Patient problems, advanced practice nurse (APN) interventions, time and contacts among five patient groups.

Full Abstract

PURPOSE:
To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs.

DESIGN AND METHODS:
Analysis of 333 interaction logs created by APNs during five randomized controlled trials:
(a) very low birthweight infants (n = 39); (b) women with unplanned cesarean birth (n = 61), (c) high-risk pregnancy (n = 44), and (d) hysterectomy (n = 53); and (e) elders with cardiac medical and surgical diagnoses (n = 139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States.

FINDINGS:
Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N = 150,131) differed across groups reflecting the health care problems common to the group.

CONCLUSIONS:
Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems.

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Author information

Author/s: Brooten, Dorothy (D); Youngblut, JoAnne M (JM); Deatrick, Janet (J); Naylor, Mary (M); York, Ruth (R);

Affiliation: Florida International University, School of Nursing, 3000 NE 151st St., AC II Rm 231A, North Miami, FL 33181, USA. brooten(-atsign-)fiu.edu

Grants: R01-NR04102 (Agency:NINR NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, P.H.S.; Review

Journal: Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau (J Nurs Scholarsh), published in United States. (Language: eng)

Reference: 2003-; vol 35 (issue 1) : pp 73-9

Dates: Created 2003/04/18; Completed 2003/05/28; Revised 2007/11/14;

PMID: 12701530, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Nurs Scholarsh. 2003;35(3):205. (PMID: 14562481)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Female
Health Care Costs
Humans
Infant, Newborn
Nurse Practitioners - economics

Nurse-Patient Relations
Nursing Process
Outcome and Process Assessment (Health Care)
Pregnancy
Problem Solving
Time and Motion Studies

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