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Practice environment for nurse practitioners in California. Identifying barriers.

Anderson, A L; Gilliss, C L; Yoder, L
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1996 EN
Relevância na Pesquisa
26.5%
Barriers exist that prevent nurse practitioners from using their primary health care knowledge and skills. We present the incidence of and specific barriers experienced by nurse practitioner respondents in California, the state with the largest number of nurse practitioners in the nation. A January 1995 survey was sent to all nurse practitioners certified in California to elicit their experiences regarding legal or social barriers in their practice, with space for an open-ended response. Of an estimated 3,895 nurse practitioners in California, 2,741 (70%) returned surveys. Most nurse practitioner (65%) respondents in California are providing primary care. Perceived barriers to practice are lack of prescriptive authority, lack of support from physicians, reimbursement difficulties, and lack of public awareness. Current barriers to nurse practitioner practice in California are similar to national barriers discovered in 1992 data. The development of interprofessional dialogue and the recognition of the contributions of all primary care professionals are some of the steps that can be taken to reduce these barriers and increase the use and effectiveness of nurse practitioners in primary care.

Nurse-midwifery practice in the United States, 1982 and 1987.

Adams, C J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1989 EN
Relevância na Pesquisa
36.32%
Surveys of certified nurse-midwives living in the United States were conducted on behalf of the American College of Nurse-Midwives for 1982 and 1987. Most of the respondents were providing prenatal and family planning care. The 1982 respondents conducted 1.8 percent of the deliveries that took place in the United States during 1982 and 1988 respondents conducted 2.5 percent of all 1987 United States deliveries.

Interspecialty differences in the obstetric care of low-risk women.

Rosenblatt, R A; Dobie, S A; Hart, L G; Schneeweiss, R; Gould, D; Raine, T R; Benedetti, T J; Pirani, M J; Perrin, E B
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/1997 EN
Relevância na Pesquisa
26.94%
OBJECTIVES: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. METHODS: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. RESULTS: Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians. CONCLUSIONS: The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.

A rural-urban comparative study of nonphysician providers in community and migrant health centers.

Shi, L; Samuels, M E; Ricketts, T C; Konrad, T R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1994 EN
Relevância na Pesquisa
26.58%
This is a study of the employment of nonphysician providers--nurse practitioners, physician assistants, and certified nurse midwives--in both rural and urban Community and Migrant Health Centers and of factors associated with their employment, based on a 1991 national survey of 383 Centers. Results of the survey suggest that nonphysician providers, in particular nurse practitioners and certified nurse midwives, primarily serve as physician substitutes, and are more likely to be employed by Centers that are larger and have affiliations with nonphysician provider training programs. Rural or urban location is not significantly related to the employment of nonphysician providers after controlling for center size. The fact that rural centers employ fewer nonphysician providers than urban centers can primarily be accounted for by their relatively small size, rather than a lack of interest. These findings demonstrate that the use of nonphysician providers is an important way both to achieve cost containment and improve access to primary care for those residing in medically underserved areas.

Evaluation of a public-private certified nurse-midwife maternity program for indigent women.

Lenaway, D; Koepsell, T D; Vaughan, T; van Belle, G; Shy, K; Cruz-Uribe, F
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1998 EN
Relevância na Pesquisa
46.42%
OBJECTIVES: This study assessed the impact of a public-private certified nurse-midwife program on prenatal and delivery outcomes among medically indigent women. METHODS: A population-based quasi-experimental design was used to compare 1 intervention county with 2 nonintervention counties. RESULTS: The program significantly reduced the number of women who received no prenatal care and the risk of acquiring less than adequate prenatal care. Reductions in the proportion of infants born premature or with low birth-weights were of borderline significance. The use of induction and/or stimulation of labor was statistically elevated. CONCLUSIONS: These results suggest that the intervention program was instrumental in reducing some, but not all, negative prenatal and delivery outcomes.

Characteristics of nurse-midwife patients and visits, 1991.

Paine, L L; Lang, J M; Strobino, D M; Johnson, T R; DeJoseph, J F; Declercq, E R; Gagnon, D R; Scupholme, A; Ross, A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1999 EN
Relevância na Pesquisa
36.32%
OBJECTIVES: This study describes the patient populations served by and visits made to certified nurse-midwives (CNMs) in the United States. METHODS: Prospective data on 16,729 visits were collected from 369 CNMs randomly selected from a 1991 population survey. Population estimates were derived from a multistage survey design with probability sampling. RESULTS: We estimated that approximately 5.4 million visits were made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity care, although fully 20% were for care outside the maternity cycle. Patients considered vulnerable to poor access or outcomes made 7 of every 10 visits. CONCLUSIONS: Nurse-midwives substantially contribute to the health care of women nationwide, especially for vulnerable populations.

Nurse-midwifery practice in the United States, 1982.

Adams, C J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/1984 EN
Relevância na Pesquisa
36.38%
During 1982 the American College of Nurse-Midwives conducted a national survey of certified nurse-midwives residing in the United States. About 68 per cent of the 1,584 respondents (response rate 76 per cent) were practicing nurse-midwifery. Most of them were providing prenatal and family planning care. The 937 participants who were conducting deliveries reported that they conducted about 1.8 per cent of the estimated 3,704,000 deliveries which took place in the United States during 1982.

Midwifery care, social and medical risk factors, and birth outcomes in the USA

MacDorman, M. F.; Singh, G. K.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em /05/1998 EN
Relevância na Pesquisa
26.98%
STUDY OBJECTIVE: To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors. DESIGN: Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors. STUDY SETTING: United States. PATIENTS: The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991. MAIN RESULTS: After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births. CONCLUSIONS: National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States...

NURSE ASSISTANT MENTAL MODELS, SENSING MAKING, CARE ACTIONS AND CONSEQUENCES FOR NURSING HOME RESIDENTS

Anderson, Ruth A.; Ammarell, Natalie; Bailey, Donald; Colóon-Emeric, Cathleen; Corazzini, Kirsten N.; Lillie, Melissa; Scotton Piven, Mary Lynn; Utley-Smith, Queen; McDaniel, Reuben R.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/2005 EN
Relevância na Pesquisa
36.22%
In a nursing home case study using observation and interview data, we described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection. We found limits to the models in that they led to actions such as infantalization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Further, we found that CNAs were isolated from clinicians; little resident information was exchanged. We suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.

Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver

Weitz, Tracy A.; Taylor, Diana; Desai, Sheila; Upadhyay, Ushma D.; Waldman, Jeff; Battistelli, Molly F.; Drey, Eleanor A.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.58%
Objectives. We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California.

Policy Options to Attract Nurses to Rural Liberia : Evidence from a Discrete Choice Experiment

Vujicic, Marko; Alfano, Marco; Ryan, Mandy; Wesseh, C. Sanford; Brown-Annan, Julie
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
26.63%
There is major geographic variation in nurse staffing levels in Liberia with the largest shortages in rural areas. A discrete choice experiment (DCE) was used to test how nurses and certified midwives in Liberia would respond to alternative policies being considered by the ministry of health and social welfare (MOHSW). The DCE methodology provides a quantitative estimate of how individuals value different aspects of their job. In Liberia we focused on six key job attributes: location, total pay, conditions of equipment, availability of transportation, availability of housing, and workload. Results were used to predict the share of nurses and certified midwives who would accept a job in a rural area under different schemes. Based on the DCE analysis there are four main actionable recommendations that emerge for improving recruitment and retention of nurses and certified midwives in rural areas of Liberia. First, the MOHSW should consider actively recruiting students from rural areas and exposing them to rural work conditions during their training. Second...

Certified sick leave as a non-specific morbidity indicator: a case-referent study among nurses.

Bourbonnais, R; Vinet, A; Vézina, M; Gingras, S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1992 EN
Relevância na Pesquisa
26.52%
A case-referent study assessed the association between medically certified sick leave from work and some occupational characteristics--namely, two work load indices (nurse patient ratio and patients' average duration of stay) and hospital and care unit. Study participants were nurses from seven general hospitals in Québec City who had been employed for at least six months at the time of study. Cases (n = 184) experienced at least one episode of medically certified sick leave for a diagnosis "most likely to be related to work load" between 1 January 1984 and 31 May 1987. Referents (n = 1165) were chosen from subjects who had no such leave, whatever the medical reason, and were matched to cases by the incidence density sampling method. Occupational data were collected from employment records and administrative files. Analysis was by multiple logistic regression. Significant associations were found between sick leave and nurse-patient ratio among head nurses, patient's duration of stay, and one hospital. Sick leave was more frequent among full time permanent nurses and among those on night and evening schedules. These associations were independent of age, duration of service in this hospital or in the actual job assignment, and care unit. This study supports the relevance of using sick leave as a non-specific indicator of health out-comes.

Using Midlevel Providers in Interventional Radiology

Beach, Debra; Swischuk, James L.; Smouse, H. Bob
Fonte: Thieme Medical Publishers Publicador: Thieme Medical Publishers
Tipo: Artigo de Revista Científica
Publicado em /12/2006 EN
Relevância na Pesquisa
26.58%
Developing and implementing clinical services, including consultations, rounds, and clinic, is time-consuming, and for the interventional radiologist this means time away from the interventional laboratory. Using a team approach to providing clinical services is logical, and the midlevel provider is a perfect fit for an interventional radiology team. Midlevel providers can be grouped into two categories, advanced practice nurses (APNs) and physician's assistants (PAs). Under the umbrella of APN are several specialties including the nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife, and certified nurse anesthetist. The midlevel providers that are particularly suited for interventional radiology are the NPs, CNSs, and PAs. This article discusses midlevel providers in-depth including skills, limitations, and expenses.

Effectiveness of educational strategies preparing physician assistants, nurse practitioners, and certified nurse-midwives for underserved areas.

Fowkes, V K; Gamel, N N; Wilson, S R; Garcia, R D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1994 EN
Relevância na Pesquisa
46.58%
A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies.

Nurse practitioners, certified nurse midwives, and physician assistants in California.

Anderson, A L; Gilliss, C L
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1998 EN
Relevância na Pesquisa
46.58%
California's health care industry includes workers prepared in many ways to perform many jobs. One significant group of health care workers prepared to provide care that often overlaps with physician-generated services is known as "nonphysician providers." Commonly, this label refers to nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). In this article, we will describe this group in five main areas: (1) the characteristics of the current and projected workforce and programs preparing these professionals; (2) the current skill expectations and knowledge bases of each; (3) trends in the education of these health professionals; (4) innovative models of education of these health professionals; and (5) the inclusion of NPs, PAs, and CNMs in workforce planning in a changing health care system. We conclude that, particularly in light of the overlapping functions of this provider group with many physician functions, the NP, CNM, and NP workforces must be recognized and considered when planning for the future of the physician workforce.

Nurse-midwifery. The beneficial alternative.

Gabay, M; Wolfe, S M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1997 EN
Relevância na Pesquisa
36.32%
The number of nurse-midwife-attended births in U.S. hospitals has jumped ten-fold in the last 20 years, rising from just 19,686 in 1975 to 196,977 in 1994. Certified nurse-midwives (CNMs) focus on childbirth as a normal event, emphasizing the educational and psychosocial aspects of care and the judicious use of technological interventions. CNM care appears particularly well suited to help solve two difficult problems in U.S. obstetric care--our country's slow progress in improving the health status of newborns and the excessive use of medical interventions during childbirth. Despite the fact that CNM care has been found to be safe and cost-effective, only a small fraction of those pregnant women who could benefit from CNM care use midwifery services. Lack of consumer awareness is part of the problem, but barriers also exist to accessing CNM services. Sixty-four percent of CNM practices responding to a survey reported practice restrictions, most commonly due to state laws, hospital policies, and inappropriately restrictive physician back-up. One state, Florida, is aggressively promoting the use of CNM care as the standard of practice for healthy pregnant women.

Profile and competencies of nurse managers at accredited hospitals

Furukawa,Patrícia de Oliveira; Cunha,Isabel Cristina Kowal Olm
Fonte: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Publicador: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2011 EN
Relevância na Pesquisa
26.45%
This descriptive study identified the profile and competencies of nurse managers of accredited hospitals from the their perspective and that of their hierarchical superiors. It was conducted in 14 hospitals certified by the National Organization of Accreditation and the Joint Commission International in São Paulo, SP, Brazil. Data were collected through two questionnaires that were applied to 24 professionals. The nurse managers' profiles showed that 69.2% came from private colleges, all with more than 10 years experience since graduation and 92.3% had attended a post-degree program in health management. The nurse managers' most frequent competencies according to their superiors were: leadership, focus on patients, and teamwork. The conclusion is that the profile and competencies of most of the nurse managers were compatible with the expectations of their superiors, who collaborate in the selection of candidates for the nurse manager position and evaluate their professional performance.

Primary Care Non-physician Clinicians in Delaware, 1998

Ratledge, Edward C.
Fonte: Center for Applied Demography & Survey Research Publicador: Center for Applied Demography & Survey Research
Tipo: Outros Formato: 446602 bytes; application/pdf
EN_US
Relevância na Pesquisa
26.58%
Non-physician clinicians have been described as falling into three categories.1 Those in the traditional group are nurse practitioners, certified nurse-midwives, and physician assistants. The alternative group includes chiropractors, naturopaths, and practitioners of acupuncture and herbal medicine. The final group, referred to as specialists includes optometrists, podiatrists, certified registered nurse anesthetists, and clinical nurse specialists. In 1998, the Division of Public Health began an effort to measure the number, type, and spatial distribution of non-physician clinicians (NPCs) who were delivering primary care in Delaware. To that end, the primary objective of this study is to determine how non-physician primary care providers were complementing primary care physicians and to understand how they impact the supply of primary care services.

Perfil e competências de gerentes de enfermagem de hospitais acreditados; Perfil y competencias de gerentes de enfermería de hospitales acreditados; Profile and competencies of nurse managers at accredited hospitals

Furukawa, Patrícia de Oliveira; Cunha, Isabel Cristina Kowal Olm
Fonte: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Publicador: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf; application/pdf; application/pdf
Publicado em 01/02/2011 ENG; POR; SPA
Relevância na Pesquisa
26.45%
Estudo descritivo que teve como objetivo identificar o perfil e as competências de gerentes de enfermagem de hospitais acreditados, sob a ótica desses e de seus superiores hierárquicos, desenvolvido em 14 hospitais certificados pela Organização Nacional de Acreditação e pela Joint Commission International do Município de São Paulo. Para a obtenção dos dados, foram elaborados dois questionários respondidos por 24 profissionais. O perfil dos gerentes de enfermagem revelou que 69,2% vieram de faculdades privadas, todos com mais de 10 anos de formação e 92,3% com pós-graduação na área de gestão em saúde. As competências que mais possuíam, na visão dos seus superiores hierárquicos, foram: liderança, foco no cliente e trabalho em equipe. Conclui-se que a maioria dos gerentes de enfermagem possuía semelhanças quanto ao perfil e competências, compatíveis com as expectativas de seus superiores hierárquicos que colaboraram na seleção para o cargo e na avaliação de seu desempenho profissional.; Estudio descriptivo que tuvo como objetivo identificar el perfil y las competencias de gerentes de enfermería de hospitales acreditados bajo la óptica de estos y de sus superiores jerárquicos, desarrollado en 14 hospitales certificados por la Organización Nacional de Acreditación y por la Joint Commision International del Municipio de Sao Paulo. Para la obtención de los datos...

Abortion care training framework for nurses within the context of higher education in the Western Cape

Smit,I; Bitzer,EM; Boshoff,ELD; Steyn,DW
Fonte: Curationis Publicador: Curationis
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2009 EN
Relevância na Pesquisa
36.4%
The high morbidity and mortality rate due to illegal abortions in South Africa necessitated the implementation of abortion legislation in February 1997. Abortion legislation stipulates that registered nurses who had undergone the proposed abortion care training - certified nurses - may carry out abortions within the first 12 weeks of pregnancy. Currently it seems that an inadequate number of nurses are being trained in the Western Cape to provide pregnant women with counselling, to perform abortions and/or refer problem cases. No real attempts have since been made by higher education institutions in the Western Cape to offer abortion care training for nurses. This case study explores the situation of certified nurses and the context in which they provide abortion care in different regions of the Western Cape. The sampling included a random, stratified (non-proportional) number of designated state health care facilities in the Western Cape, a non-probability purposive sampling of nurses who provided abortion care, a non-probability convenience sample of women who had received abortion care, and a non-probability purposive sampling of final-year pre-registration nursing students. Data was generated by means of questionnaires, a checklist and semi-structured interviews. The main findings of this study indicate that the necessary infrastructure required for legal abortion is in place. However...