Processes of care: comparison between nurse practitioners and physician residents in acute care.

The purpose of this study was to compare the processes of care (performance of role functions, provision of comprehensive care, coordination of services) of acute care nurse practitioners (ACNPs) and physician residents (PRs) assigned to various medical and surgical programs in acute care settings. A cross-sectional comparative design was used. ACNPs (n = 31) and PRs (n = 10) completed the study questionnaire within two weeks of consenting. Patients who received ACNP care (n = 320) and those who received PR care (n = 46) completed the questionnaire within one week of discharge. The results indicate that ACNPs engaged in management and informal coordination activities more than PRs did, while PRs engaged in more formal coordination activities compared to ACNPs. ACNPs encouraged more patient participation in care and provided more patient education than PRs. These findings, which reflect differences in the processes used by ACNPs and PRs to provide care to patients, could influence the quality and cost outcomes expected of these two groups of healthcare providers.

A balanced scorecard approach for nursing report card development.

In this article we describe the process used to introduce and structure a nursing perspective as part of a balanced scorecard framework within a provincial hospital performance report. Results of a critical literature review and consultative process with key informants are outlined. Nurse-sensitive indicators emerged in the areas of system integration and change, clinical utilization and outcomes, patient satisfaction, and financial performance.

Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing.

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.