Clarifying Nurse Practitioners' Unique Contributions: Application of The Shuler Nurse Practitioner Practice Model

Shuler, Pamela; Huebscher, R

doi:10.1111/j.1745-7599.1998.tb00478.x

Cited by 14 publications

(12 citation statements)

References 22 publications

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“…The Shuler Nurse Practitioner Practice Model (Shuler, & Davis, 1993a, 1993bShuler, & Huebscher, 1998) provides the theoretical framework for practice. In the model, the APN manages clients with three types of health visits: episodic visits, comprehensive visits with health problems, and comprehensive visits without health problems.…”

Section: Practice Modelmentioning

confidence: 99%

House Calls: Is There an APN in the House?

Restrepo¹,

Davitt

Thompson

2001

Journal of the American Academy of Nurse Practitioners

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Purpose To report how a group of geriatric advanced practice nurses (APNs) participated in a house calls program that increased access to care for homebound and frail community‐dwelling elders. Data Sources Selected literature and author experiences, illustrated with clinical examples. Conclusions Many frail older adults are unable to access healthcare due to functional impairments related to multiple, chronic medical conditions. Many of these adults inappropriately utilize the emergency department for episodic care. Implications for Practice The model of care maximizes utilization of APNs to provide cost effective, culturally sensitive, quality care. The goal of geriatric assessment and primary care in this practice is to add quality to later years of life, promoting dignity and comfort to older adults and their families.

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Section: Practice Modelmentioning

confidence: 99%

House Calls: Is There an APN in the House?

Restrepo¹,

Davitt

Thompson

2001

Journal of the American Academy of Nurse Practitioners

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“…Some have argued that NPs may enhance primary care because they are trained specifi cally for health promotion and education. 2,20,21 In fact, Hopkins et al 22 found that compared with physicians, NPs performed better at secondary prevention, assessment, and counseling. In addition, Kinnersely et al 15 and…”

Section: Introductionmentioning

confidence: 99%

“…In addition, NPs may add new perspectives within a team of clinicians because of their background in nursing as well as their emphasis on the well-being of the whole patient, prevention of illness, and patient education. 21,22 Alternatively, the rationale that practices have for hiring and integrating a particular type of midlevel clinician may result in different models of care. For example, practices wishing to improve quality of care or adhere to a more holistic approach to medicine may tend to hire NPs, whereas those that want to increase patient volume may tend to hire PAs, although our analysis of our market orientation measures of the practices did not confi rm this explanation.…”

mentioning

confidence: 99%

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

Ohman‐Strickland¹,

Orzano²,

Hudson³

et al. 2008

The Annals of Family Medicine

105

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PURPOSE The aim of this study was to assess whether the quality of diabetes care differs among practices employing nurse-practitioners (NPs), physician's assistants (PAs), or neither, and which practice attributes contribute to any differences in care.METHODS This cross-sectional study of 46 family medicine practices from New Jersey and Pennsylvania measured adherence to American Diabetes Association diabetes guidelines via chart audits of 846 patients with diabetes. Practice characteristics were identifi ed by staff surveys. Hierarchical models determined differences between practices with and without NPs or PAs. RESULTSCompared with practices employing PAs, practices employing NPs were more likely to measure hemoglobin A 1c levels (66% vs 33%), lipid levels (80% vs 58%), and urinary microalbumin levels (32% vs 6%); to have treated for high lipid levels (77% vs 56%); and to have patients attain lipid targets (54% vs 37%) (P ≤.005 for each). Practices with NPs were more likely than physician-only practices to assess hemoglobin A 1c levels (66% vs 49%) and lipid levels (80% vs 68%) (P ≤.007 for each). These effects could not be attributed to use of diabetes registries, health risk assessments, nurses for counseling, or patient reminder systems. Practices with either PAs or NPs were perceived as busier (P = .03) and had larger total staff (P <.001) than physician-only practices.CONCLUSIONS Family practices employing NPs performed better than those with physicians only and those employing PAs, especially with regard to diabetes process measures. The reasons for these differences are not clear. Ann Fam Med 2008;6:14-22. DOI: 10.1370/afm.758. INTRODUCTIONI ncreasingly, nurse-practitioners (NPs) and physician's assistants (PAs) serve as a primary point of contact for patients within primary care practices.1,2 Bolstering this trend is the development of new models of primary care practice advocating collaborative teams of diverse clinicians.3-5 Yet, among family physicians, some uncertainty and unease persists about the use of these clinicians, [6][7][8] particularly with regard to quality of care, 9,10 patient satisfaction, 11,12 and fi nancial effi ciency. 13,14 Most randomized clinical trials and observational studies have focused on comparing the quality of care between physicians and NPs, with relatively little published research comparing PAs with either physicians or NPs. 9,[15][16][17][18] For example, in a study comparing NP and physician performance in the care and attainment of outcomes for patients with diabetes, Lenz et al 19 found signifi cant differences in documentation but not in patient outcomes. Some have argued that NPs may enhance primary care because they are trained specifi cally for health promotion and education. 2,20,21 In fact, Hopkins et al 22 found that compared with physicians, NPs performed better at secondary prevention, assessment, and counseling. QU A L I T Y O F DIA BE T ES C A R E W I T H NP s A ND PA sSakr et al 16 found that patients cared for by NPs received more inf...

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“…More recent surveys have concentrated on providing national or regional overviews on issues of NP education, credentialing, compensation, professional organization participation, and practice regulation (Hayes, Allen, Gruen, Wilson, & Kalmakis, 2001;Towers, 2003). The need to identify, clarify, and document the practices of NPs in primary care settings remains, on both the national and regional levels, to ascertain cost-effectiveness, establish fair compensation, guide NP primary care practices through practice-based research, and influence health policy formulation (Courtney & Rice, 1995;Shuler & Huebscher, 1998).…”

Section: Introductionmentioning

confidence: 99%