Kathryn Fiandt

Quality and safety in graduate nursing education: Cross-mapping QSEN graduate competencies with NONPF's NP core and practice doctorate competencies

To ensure that nurse practitioners are prepared to deliver safe, high-quality health care, the National Organization of Nurse Practitioner Faculties (NONPF) publishes documents that outline the expected competencies for nurse practitioner (NP) practice (Domains and Core Competencies of Nurse Practitioner Practice and Practice Doctorate Nurse Practitioner Entry-Level Competencies). Having participated in the development of the Quality and Safety Education for Nurses (QSEN) competencies for graduate education, NONPF convened a task force to compare NONPF competencies with QSEN competencies for graduate education. This paper reports the first step of that cross-mapping process, comparing NONPF competencies with the QSEN knowledge objectives. Overall findings indicate close congruence across the 2 sets of competencies; however there are areas in which gaps are noted or for which clarification is required.

Toward a national nurse-managed health center data set: Findings and lessons learned over 3 years

Although primary care nurse-managed health centers (NMHCs) have gained increasing recognition, there are limited standardized clinical and financial data on these centers. The purpose of this paper is to present the process, benefits, and challenges in collecting standardized national data based on a consensus process from NMHCs over 3 consecutive years. The Institute for Nursing Centers (INC) NMHC Survey focuses on demographic, clinical, and financial data. A detailed codebook accompanied the INC NMHC Survey. A total of 42 NMHCs responded in at least 1 of the 3 years. Despite the challenges in collecting some of the data, especially for the first survey year, data quality improved remarkably when the INC NMHC Survey was repeated. Financial data seemed to be more easily reported than demographic or clinical data. NMHCs increase access to care, often for vulnerable populations, yet to date there are limited standardized clinical and financial data on these centers. The INC NHMC Survey and data described in this paper begins to address that gap.

Integral Nursing: an emerging framework for engaging the evolution of the profession.

These are turbulent times for health care as well as nursing. Nursing needs to consciously evolve to survive and thrive in the 21st century. The authors suggest that nursing has many of the theoretical and conceptual models needed to facilitate this evolution. However, the profession would benefit from the addition of a comprehensive framework that can integrate various aspects of nursing and serve as a device to effectively interface nursing with the rest of the health care system. We believe that the Integral Nursing approach described here is such a framework. In this article, we describe the model and explore benefits of its application for nursing within health care.

Characteristics of risk in patients of nurse practitioner safety net practices

Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse-managed health clinic, an urban nurse-managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse-managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP-provided safety net services to healthcare insurers and federal health policy makers.Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse‐managed health clinic, an urban nurse‐managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse‐managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP‐provided safety net services to healthcare insurers and federal health policy makers.

Medication adherence in a nurse practitioner managed clinic for indigent patients

Purpose:Little is published in the literature about medication adherence rates among patients who are medically indigent and patients receiving primary care from nurse practitioners (NPs). This project examined adherence rates and barriers to adherence among patients at an NP‐managed health clinic (NPMC). Data sources:The setting for this research was an NPMC for uninsured and low‐income patients. A cross‐sectional convenience sample of patients (n = 119) completed surveys eliciting demographic information, self‐report of medication adherence, health literacy, and barriers to adherence. Conclusions:Analysis of subjects demonstrated a vulnerable population, yet the mean adherence rate was surprisingly high (77%), compared to the rate usually cited in published literature. The best predictive model differentiating patients with high adherence from those with low adherence combined the total number of reported barriers, health literacy, and employment status. The barriers most frequently cited by subjects were difficulty paying for medications, and difficulty reading and understanding written prescription labels, which was particularly prevalent among Spanish‐speaking patients. Implications for practice:Clinic efforts to improve patient access to affordable medications may have contributed to subjects’ high rates of adherence. These efforts included helping patients with filling out prescription assistance program paperwork, prescribing generic medications, providing samples, and providing effective patient education.

ORIGINAL RESEARCH: Characteristics of risk in patients of nurse practitioner safety net practices

Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse-managed health clinic, an urban nurse-managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse-managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP-provided safety net services to healthcare insurers and federal health policy makers.Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse‐managed health clinic, an urban nurse‐managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse‐managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP‐provided safety net services to healthcare insurers and federal health policy makers.

ORIGINAL RESEARCH: Characteristics of risk in patients of nurse practitioner safety net practices: Characteristics of risk in patients of NPs

Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse-managed health clinic, an urban nurse-managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse-managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP-provided safety net services to healthcare insurers and federal health policy makers.Purpose: The purpose of this article is to describe the characteristics of vulnerability in patients at safety net practices where nurse practitioners (NPs) provide the majority of the health care and to discuss the implications regarding patient data collection for all NPs who provide safety net care. Data Sources: Data were collected from patients at four safety net practices: a rural health clinic, a rural nurse‐managed health clinic, an urban nurse‐managed health clinic, and an urban Indian health clinic. Conclusions: The users of these practices reflected a significant degree of risk for poor health outcomes based on characteristics of risk identified in the literature. Patients seen in nurse‐managed health clinics without federal subsidies had more risk that those in federally supported clinics. Implications for Practice: Given the increasing evidence of the impact of social and environment factors on poor health outcomes, the importance of assessing and describing the characteristics of risk is discussed. These data are essential for supporting the value of these NP‐provided safety net services to healthcare insurers and federal health policy makers.