EVALUATION OF NURSING PROCESS AND OUTCOMES OF CARE UTILIZING NURSE PRACTITIONERS TO PROVIDE HEALTH CARE FOR ELDERLY PATIENTS IN MASSACHUSETTS NURSING HOMES.
Contributors: Florence Heller Graduate School for Advanced Studies in Social Welfare.
Published: 1990
Number of pages: 259
Subjects: Health Sciences, Nursing.; Sociology, Public and Social Welfare.; Gerontology.
Description: This study examines the frequently cited issues of quality and accessible health care for institutionalized elderly. Specifically, this dissertation evaluates the nursing contribution to the process and outcome of care utilizing nurse practitioners to provide health care for nursing home patients residing in Massachusetts.

The major research question asked: Does the Nurse Practitioner Provide a Complementary Nursing Role, Over and Above that of a Purely Medical Care Substitute for the Physician, in the Institutional Long-Term Care Setting?.

Using magnetic tapes of data collected through retrospective chart reviews of 2651 patient records in 110 Massachusetts nursing homes, comparisons were made of the process and outcome variables of nurse practitioner and traditional medical models of care. Additionally, qualitative indepth interviews with a 15 percent subsample of participating Directors of Nursing, using an open-ended questionnaire and hypothetical patient case study, were conducted.

Data analysis techniques included descriptive statistics to synthesize data obtained from retrospective chart reviews and the Director of Nursing survey responses. Bivariate analysis was used to examine the correlation between practice model and nursing process variables. Discriminant function analysis was used to determine whether nursing process and outcome variables discriminated between nursing home patients receiving nurse practitioner versus traditional medical models of care. In addition, multiple regression analysis was used to examine predictions of functional status.

As hypothesized by the conceptual model, nursing process of care variables did discriminate between nursing home patients receiving nurse practitioner versus traditional medical models of care; however, nursing outcome variables did not. However, receiving care from the nurse practitioner model was associated with less functional impairment at the end of the twelve-month study period. Directors of Nursing identified both a substitutive medical and complementary nursing role for the nurse practitioner in the care of institutionalized elderly.

The conclusion that nurse practitioners provide not only a substitutive role to that of medical care, but a complementary one as well, should be instrumental in enabling policy decisions which encourage the full utilization of nurse practitioners. Implications for federal and state reimbursement and regulatory policies, nurse practitioner education and funding, and the recruitment and retention of nurses in long-term care are detailed.
Notes: Source: Dissertation Abstracts International, Volume: 51-08, Section: B, page: 3780.

Thesis (PH.D.)--BRANDEIS U., THE F. HELLER GRAD. SCH. FOR ADV. STUD. IN SOC. WEL., 1990.

School code: 0541.