| Learning Objective #1: State at least two contributions of the study to the science of community-based, nurse-managed practice | |||
| Learning Objective #2: Describe the data collection strategy used to elicit views of the study's community participants |
Design: Multiple case study design was used in this IRB-approved study.
Population, Sample, Setting, Years: CBNMP offers vulnerable populations the opportunity to contract directly with professional nurses for primary health care services. The study was conducted at three CBNMPs (urban-academic, urban-private/not-for-profit, and rural-federally qualified health center) in a South Central US State during 2002-2003.
Concept: The study analyzed the innovation development process of CBNMP as derived from the Theory of Diffusion of Innovations and the Theory of Community as Partner.
Methods: Two site visits were conducted totaling 9 or 10 days at each site. Data collection strategies included background survey, document review, observations, and interviews (N=85). Matrix analysis facilitated triangulation of qualitative and quantitative results.
Findings: Evolutionary commonalties across sites included diminished reliance on grant or federal funding, increased size of practice, increased diversity and acuity among patients, and transformation from local clinic to citywide or regional practice. Themes derived from data analysis were covenantal care (serving through sacrificial efforts), contextual stewardship (managing resources and responsibilities), community partnership (identifying and targeting populations’ needs), chronic invisibility (lacking recognition), and compelling distinction (delivering holistic primary health care to diverse populations).
Conclusions: CBNMPs have been able to advance their missions, expand their practices, and promote their sustainability despite legal, reimbursement, and interdisciplinary barriers. CBNMP lacks direct linkages with nursing theory.
Implications: Making explicit the science behind CBNMP’s compelling distinction of care suggests a way to countermand the invisible nature of CBNMP and fulfill its promise in primary health care delivery. Contributions of the study include description of potential patients, lack of referral sources for CBNMP, impact of word of mouth on diffusion, examples of survivable crises, role of visionary advocates, and patients’ trust in advanced practice nurses.
Back to Public Health/Community Health Nursing
Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004