Implementing Interventions Aimed at Reducing Rates of Cesarean Birth.

Increased incidence of both nulliparous, term, singleton, vertex and overall cesarean birth rates has warranted close monitoring and scrutiny by various health care associations and by individual obstetric facilities and providers of obstetric care. Concerted efforts to reduce rates of nonmedically indicated cesarean birth have resulted in the development and implementation of comprehensive action plans aimed at effecting reductions and enhancing overall obstetric quality care. Here we describe how a multidisciplinary team at our hospital developed and implemented interventions aimed at reducing rates of cesarean birth.

Patient satisfaction with nurse practitioner-delivered primary healthcare services.

PURPOSE: To identify levels of satisfaction with nurse practitioner (NP)-delivered primary healthcare services and to determine demographic differences in degrees of general satisfaction reported by patients. DATA SOURCES: The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, 5-point, Likert-type survey instrument was developed; data from 300 female and male clients over 18 years of age presenting for primary healthcare visits at the employee health department of a not-for-profit hospital in the Southern United States were analyzed. CONCLUSIONS: Although many studies using a variety of healthcare-related patient satisfaction instruments have demonstrated acceptable patient satisfaction with NPs, few have investigated patient satisfaction with NPs in the outpatient primary care occupational health arena. Overall the population seeking health care was satisfied with NP services. In particular, married or cohabitating subjects reported general satisfaction scores that were statistically significantly higher than those who were single and never married. No other differences were found. IMPLICATIONS FOR PRACTICE: The provision of on-site, employer-sponsored NP primary healthcare services that are perceived as acceptable and satisfactory to employees and families affords significant opportunity and advantage to both employee and employer. Such benefits include enhanced employee and family wellness, facilitated health promotion, enhanced access to care, reduced illness related to time away from work, improved employee productivity, and reduced overall organizational healthcare costs. Knowledge regarding those characteristics contributing to general satisfaction with NP-delivered care serves to facilitate practice pattern changes within the profession that further enhances the visibility, utilization, and acceptability of NPs as primary care providers.

Psychometric evaluation of the Nurse Practitioner Satisfaction Survey (NPSS).

The purpose of this study was to identify and define underlying latent constructs within the concept of patient satisfaction with nurse practitioner delivered primary health care. The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, Likert-type, researcher developed instrument was completed by 300 clients presenting for primary health care visits in a hospital outpatient clinic. Factor analysis with promax rotation resulted in a three factor model explaining 70.77% of the variance. Eighteen items loaded on general satisfaction. Six items loaded on communication, and four items loaded on accessibility and convenience. Cronbach's alpha internal consistency reliability coefficients were .98, .83, and .76 for the three factors, respectively. The NPSS was found to be reliable and valid for measuring patient satisfaction with nurse practitioner delivered primary health care services.

Self-reported back pain among farm women in southeast Louisiana.

This cross-sectional survey details the incidence and predictors of self-reported back pain among farm women from southeastern Louisiana. The sample was obtained from a preexisting data set of a cross-sectional randomized sample of farm women who participated in the Louisiana Farm Family Injury Prevention and Health Initiative research project. The Haddon Injury Model was used as the conceptual framework. Approximately one fourth of the women in the sample reported back pain in the past year. The major findings from logistic regression analysis were that women reported back pain if they were hauling animals to market and had physical health conditions. Implications for nursing practice include assessing the risk of back pain among farm women and providing client education that includes the importance of compliance with recommended health screenings for early detection and treatment of physical health conditions associated with back pain.