Publications

Abstract

Thirty-four of 67 MCOs in New York and Connecticut responded to requests for information on the roles, participation, and listing of nurse practitioners as primary care providers or in other capacities. MCO executives report a high degree of satisfaction with NPs who serve as their primary care providers, especially in women's health and geriatrics, as they spend more time teaching and explaining procedures than physicians. Ongoing lack of up-to-date information and/or confusion about the scope of NP practice exists among both health care professionals and the public. Perceived differences in the scope of care provided by NPs was related to state regulations, physician practice patterns, and availability of primary care physicians. Eighty-five percent of MCO executives thought their organizations should encourage the use of NPs.

Abstract

This study describes nurse practitioners' (NPs) practice and employment trends, primary care/direct patient care involvement, scope of practice issues, productivity, and demographic characteristics. Data were collected by mailed survey from 2,499 NPs in New York State. NPs were predominantly certified as Adult, Pediatric or Family NPs. The vast majority of NPs were working (64.1% full-time; 22.7% part-time). Fifty percent said they spend over 80% of their time providing primary care. Over 50% of the NPs employed in non-hospital settings said that their organizations had contracts with four or more managed care organizations.

Abstract

Managed care poses opportunities for nurse practitioners, providing they successfully negotiate new health care systems. This requires being familiar with Medicaid waivers and state policies regarding health insurance. In addition, knowledge of credentialing and compensation mechanisms under managed care enhances nurse practitioners' ability to forge providers roles. Because of the overlap between priorities of nurse practitioner practice and managed care, nurse practitioners have the potential to strenghten their roles as primary and specialty care providers in traditional and nontraditional settings.

Abstract

The purpose of this project was to study the applicability of pen-based computer technology to home health care through the development of a pen-based computer system for a Hospital/Community-Patient Review Instrument (H/C-PRI) used for nursing home placement. The sample included nurses (n = 12) from the four regional Visiting Nurse Service of New York offices, as well as all patients on whom a H/C-PRI was completed during the pre-period (n = 238) and patients on whom a H/C-PRI was completed during the post-period (n = 238). The quality of documentation was higher for patients whose H/C-PRI was performed using the pen-based computer (0% calculation errors) than for those patients whose H/C-PRI was documented in the usual manner (11% calculation errors).

Abstract

This article describes the various outcomes programs supported by the Agency for Health Care Policy and Research (AHCPR). The mission of the agency is to generate and disseminate information that improves the delivery and quality of health care. The agency is charged with helping consumers, providers, purchasers, health plans, and policy makers meet the challenge of improving the quality of health care services while reducing spending. AHCPR has been recognized as funding the development of "gold standard" clinical practice guidelines and the source of unbiased, science-based information on what works and does not work in health care.

Abstract

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.

Abstract

The most common types of psychiatric diagnoses linked with substance abuse or dependence in women are defined and discussed. A framework is described to facilitate the nurse provider's understanding of the various relationships psychiatric symptoms can have to substance-using patterns. Guidelines are provided to assist the nurse in identifying problems of dual diagnoses and providing care to women with dual diagnoses in general care settings.

Abstract

Intraparenchymal injections of the neurotoxin 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle in rats destroys the dopaminergic neurons in the pars compacta of the substantia nigra. In other transmitter systems it has been found that axotomy or neurotoxin exposure produces an initial loss of neurotransmitter phenotype, with cell death occurring over a much slower time course. To determine whether this also occurs in dopamine neurons after 6-OHDA, two approaches were utilized. First, the effect of injections of 6-OHDA into the medial forebrain bundle on nigral dopaminergic neurons was studied using combined fluorogold and immunocytochemical labeling. Four weeks after the 6-OHDA injection, there was an 85% reduction in the number of tyrosine hydroxylase (TH)-immunoreactive cells on the lesioned side. In contrast, there was only a 50% reduction in the number of fluorogold-labeled cells on the lesioned side. Second, the time course of the rescue of dopaminergic neurons after 6-OHDA by glial cell line-derived neurotrophic factor (GDNF) was determined using TH immunocytochemistry. Greater numbers of dopamine neurons were rescued 9 weeks after GDNF compared with counts made 5 weeks after GDNF. Taken together, these results suggest loss of dopaminergic phenotype is greater than cell loss following 6-OHDA injections, and that GDNF restores the phenotype of affected cells.

Abstract

Advanced practice nurses have contributed significantly to the nation's healthcare for decades by providing primary care and specialty services. Despite financial and regulatory barriers, opportunities for advanced practice nurses continue to flourish, due, in part, to the unique contributions that these nurses can make in the areas of healthcare access, quality, and cost-effectiveness. This article analyzes the role and scope of advanced practice nurses in relation to organized delivery systems. The success of these systems depends on health-needs assessment and capitated-based risk for defined populations, as well as on the development of innovative governance and health delivery models. Advanced practice nurses can contribute to each of these success factors by providing access to primary care services and specialized care to high-risk populations. To achieve success, organized delivery systems must include advanced practice nurses as providers and partners in governance structures.

Abstract

The purpose of this article is to advance the debate about whether the NP or the CNS alone should be the predominant advanced practice role in psychiatric-mental health nursing, or whether a blended advanced practice role is more appropriate for meeting the needs of services in the 21st century. We argue that a blended role is most appropriate in moving the psychiatric-mental health nursing specialty forward. The blended advanced practice role retains the excellence of our psychosocial tradition and incorporates the biological perspective of the future.

Abstract

Chronic diarrhea, common in people with HIV infection, can be both debilitating and demoralizing. But with a diet-based management strategy, you can help your patient keep it in check.

Abstract

The chief nurse officer brings the value-adding contribution of client partner to the executive management team. The nurse executive contributes professional nursing's client-centered, health-enabling approach to care delivery to assist organizations in developing new client and community services. The single most important leadership-challenge presented to nurse administrators, leaders, and managers is the ability to articulate a vision of client-centered care, demonstrate the costs and benefits of service innovations, and effectively shape organizational cultures to achieve innovations in service delivery.