2.50
Hdl Handle:
http://hdl.handle.net/10755/158326
Type:
Presentation
Title:
Out of the Briar Patch: Sustainability of Nurse-managed Practice
Abstract:
Out of the Briar Patch: Sustainability of Nurse-managed Practice
Conference Sponsor:Western Institute of Nursing
Conference Year:2004
Author:Campbell, L.
P.I. Institution Name:Loretto Heights Dept. of Nursing - Regis University
Contact Address:3333 Regis Blvd, Mail CodeG-8, Denver, CO, 80221-1099, USA
Purpose/aims: A multiple case study was conducted to analyze the innovation development process of community-based nurse-managed practice (CBNMP). Specific aims were to (a) describe the initiation and evolution of CBNMP for three prevalent practice contexts (urban-academic, urban-private/not-for-profit, and rural-federally qualified health center); (b) identify the respective communication processes that facilitated or hindered diffusion of CBNMP in these contexts; (c) describe the respective social system integration as reflected by adoption and sustainability of CBNMP in these contexts; and (d) compare the innovation development process of CBNMP in three settings that differed on environmental and practice contexts. Rationale, Conceptual Basis, Background: Despite provision of high quality care below the average cost of primary care providers, an estimated 21 percent decline in the number of academic CBNMPs was documented during the 1990s. The study’s conceptual basis derived from the Theory of Diffusion of Innovations and the Theory of Community as Partner. CBNMP offers local populations the opportunity to contract directly with professional nurses for primary health care services. Methods: Case study design was selected for this IRB-approved study. Rigorous procedures and four data collection strategies were used during two site visits totaling 9 or 10 days at each site: background survey, document review, observations, and interviews (N=85). Matrix analysis facilitated triangulation of qualitative and quantitative results. Results: Evolutionary commonalties across sites included diminished reliance on grant or federal funding, increased size of practice, increased diversity and acuity among patients, and transformation from local clinic to citywide or regional practice. Themes derived from data analysis were covenantal care (serving through sacrificial efforts), contextual stewardship (managing resources and responsibilities), community partnership (identifying and targeting populations’ needs), chronic invisibility (lacking recognition), and compelling distinction (delivering holistic primary health care to diverse populations). The first three themes reflect how CBNMPs have been able to advance their missions, expand their practices, and promote their sustainability. The theme of chronic invisibility, however, is a pervasive problem due not only to legal, reimbursement, and interdisciplinary barriers but also to lack of direct linkages with nursing theory. Implications: Making explicit the science behind CBNMP’s compelling distinction of care suggests a way to countermand the invisible nature of CBNMP and fulfill its promise in delivery of primary health care. Contributions of the study include description of potential patients, lack of referral sources for CBNMP, impact of word of mouth on diffusion, examples of survivable crises, role of visionary advocates, and patients’ trust in advanced practice nurses. In addition, the themes of covenantal care, contextual stewardship, and compelling distinction had not been articulated in the literature. Study Support: Grants from NIH/National Institute for Nursing Research (NRSA 5 F31 NR07573-02) and Sigma Theta Tau International, Alpha Kappa Chapter-at-Large, Denver.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleOut of the Briar Patch: Sustainability of Nurse-managed Practiceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158326-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Out of the Briar Patch: Sustainability of Nurse-managed Practice</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Campbell, L.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Loretto Heights Dept. of Nursing - Regis University</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3333 Regis Blvd, Mail CodeG-8, Denver, CO, 80221-1099, USA</td></tr><tr><td colspan="2" class="item-abstract">Purpose/aims: A multiple case study was conducted to analyze the innovation development process of community-based nurse-managed practice (CBNMP). Specific aims were to (a) describe the initiation and evolution of CBNMP for three prevalent practice contexts (urban-academic, urban-private/not-for-profit, and rural-federally qualified health center); (b) identify the respective communication processes that facilitated or hindered diffusion of CBNMP in these contexts; (c) describe the respective social system integration as reflected by adoption and sustainability of CBNMP in these contexts; and (d) compare the innovation development process of CBNMP in three settings that differed on environmental and practice contexts. Rationale, Conceptual Basis, Background: Despite provision of high quality care below the average cost of primary care providers, an estimated 21 percent decline in the number of academic CBNMPs was documented during the 1990s. The study&rsquo;s conceptual basis derived from the Theory of Diffusion of Innovations and the Theory of Community as Partner. CBNMP offers local populations the opportunity to contract directly with professional nurses for primary health care services. Methods: Case study design was selected for this IRB-approved study. Rigorous procedures and four data collection strategies were used during two site visits totaling 9 or 10 days at each site: background survey, document review, observations, and interviews (N=85). Matrix analysis facilitated triangulation of qualitative and quantitative results. Results: Evolutionary commonalties across sites included diminished reliance on grant or federal funding, increased size of practice, increased diversity and acuity among patients, and transformation from local clinic to citywide or regional practice. Themes derived from data analysis were covenantal care (serving through sacrificial efforts), contextual stewardship (managing resources and responsibilities), community partnership (identifying and targeting populations&rsquo; needs), chronic invisibility (lacking recognition), and compelling distinction (delivering holistic primary health care to diverse populations). The first three themes reflect how CBNMPs have been able to advance their missions, expand their practices, and promote their sustainability. The theme of chronic invisibility, however, is a pervasive problem due not only to legal, reimbursement, and interdisciplinary barriers but also to lack of direct linkages with nursing theory. Implications: Making explicit the science behind CBNMP&rsquo;s compelling distinction of care suggests a way to countermand the invisible nature of CBNMP and fulfill its promise in delivery of primary health care. Contributions of the study include description of potential patients, lack of referral sources for CBNMP, impact of word of mouth on diffusion, examples of survivable crises, role of visionary advocates, and patients&rsquo; trust in advanced practice nurses. In addition, the themes of covenantal care, contextual stewardship, and compelling distinction had not been articulated in the literature. Study Support: Grants from NIH/National Institute for Nursing Research (NRSA 5 F31 NR07573-02) and Sigma Theta Tau International, Alpha Kappa Chapter-at-Large, Denver.</td></tr></table>en_GB
dc.date.available2011-10-26T20:44:06Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:44:06Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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