue debridement was 37.7% per week. Older patients (>80 years of age) had significantly lower rates of wound debridement (mean 18.1% per week) than those <51 years of age (mean 36% per week, P = 0.009). Other variables (age, wound type, wound duration and diagnosis of diabetes) were not found to significantly affect the rate of wound debridement. Wound debridement rates of commonly available modalities are largely unknown. However, these results suggest that activated polyacrylate dressings are an effective, atraumatic, and easy-to-use method of debriding chronic wounds. (+info)
A study to compare a new self-adherent soft silicone dressing with a self-adherent polymer dressing in stage II pressure ulcers.
Pressure ulcers are common among elderly nursing home residents. To be effective in managing these wounds, a dressing should maintain a moist environment, facilitate healing, absorb exudate, remain in place for a number of days, and prevent trauma to the surrounding skin. An 8-week, open, randomized, multicenter, controlled study was conducted to compare the effects of a new self-adherent soft silicone dressing and a self-adherent hydropolymer dressing on Stage II pressure ulcers. Thirty-eight (38) residents participated in the study. Eighteen residents (mean age 83.8 years, range 74.9 to 95.1 years) were randomized to wound management with a soft silicone dressing, and the ulcers of 20 residents (mean age 82.5 years, range 66.4 to 91.9 years) were managed with a hydropolymer dressing. Wound healing, wound and surrounding skin characteristics, and ease of dressing removal were measured and documented. During the study, eight (44%) ulcers in the soft silicone group and 10 (50%) in the hydropolymer dressing group healed. Both dressings were changed approximately once a week and no differences in signs of inflammation, amount of exudate and odor, or incidence of leakage were observed. Damage to the surrounding skin, maceration, and dressing removal difficulties were less common with the soft silicone dressing. Differences in tissue damage between the two dressings were significant during weeks 1, 2, and 3 (P < 0.05). Studies with a larger sample size are needed to confirm these findings. (+info)
Online exclusive: functional integration of nursing research into a pediatric oncology cooperative group: finding common ground.
PURPOSE/OBJECTIVES: To provide a brief description of the historic role of nursing and nursing research in the culture of previous pediatric oncology cooperative groups and compare the research language used in cooperative groups with the language used in nursing research. DATA SOURCES: Published empirical, clinical, and methodologic reports. DATA SYNTHESIS: The culture and language of nursing research differ from those of medical research and the pediatric oncology cooperative group, the Children's Oncology Group (COG). Different approaches exist to integrate nursing research priorities into the priorities of COG, including freestanding protocols, companion protocols, and research objectives included in therapeutic protocols. CONCLUSIONS: Full integration of nursing research into COG is feasible but dependent on recognition of cultural and language differences among researchers. Integration will be demonstrated by the number of concepts and protocols contributed to or developed by active nurses in COG. IMPLICATIONS FOR NURSING: Significant advances exist for nurses conducting research in COG. These research efforts are facilitated by a familiarity with the science language used by other disciplines in COG and an understanding of COG's research processes. Increased interdisciplinary scientific collaborations involving nurses in COG particularly benefit pediatric patients with cancer. (+info)