Acute care nurse practitioners (ACNPs) are a new addition to the Canadian health care system, having been introduced in the Canadian health care system in the late 1980s. While some authors have suggested that nurse practitioners offer “something special” to patient care, no evidence to date has substantiated this claim. The findings of this grounded theory study offer a theory (Acute Care Health Professional-Patient Relationship (ACHPPR) Theory) to describe how three types of health care professionals establish relationships with patients in acute care settings (Figure 7). This qualitative study explored relationships that ACNPs, physicians and staff nurses establish with patients in a large urban multi-site university-affiliated hospital. Six quartets (patient, ACNP, physician, staff nurse) were recruited and interviews, using a semi-structured guide were audio-taped and subsequently transcribed verbatim. Each type of relationship was found to have a unique focus; ACNPs focus on making connections with patients, physicians focus on managing patients’ diseases and staff nurses focus on meeting patients’ needs. In order to establish relationships with patients, readiness conditions must be met. Health professionals use strategies to influence the achievement of readiness conditions as well as to move forward with relationship development. Each type of relationship varies in the range of potential intensity that can be achieved, which is influenced by various dimensions. Relational intensity ranges from the uncommon clinical relationship, which focuses on the patient’s disease, through the more typical professional relationship characterized by a comfortable rapport and then finally to the most relationally intense, but rare, personal relationship. If a relationship reaches professional or personal levels of relational intensity, relational products become evident. When comparing these three health professional-patient relationships, similarities and differences have been identified. Analysis of patient interviews yielded themes that substantiate the ACHPPR theory. The ACHPPR theory offers a beginning understanding of the complementary nature of three types of health professional-patient relationships in the acute care setting and has the potential to influence practice, education, theory development and future research related to ACNP-patient relationships.

Thesis (M.S.)--University of Michigan, 1999. / Running title: Nurse practitioners' perception on functional decline. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2010. / Thesis presented in partial fulfilment of the requirements for the degree of Master of Nursing at Stellenbosch University / ENGLISH ABSTRACT: The trend towards specialisation in nursing has resulted in the development of the role of the Clinical Nurse Specialist (CNS) since the 1960s and 1970s in North America and the United Kingdom respectively. A Clinical Nurse Specialist should demonstrate excellent skills in leadership, communication, critical thinking, clinical and collaborative ethical decision-making, as well as mentoring. Research done internationally has shown that advanced practice nursing leads to higher patient satisfaction and compliance, fewer hospitalisations and shorter length of stays. The development of the CNS role in SA is slow in implementation. The South African Qualifications Authority has only recently published qualification rules for a master’s certificate and master’s degree in Nursing for advanced specialist nurses in SA. This situation led to the following research question: What is the expected role of the Critical Care Clinical Nurse Specialist in private hospitals in the northern and southern suburbs of the Cape Peninsula, South Africa? A non-experimental, explorative, descriptive study with a quantitative orientation was conducted in eight private hospitals in the Cape Peninsula. Through non-probability sampling 73 critical care health professionals (critical care professional nurses, clinical nurse specialists, nursing managers, unit managers, nurse educators, clinical facilitators, clinical coordinators and doctors) out of a population of 170 critical care health professionals participated in the study. A survey tool was designed and validated to collect the data. Quantitative data was analysed through Statistica® and qualitative data was analysed thematically. It was found that 81% of the participants agreed that Clinical Nurse Specialists should be appointed in the South African critical care environment as soon as possible to improve patient outcomes, to contribute to safer nursing care, to relieve work stress of shift leaders and bedside nurses and to improve the professional status of nursing. It is recommended that greater awareness regarding the Clinical Nurse Specialist should be developed. The relevant educational requirements should be finalised and a clear job description should be compiled. Nursing managers should appoint Clinical Nurse Specialists in each critical care unit as soon as possible. / AFRIKAANSE OPSOMMING: Die rol van die Kliniese Verpleegspesialis het as uitvloeisel van spesialisering in verpleging sedert 1960 en 1970 in Noord-Amerika en Groot-Brittanje onderskeidelik ontwikkel. `n Kliniese Verpleegspesialis behoort die volgende eienskappe te openbaar: uitmuntende vaardighede met betrekking tot leierskap, kommunikasie, kritiese denke, kliniese en etiese besluitneming en mentorskap. Internasionale navorsing het aangetoon dat gevorderde verpleegkunde tot `n hoër vlak van pasiënttevredenheid en nakoming van behandelingsvoorskrifte, minder hospitalisasie en korter hospitaalverblyf aanleiding gee. Die ontwikkeling van die rol van die Kliniese Verpleegspesialis in Suid- Afrika geskied langsaam. Die Suid-Afrikaanse Kwalifikasie-Outoriteit (SAKO) het eers onlangs die reëls vir `n meestersertifikaat en meestersgraad in Verpleegkunde vir gevorderde spesialisverpleegkundiges gepubliseer. Hierdie situasie het tot die onderstaande navorsingsvraag aanleiding gegee: Wat is die verwagte rol van die Kritiekesorg- Kliniese Verpleegspesialis in privaathospitale in die noordelike en suidelike voorstede van die Kaapse Skiereiland, Suid-Afrika? `n Nie-eksperimentele, beskrywende studie met `n kwantitatiewe benadering is in agt hospitale in die Kaapse Skiereiland onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 73 professionele betrokkenes by kritiekesorggesondheid (professionele kritiekesorgverpleegkundiges, kliniese verpleegspesialiste, verpleegbestuurders, eenheidsbestuurders, opvoeders in verpleegkunde, kliniese fasiliteerders, kliniese koördineerders en dokters) uit `n populasie van 170 professionele betrokkenes by kritiekesorggesondheid in die studie ingesluit. `n Vraelys is ontwerp en gevalideer vir die insameling van data. Kwantitatiewe data is deur middel van Statistica® ontleed terwyl die kwalitatiewe data tematies ontleed is. Daar is gevind dat die meerderheid van die deelnemers saamgestem het dat Kliniese Verpleegspesialiste so gou moontlik in die kritiekesorgomgewing in Suid-Afrika aangestel behoort te word. Die Kliniese Verpleegspesialis dra by om pasiëntuitkomste te verbeter, om tot veiliger verpleegsorg by te dra, om werkspanning van skofleiers en verpleegsters te help verlig en om die professionele status van verpleging te verbeter. Daar word aanbeveel dat daar groter bewusmaking aangaande die Kliniese Verpleegspesialis moet wees. Vereistes vir opleiding behoort gefinaliseer te word en `n duidelike werksbeskrywing moet opgestel word. Verpleegbestuurders behoort Kliniese Verpleegspesialiste so gou moontlik in die kritiekesorgomgewing aan te stel.

Purpose: Drug-drug interactions (DDIs) place a burden on our nation and cause potential harm to patients. Awareness of potential DDIs is essential for safe prescribing. Nurse practitioners (NP) have prescriptive authority throughout the nation, however, little is known about NP prescribing habits. The purpose of this study was to identify NPs' demographic and practice characteristics, DDI knowledge and factors that influence this knowledge.Data Sources: A survey was administered to NP prescribers recruited from a national conference. Data was collected on demographics, practice and technological characteristics, and perceptions and knowledge of DDIs.Conclusions: Data from 305 questionnaires were analyzed. NPs correctly classified 31% of drug pairs. Nitroglycerin and Sildenafil (drug combination to avoid) was classified correctly by the most respondents (90.8%, n = 305); Warfarin and Gemfibrozil (drug combination to usually avoid) the fewest 15.7% (n = 302). A positive correlation was found between NPs in acute care hospital settings and DDI knowledge, indicating higher knowledge scores. Neither hierarchical linear regression model was significant at predicting NPs' DDI knowledge.Implications for Practice: Continuing education needs to be targeted to enhance NPs knowledge of potential clinically significant DDIs. The increased recognition of potential DDIs among NPs will enhance patient safety.

The purpose of this thesis was threefold – First to investigate the emergence from the existing health system of nurse practitioners as a new occupation. Second to make sense of how nurse practitioners developed as primary care providers in the province of Ontario. Third to understand the nature and development of the intra-professional relationship between primary care nurse practitioners and physicians in local practice settings. I used a case study approach, with both historical (document review) and empirical (ethnography and interview) components. The empirical data was analyzed from an interpretive perspective using thematic analysis. A number of theoretical perspectives were drawn on, including Kingdon’s Agendas, Alternatives and Public Policy model, Abbott’s Occupational Jurisdiction model, Van de Ven et al’s Innovation Journey model, and Closure Theory. The study makes 3 contributions to new knowledge. First it documents the unfolding of events and actions over time, and thus serves as a historical summary. Second it adds an analysis of the case of nurse practitioners as an emergent occupation to the existing body of sociological analyses of professions. Third, it provides insight into how nurse practitioner - physician relationships are impacted at the local level because nurse practitioners are obligated to develop a relationship with a physician in order to be able to deliver comprehensive primary care services. The empirical component of the thesis analyzes and describes the nature of this relationship at a practice level. It also describes the use of ‘workarounds’ to bypass legislated restrictions in nurse practitioners’ scope of practice. It analyzes how structural differences in the manner of regulation, payment, and employment status between nurse practitioners and family physicians contribute to different styles of practice and perpetuate the hierarchical relationships between nurses and physicians. This knowledge has potential generalization to other emerging occupations, such as physician assistants and paramedics.

Maltreatment affected an estimated 794,000 children in the 50 States, the District of Columbia, and Puerto Rico in 2007 (United States Department of Health and Human Services [USDHHS], 2009). The purpose of this study was to examine the risk factors of young maternal age, parents' marital status, multiple birth, preterm birth, birth defects/disability, low economic status, and parental substance abuse related to suspected maltreatment of children 3 years of age or younger from the prospective of pediatric nurse practitioners (PNPs). A cross-sectional survey design, using the Tailored Design Method, was used in this study. A convenience sample consisting of the National Association of Pediatric Nurse Practitioners (NAPNAP) email registry was used for this study with a response rate of 11%. The respondents represented all regions of the United States. Seventy-nine percent of the PNP's (n=363) who completed the survey had suspected child abuse or neglect within the last year in a child three years of age or younger compared to 21% of PNPs (n=96) who did not suspect child maltreatment within the past year. The prevalence of suspected child maltreatment in the study population was 2.35%. According to the model examining child risk factors and abuse, the log of the odds of a child being abused was negatively related to preterm birth (p = .036) and birth defects/disability (p = .001). Multiple birth was positively related but not significant (p = .359). There were no statistically significant child risk factors found in the logistical regression for neglect (preterm birth, p = .180; multiple births, p = .938; birth defects/disabilities, p = .234). When examining the abuse and neglect groups together, the log of the odds of a child being abused and neglected was negatively related to birth defects/disabilities (p = .030). Preterm birth (p = .364) and multiple birth (p = .298) were positively related to the abuse and neglect group but were not significant. According to the model examining parental risk factors and abuse, the log of the odds of a child being abused due to a parent characteristic was negatively related to low economic status, with the proxy being WIC eligibility (p = .001) and a history of substance abuse (p = .031). The regression for abuse indicated a positive, yet insignificant, relationship with young maternal age (p = .129) and single marital status (p = .816). The logistic regression for neglect indicated a positive significant relationship with a substance abuse history (p = .012). The regression for neglect indicated positive but insignificant relationships for young maternal age (p = .693), marital status (p = .343), and WIC eligibility (p = .106). There were no statistically significant parental risk factors found in the logistical regression for abuse and neglect together (young maternal age, p = .263; marital status, p = .523; WIC eligibility, p = .131; substance abuse, p = .985). Findings indicated that child maltreatment is suspected by PNPs in primary care settings, and that PNPs recognize signs and symptoms of abuse and neglect.

In Canada, the nursing shortage and high turnover rate of nurses are expected to worsen over the next ten years, making the recruitment and retention of nurses a priority for health care. Previous research has indicated that job satisfaction influences the recruitment and retention of nurses. Most of the research on job satisfaction, thus far, has focused on nurses practicing in urban, acute-care settings. There has been little research on job satisfaction of nurses practicing in rural and remote settings in Canada, and even less on nurses practicing in advanced nursing practice (ANP) roles, specifically nurse practitioner (NP) roles. <p>A secondary analysis of data from the national survey The Nature of Nursing Practice in Rural and Remote Canada was conducted with a group of 327 RNs practicing in NP roles and 1,151 RNs practicing in non-NP roles. The objectives of the present study were to describe similarities and differences between RNs in NP versus non-NP practice roles in rural and remote settings in Canada in relation to: (1) demographic profile, (2) job satisfaction, and (3) community satisfaction. The final objective of the study was to explore what the most important work-related attributes for RNs whose practice roles were categorized as NP. <p>A modified version of Stamps (1997) Index of Work Satisfaction (IWS) was used to measure job satisfaction and the Community Satisfaction Scale (Henderson-Betkus & MacLeod, 2003) was used to operationalize community satisfaction. The study found that the reported overall level of job satisfaction was higher for RNs practicing in NP roles versus non-NP roles. Further findings suggested that the reported level of intrinsic job satisfaction factors was higher for RNs practicing in NP roles versus non-NP roles. The themes that were identified during the content analysis of NPs responses to the open-ended survey question related to the most important work-related attributes included: the nature of advanced nursing practice in rural and remote areas, work life, personal and professional development, practice philosophy, and the community. The findings of the present study provide useful information for health care administrators and policy makers on factors associated with job satisfaction of nurses practicing in NP and non-NP roles in rural and remote settings in Canada.

In Canada, the nursing shortage and high turnover rate of nurses are expected to worsen over the next ten years, making the recruitment and retention of nurses a priority for health care. Previous research has indicated that job satisfaction influences the recruitment and retention of nurses. Most of the research on job satisfaction, thus far, has focused on nurses practicing in urban, acute-care settings. There has been little research on job satisfaction of nurses practicing in rural and remote settings in Canada, and even less on nurses practicing in advanced nursing practice (ANP) roles, specifically nurse practitioner (NP) roles. <p>A secondary analysis of data from the national survey The Nature of Nursing Practice in Rural and Remote Canada was conducted with a group of 327 RNs practicing in NP roles and 1,151 RNs practicing in non-NP roles. The objectives of the present study were to describe similarities and differences between RNs in NP versus non-NP practice roles in rural and remote settings in Canada in relation to: (1) demographic profile, (2) job satisfaction, and (3) community satisfaction. The final objective of the study was to explore what the most important work-related attributes for RNs whose practice roles were categorized as NP. <p>A modified version of Stamps (1997) Index of Work Satisfaction (IWS) was used to measure job satisfaction and the Community Satisfaction Scale (Henderson-Betkus & MacLeod, 2003) was used to operationalize community satisfaction. The study found that the reported overall level of job satisfaction was higher for RNs practicing in NP roles versus non-NP roles. Further findings suggested that the reported level of intrinsic job satisfaction factors was higher for RNs practicing in NP roles versus non-NP roles. The themes that were identified during the content analysis of NPs responses to the open-ended survey question related to the most important work-related attributes included: the nature of advanced nursing practice in rural and remote areas, work life, personal and professional development, practice philosophy, and the community. The findings of the present study provide useful information for health care administrators and policy makers on factors associated with job satisfaction of nurses practicing in NP and non-NP roles in rural and remote settings in Canada.

Thesis (Ph.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 84-94).

Thesis (Ph.D.) - James Cook University, 2004. / Typescript (photocopy) Appendices : leaves 321-329. Bibliography : leaves 293-320.