Ann M. Mayo

Tool Development for Measuring Caller Satisfaction and Outcome with Telephone Advice Nursing

Caller descriptions and evaluations of their experiences with telephone advice services provide unique information that correlates highly with objective measures of quality and can help interpret data from other sources. An author-developed questionnaire assessed caller outcomes of telephone nursing advice. In Phase I an iterative, purposive sample of 40 callers was interviewed by phone. An emergent design was used to develop questions, analyze constructs of interest, and test questions for a draft caller questionnaire, which was tested in Phase II. Responses to the questionnaire provided information about caller characteristics, advice call characteristics, and nurse practice behaviors that caused the authors to further revise the questionnaire. The resulting tool provides feedback to advice nurses about the outcomes of their practice and information to design orientation and development programs and support fund allocation decisions.

Clinical nurse specialist practice patterns.

Purpose: The study purpose was to describe clinical nurse specialist (CNS) practice patterns (activities, outcomes, and practice barriers). Design: A cross-sectional survey design was used for this research study. Setting and Sample: California Board of Registered Nursing certified CNSs (N = 1,523). Method: Surveys were mailed to CNSs and included the CNS Activity Questionnaire, the Clinical Nurse Specialist Outcomes and Barriers Analysis Survey, and a demographic survey. Descriptive (means, percentages) and inferential (t tests and one-way analyses of variance) statistics were used to analyze the data. Conclusions: Practicing CNSs (n = 947) demonstrated a role preference for expert clinical practice. Practice patterns (activities, outcomes, and barriers) differed in terms of CNS specialty, years of experience, number of units covered, and CNS reporting structure.Clinical nurse specialists are spending time in the 5 broad role components expert (clinical practice, consultation, education, clinical leadership, and research) utilized by the California Board of Registered Nursing as an organizing framework for practice; however, CNS practice patterns from this study reflect more discrete and functional activities that may be better encompassed under the CNS spheres of influence practice model. A number of barriers to practice exist, the most commonly reported being reporting structure. Years of experience in the role result in differences in both practice patterns and perceptions of barriers. Recommendations for CNSs and organizations include evaluating CNS reporting structures, developing advanced practice outcome-based job descriptions and competencies, and designing performance evaluations that recognize differences between inexperienced and experienced CNSs.

A model for examining predictors of outcomes of telephone nursing advice

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers’ decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.

Use of Protocols and Guidelines by Telephone Nurses

Changes in health care delivery, specifically the addition of telephone advice, affect how nurses work and how patients perceive care. It is important to understand the resources available to these nurses, the process by which they provide care, and patient outcomes. This descriptive study describes one type of resource, the availability and use of protocols. It also describes relationships between protocols and the quality of the nursing process and patient outcomes. Two-hundred-three taped calls to 32 advice RNs and 156 patient follow-up calls were used to measure protocol usage, nursing process quality, and patient outcomes. Although protocols were available for 78.8% of the calls, nurses varied in their extent of use (63.9% not fully used). There was a negative relationship (r = −0.395, p < 0.000) between the availability of protocols and overall quality of the nursing process. Protocol availability and use did not affect patient outcomes.

Making it work: organization and processes of telephone nursing advice services.

Efforts of health plans to balance service quality with cost control have spurred rapid growth in telephone nursing advice services. Service system design can affect costs, patient outcomes, and staff retention. Research has not addressed how the organization of nursing services affects practice outcomes in telephone advice settings. We describe observed variations in telephone advice nursing services and the organizational and process factors the nurses identified as supporting or hindering their work.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support.

Social support is a complex multidimensional construct that is integral to an individual’s physical and psychological well-being. A number of authors have proposed that social support buffers the effect of stressful life events through coping mechanisms, making it an important construct for clinical nurse specialists (CNSs) and other advanced practice nurses (APNs) interested in preventing illness and promoting health among their patients. The use of well-tested instruments that purport to measure social support, demonstrate reliability, and produce valid data is critical for testing interventions designed to improve patient and client outcomes, improve quality, and decrease healthcare costs.

Evaluating Quality of Telehealth Advice Nursing

Despite an increased interest in advice nursing, the quality of care has not been addressed. This article examines the quality of the nursing process (including problem identification, care planning, intervention, and evaluation) and its relationship to patient (consumer) outcomes. A sample of 157 nonredundant telephone calls from adults with medical-surgical problems were audiotaped, with providers’ and callers’ consent, and were rated through an implicit review method by registered nurse raters. The quality of the nursing process was found to be the best in the area of intervention. Patient (consumer) satisfaction was high with 95.4% of the consumers rating the calls as completely or at least somewhat satisfying, and 93.2% stating the advice was very or somewhat helpful. This study pioneers a way to rate the quality of advice nursing and lays the groundwork for further investigations of health care provider behavior and consumer outcomes.

A Critique of the Short Test of Functional Health Literacy in Adults.

Effective healthcare relies on the ability to communicate with patients. Ninety-eight million Americans are estimated to have limited health literacy that can impair their ability to read and interpret health-related education and information. Low health literacy is associated with higher mortality and 30-day hospital readmissions. Clinical nurse specialists and other advanced practice nurses must be able to evaluate and select a health literacy assessment instrument that is both reliable and produces valid data for the populations they serve. To assist with this important decision-making process, the psychometric properties of the Short Test of Functional Health Literacy in Adults are critiqued in the following article.

Integrating Geropsychiatric Nursing and Interprofessional Collaborative Practice Competencies Into Adult-Gerontology Clinical Nurse Specialist Education.

Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education. Therefore, the purpose of this manuscript is to propose aligning the current AGCNS population-focused competencies with the CNS geropsychiatric nursing competency enhancements and interprofessional collaborative practice education competencies. Examples of the proposed alignment and educational application strategies are presented. When AGCNS educational curricula encompass P/MH nursing at an advanced level from an interprofessional perspective, future AGCNSs will continue to be positioned to make significant contributions to the design of care systems and monitor and trend important outcomes, while ensuring safe and efficient, high-quality healthcare for older adults with P/MH comorbidities.

Critique of the STOP-Bang Sleep Apnea Questionnaire.

E fficient decision making is essential in any venue of healthcare. Many decisions must be made from an abundance of information with limited time and finite resources. The challenge is to decide what information is important, accessible, and accurate for the task at hand. To facilitate decision making, clinical nurse specialists (CNSs) and other healthcare providers use screening questionnaires and other instruments to help focus on important characteristics of a disease or condition and then determine the risks and benefits of different treatment plans. The preoperative assessment is an example of a critical need for efficient decision making. Patients who need surgery may have comorbid conditions, and clinicians may have a limited amount of time to assess, diagnose, and manage their condition. Obstructive sleep apnea (OSA) is a comorbid condition that requires planning, may take considerable time and effort to diagnose, and has significant risks to health. For the CNS working in a surgical clinic, surgical unit, or any environment involving sedation, being aware of a patient’s risk of OSA may prevent a catastrophic outcome. The purpose of this article is to present the psychometric properties of the STOP-Bang sleep apnea questionnaire, an instrument designed to help identify OSA in adults prior to surgery.