With passage of the Patient Protection and Affordable Care Act (PPACA) and the publication of the Institute of Medicine’s report on the future of nursing, nurses are slated to take on an expanded role in primary healthcare delivery in the near future. Nurse practitioners, in particular, will be instrumental in filling the gap in primary care availability engendered by the increasing specialization of physician practice and increased access to healthcare made possible by the provisions of the PPACA. The need for this study was identified through gaps in the literature related to nurse practitioner practice; specifically, the paucity of quantitative research regarding patients’ perspectives of core holistic nursing values in nurse practitioner care, and, since nursing care is by definition and tradition holistic in nature, this inquiry attempted to quantify the degree to which nurse practitioner care upholds and preserves core holistic nursing values. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Graduate nursing education is a combination of didactic and clinical instruction. Clinical instruction is achieved primarily by pairing a student with either an experienced physician or certified nurse practitioner (NP) who will serve as a preceptor. The student/preceptor relationship may be initiated by nursing faculty or by the student. The quality of clinical instruction is crucial to the professional development of the NP. During this time of intense clinical instruction, students learn the process of applying the principles of diagnostic reasoning in a real world setting. Socialization into the role of the NP is an important component of the clinical education and may be impacted by the relationship established between the student and the preceptor. Multiple factors may have an impact on the resulting experience and relationship. Attitudes of both student and preceptor define and shape the relationship that develops throughout the clinical rotation. The student’s perception of the quality of the clinical experience may impact the outcome of the experience including the student’s sense of self-efficacy and confidence in practice skills and socialization into the role. This study focuses on the student’s perception of self-efficacy and confidence based on whether a mentoring relationship was established with at least one preceptor during the clinical experience. The study, a modified replication of Hayes’ 1997 study, demonstrated a strong sense of mentoring, self-efficacy and self-confidence in students enrolled in the final clinical course of a nurse practitioner program. The single most predictive factor for self-efficacy and self-confidence is length of time the student works with the preceptor as measured by months of clinical rotation. Other predictors of self-efficacy and self-confidence included the students’ perception of a mentor and how that mentorship was instrumental in the development of the skills and abilities necessary for transition into the role of the nurse practitioner. Self-efficacy was found to correlate highly with feelings of self-confidence in beginning skills such as physical assessment as well as higher level skills of diagnostic reasoning. As the students neared the end of clinical courses in the nurse practitioner program, most felt prepared to begin practice and cited traits similar to those attributed to preceptors as indicators of preparedness. / Department of Educational Studies

Thesis (MCUR)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This study attempts to provide a historic background of the clinical nurse practitioner. Areas of potential conflict, malpractice, future research, service delivery, tuition and support are revealed. The current role and function and the work environment of the clinical nurse practitioner functioning on primary health care level in the Metropole Region of the Western Cape were examined as major themes. Triangulation is applied as methodology. Structured questionnaires were completed by 60 clinical nurse practitioners that completed their training during the period 1994 to 2002. Pre-compiled checklists were completed at 8 different primary health care institutions. Qualitative data were obtained by comments on the questionnaires, field notes, as well as structured and unstructured interviews conducted with clinical nurse practitioners. Needs identified include outcomes based theoretical and clinical methods of tuition, additional training in pharmacology and chronic care, transcultural nursing and the development of criteria for recognition of prior learning and experience. Disparities were identified on service level pertaining to the difference between service delivery and service needs, daily checking of emergency equipment and the establishing of partnerships on service level to improve service delivery. Utilisation, post-levels and remuneration need attention. The development of courses in pharmacology for the Western Cape is identified as a priority as well as in service training, the possibility of a year of internship and the expedite of the amalgamation of fragmented services. Clinical nurse practitioners in managerial positions need to become more involved in promotion, motivation, development, audit and marketing of the clinical nurse practitioner and the establishment of a forum for clinical nurse practitioners. / AFRIKAANSE OPSOMMING: Hierdie studie poog om ʼn historiese agtergrond te skets van die kliniese verpleegpraktisyn. Areas is blootgelê vir potensiële konflik en wanpraktyke, sowel as areas vir toekomstige navorsing, dienslewering, onderrig en ondersteuning. Twee hooftemas, naamlik die huidige rol en funksie, asook die werkomgewing van die kliniese verpleegpraktisyn in die Metropoolstreek van die Wes-Kaap, is ondersoek. Triangulasie is as navorsingsmetodiek aangewend. Gestruktureerde vraelyste is deur 60 kliniese verpleegpraktisyns wat hul kursus gedurende die tydperk 1994 tot 2002 voltooi het, ingevul. Voorafopgestelde kontrolelyste is by 8 verskillende primêre gesondheidsorginstansies aangewend. Kwalitatiewe data is verkry deur middel van kommentaar op die vraelyste, veldnotas, sowel as gestruktureerde en ongestruktureerde onderhoudsvoering met kliniese verpleegpraktisyns. Uitkomsgebaseerde teoretiese en kliniese wyses van onderrig, aanvullende farmakologie, chroniese sorg, transkulturele verpleging, taalvaardigheid, asook die ontwikkeling van kriteria vir akkreditasie vir voorafleer en ondervinding blyk onderrigbehoeftes te wees. Leemtes op diensvlak sluit die verskil tussen diensverskaffing en diensbehoeftes, daaglikse kontrolering van noodtoerusting en vennootskappe ter diensverbetering in. Aanwending, posbenamings en vergoeding benodig aandag. Die ontwikkeling van aanvullende farmakologiekursusse vir die Wes-Kaap is as prioriteit geïdentifiseer asook indiensopleiding, die moontlikheid van ʼn verpligte internskapjaar en die bespoediging van amalgamasie van gefragmenteerde dienste. Kliniese verpleegpraktisyns in bestuursposisies behoort meer betrokke te raak by die bevordering, motivering, ontwikkeling, oudit en bemarking van die kliniese verpleegpraktisyn asook by die daarstel van ʼn forum vir kliniese verpleegkundiges.

Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)

Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)