Advanced practice nursing interventions and outcomes : an exploration of transitional care services post prostatectomy / Regina S. Cunningham.

Format:

Book

Manuscript

Microformat

Thesis/Dissertation

Author/Creator:

Cunningham, Regina S.

Contributor:

Richmond, Therese, advisor.

University of Pennsylvania.

Language:

English

Subjects (All):

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Nursing.

Academic Dissertations as Topic.

Medical Subjects:

Nursing.

Academic Dissertations as Topic.

Local Subjects:

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Physical Description:

xii, 198 pages ; 29 cm

Production:

2003.

Summary:

Questions about the adequacy of healthcare delivery in the United States have led to intense scrutiny of the processes and outcomes of care. Developing an understanding of how providers and care delivery models specifically influence the development of outcomes is a top research priority. This study examined how the process of care, delivered by Advanced Practice Nurses (APNs), in the home care setting, affected selected clinical outcomes. APN care is associated with a number of positive outcomes; however, the reasons why APNs create these outcomes have not been clearly explicated. This study was predicated on the assumption that APNs are skilled in interpreting research findings and incorporating research evidence into their practice; this is one of the possible explanations for the improvements in outcomes that have been associated with their care. A recently completed clinical trial examining the effects of APN interventions in patients with clinically localized prostate cancer provided a unique opportunity to investigate this issue. The parent study examined the effects of APN interventions provided to men in their homes after discharge following radical prostatectomy; APNs documented their care in documentation logs. This study compared intervention statements recorded in the documentation logs to key elements of Agency for Healthcare Research and Quality Clinical Practice Guidelines (CPGs); these elements were used as a proxy to represent evidenced-based care. The documentation logs revealed a total of 12,317 statements meeting the defined criteria for nursing intervention. These statements were examined, subject to content analysis, coded, and compared to core elements of established CPGs. The level of consistency between documented interventions and core CPG elements was established. The mean level of consistency between APN interventions and core elements of the pain, incontinence, and depression guidelines was 91.03%, 80.35%, and 69.1%, respectively. These positive findings suggested that APNs in the parent study used research evidence to guide their clinical decision-making. Control of clinical and demographic factors (age, race, level of education, number of symptoms, and Gleason score), through regression techniques, identified that higher levels of consistency with CPGs did not predict pain, depressive symptom, and urinary incontinence outcomes measured three months after surgery. This is the first study to systematically assess the level of consistency between APN interventions and CPGs. Major findings of the investigation illustrated that APN practice in this sample and setting was highly reflective of care outlined in the CPGs, suggesting that this group of providers utilized evidence to make clinical decisions about care delivery. This finding was significant since little was known about how effectively advanced practice nurses use guidelines in their clinical practice.

Notes:

Supervisor: Therese Richmond.

Thesis (Ph.D. in Nursing) -- University of Pennsylvania, 2003.

Includes bibliographical references.

Local Notes:

University Microfilms order no.: 3095871.

OCLC:

244973008