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This study sought to: 1) describe perceived nursing practice problems identified by online Advanced Practice Nursing (APRN) students, and, 2) describe clinical outcomes evident in peer-reviewed, scholarly resources focusing on APRN care and roles.
Methods:
a. Background
There are four nationally accepted advanced practice registered nurse (APRN) roles: nurse practitioners (NPs), clinical nurse specialists (CNS), certified nurse midwives (CNM), and certified registered nurse anesthetists (CRNA) (Glembocki & Fitzpatrick, 2013; Joel, 2009). APRNs function in their various roles through application of advanced knowledge, skills, and competencies obtained that focus on core competencies requisite to practice in an APRN role. Preparation for the APRN roles in 21stcentury health care organizations requires requisite knowledge, skills, and competency in measuring outcomes of care in complex and chaotic health care systems (Patton, 2013; 2015). Continuous improvement focusing on quality and safety outcomes for individual and population health is essential in contemporary health care systems (Sherwood & Barnsteiner, 2012).
APRN education is focused on preparing the APRN graduate with requisite knowledge, skills, and competencies preparing them for the core competencies for entry into their respective APRN roles (Institute of Medicine, 2010; Rhodes, Schutt, Langham & Bilotta, 2012). Assessment and measurement of clinical outcomes is one of the core competencies APRNs must have when they enter into their respective practices though few of those problems have clearly identified evidence in patient outcomes (Kleinpell, 2013). Many external stakeholders are the impetus behind demands for patient quality and safety. Assessment and measurement of clinical outcomes is a challenge for many APRN students. Teaching outcomes assessment and measurement to APRN students can be a challenge in nursing education for a variety of reasons.
One of the greatest challenges for APRNs with regard to assessment and measurement of clinical outcomes is that measurement of clinical outcomes is not typically learned or taught in clinical practice (Kleinpell,2013). Assessment of outcomes is usually conducted in contemporary health care systems in the form of metrics not with valid and reliable outcome measurement instruments. In order to assessment and measure clinical outcomes of APRN practice, it is essential to examine strategies and processes for selecting outcome measures and monitoring clinical indicators relevant to APRN practice. Clinical outcome parameters are evident in peer-reviewed, scholarly resources focusing on evaluation of APRN care and APRN roles (Blair & Jansen, 2015). The specific clinical outcomes for this research project are 1) symptom management; 2) adverse events; 3) patient self- efficacy; 4) blood pressure control; 5) readmission rates; and, 6) rates of adherence to best practices. Only when APRNs are able to assess and measure clinical outcomes in a valid and reliable manner will nursing science advance and only then will APRNs have requisite data indicating the impact of the APRN roles in 21stcentury U.S. health care systems.
b. Sample and Method
This study included two phases: Phase I which consisted of a secondary analysis of final course papers using primarily qualitative analyses. The original sample for this study included 300 geographically diverse online students who completed two online graduate Nursing courses: (1) A Research Methods and Statistics course and, (2) an Ethics course during the 2013-2014 academic year. The final sample consisted of 124 advanced practice nursing students (APRN) primarily coming from the Nurse Practitioner and Nurse Anesthesia tracts.
To maintain confidentiality of all data from the faculty researchers, an honest broker was used to abstract all data (student papers) from the files stored in Blackboard learn. This included excluding all identifiers located in all of the data files (student papers). Abstracted data were managed and organized by using Survey Monkey. Demographic data were entered directly into Survey Monkey using folders that contained de-identified papers. Data were sent to Survey Monkey which is a data collection repository so that typologies were developed for the practice-based problems.
The Krippendorf method (2005) of content analysis was used to identify the key categories or themes of practice-based problems within a typology perceived by the advanced practice nursing students.
Phase II of the study included examining clinical outcome parameters evident in peer-reviewed, scholarly resources focusing on evaluation of APRN care and APRN roles- and comparing them to the perceived problems identified by the APRN students. A critical appraisal of published systematic reviews was identified to examine the outcomes by the APRN care and roles during the years 2000-2013 using the procedure by the Cochrane Collaboration handbook (Higgins & Green, 2008).
Results:
Using descriptive statistics, demographic data were analyzed using frequency and percentage distributions to describe the sample. Practice-based problems were identified within a typology. The following problems were included in that typology: pain, inadequate sleep, delirium, falls, hospital-acquired infections and/or sepsis, ventilator –assisted pneumonia, noise in the environment such as from alarms, hypothermia, catheter-related bloodstream infections, stress and anxiety in families, non-adherence to medical regimen (i.e., diabetic patients), effects of polypharmacy on readmissions, caregiver stress and anxiety, and readmissions in cardiac patients.
Results from the critical appraisal of the outcomes of care and roles of the APRN included: 1) symptom management; 2) adverse events; 3) patient self- efficacy; 4) blood pressure control; 5) readmission rates; and, 6) rates of adherence to best practices and will be discussed further in the presentation.
Conclusion:
Further research needs to identify to be conducted in order to better identify the roles and care of the advanced practice registered nurse. There is a dearth of systematic reviews available for care and roles dealing with many practice-based problems for the APRN.