Glycemic control: Can nurse practitioners on interprofessional collaborative practice teams enhance clinical outcomes?

BACKGROUND AND PURPOSE: Care coordination and specialized knowledge of prescriptive authority are fundamental to advanced nursing practice. Little research documents patient clinical outcomes in primary care when nurse practitioners are members of an interprofessional education and collaborative practice (IPECP) team. This cross-sectional study examined differences in glycemic control among Texas patients who received care by a Family Nurse Practitioner (FNP) and an IPECP team in one calendar year. METHODS: A convenience sample of 120 adult volunteers with diabetes was followed in a community-based clinic by an FNP; of these, 34 received additional care by an IPECP team. Data on selected demographic indices and HgbA1c were derived from the health center's Electronic Medical Record using a retrospective review, and linkage with the federally funded IPECP Project database. CONCLUSIONS: Patients with two or more FNP visits and two or more visits with the IPECP team had statistically significant reductions in HgbA1c levels at the end of 1 year. IMPLICATIONS FOR PRACTICE: Actualizing point-of-care treatment adjustments is a particular strength of advanced practice nurses but potentially a missed opportunity on interprofessional teams. Further study is needed on clinical outcomes of nurse practitioner contributions to IPECP team care.

Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas.

Healthy People 2010 goals set a target of 90% of mothers starting prenatal care in the first trimester of pregnancy. While there are questions about the value of prenatal care (PNC), there is much observational evidence of the benefits of PNC including reduction in maternal, fetal, perinatal, and infant deaths. The objective of this study was to understand barriers to PNC as well as factors that impact early initiation of care among low-income women in San Antonio, Texas. A survey study was conducted among low-income women seeking care at selected public health clinics in San Antonio. Interviews were conducted with 444 women. Study results show that women with social barriers, those who were less educated, who were living alone (i.e. without an adult partner or spouse), or who had not planned their pregnancies were more likely to initiate PNC late in their pregnancies. It was also observed that women who enrolled in the WIC program were more likely to initiate PNC early in their pregnancies. Women who initiated PNC late in pregnancy had the highest odds of reporting service-related barriers to receiving care. However, financial and personal barriers created no significant obstacles to women initiating PNC. The majority of women in this study reported that they were aware of the importance of PNC, knew where to go for care during pregnancy, and were able to pay for care through financial assistance, yet some did not initiate early prenatal care. This clearly establishes that the decision making process regarding PNC is complex. It is important that programs consider the complexity of the decision-making process and the priorities women set during pregnancy in planning interventions, particularly those that target low-income women. This could increase the likelihood that these women will seek PNC early in their pregnancies.

Learning public health nursing in urban, rural, and border counties of Texas.

A partnership between the 3 types of public health agencies present in South Texas was created to allow baccalaureate nursing students to increase their understanding of public health through clinical experiences in a city/county health department, a rural county health department, and a regional health department. The students assessed the health of a selected population, identified factors affecting the health of the selected population, gained skills in community participation and decision making, worked with community partners and other public health professionals, and functioned as members of a team of public health practitioners in promoting, protecting, and maintaining the health of the public in Bexar, Medina, and Val Verde Counties of Texas.