Dissertation

Identification of Primary Care Nurse Practitioner Clinical Procedural Skills Used in Practice: Examination of Frequency of Use, Importance of Skill, and Training for Skill

Want, David R

2020

Overview

NP programs educate NPs in CPS commonly encountered in the care of specific populations. However, NPs transitioning to practice do so in a wide variety of settings and provide care to patients with a wide diversity of acuities whose care and management may require recognition of the need or performance of new CPS. Statement of the problem. With primary care NPs functioning in varied settings and roles requiring additional CPS knowledge and skills, NPs have expressed lack of preparedness regarding CPS. Although some evidence identified those CPS considered important to and frequently performed by NPs, the literature provides insufficient evidence to identify the CPS performed most frequently and rated as most important by primary care NPs in practice, and existing curricular standards lack clarity regarding which CPS to include in program curricula. This project aimed to conduct a practice analysis of the most frequently performed and most important CPS to primary care NPs in one region of the country to provide data to inform regional and national stakeholders regarding the current state of primary care NP CPS, and to guide standardization of primary care NP CPS curricular requirements. The Donabedian Model provided the theoretical underpinning for this project. The model component Structure represented academia and CCNE, individual state/jurisdiction boards of nursing, and the individual clinical practice settings. The model component Process represented the NP’s CPS knowledge and skills to diagnose and treat his patient in accordance with established practice standards. The model component Outcomes represented the patient’s receipt of high-quality care to facilitate improved health, and delivery of high-quality care also represented the outcome for the practice settings. Method. This project utilized a correlational design with a cross-sectional approach of a convenience sample, to recruit 102 NPs working in primary care in one multi-state/jurisdiction regions of the United States. Laustsen’s (2013) PCCSSI was modified and served as the data collection tool. The Catholic University of America IRB reviewed and approved the project before commencing to ensure the protection of human subjects. Data cleaning, frequency analysis to check for errors, outliers, and missing data, and Little MCARs test assessed for missing data patterns prior to analysis. This project answered five specific questions. Results. Question one: What is the frequency of individual CPS performance by primary care NPs? The results demonstrate of the 94 CPS surveyed, 62 were reported as performed “never” by > 50% of participants. Of the remaining 32 CPS, seven were reported as being performed “at least once a week” by > 30% of participants. Question two: What is the level of importance of individual CPS performed by primary care NPs? The results demonstrate of the 94 CPS surveyed, 43 were reported as “not important” by > 50% of participants. Of the remaining 51 CPS, eight were reported as “very important” by > 50% of participants. Question three: Does a relationship exist between the frequency and level of importance of CPS? The results demonstrated significant associations between frequency and importance in all 50 CPS examined, with effect sizes ranging from moderate to large. Question four: Does the level of importance and frequency of performance vary by geographic practice setting (urban vs. suburban vs. rural)? The results demonstrated significant associations between importance and location in 8 of the 50 CPS and demonstrated significant associations between frequency and location in 16 of the 50 CPS. Question five: For a CPS, does a relationship exist across performance of the CPS, importance of the CPS and receipt of CPS training in a NP program? Results across frequency, importance, and training demonstrated that the highest-order interaction (frequency x importance x training) was significant for three CPS: abscess- incision and drainage; splinting: wrist and hand; and eye irrigation. Summary of conclusions. Prior research from an exemplar study by Kennedy-Malone et al. (2008) supports this project’s finding that certain CPS are more likely to be performed more often by participants practicing in suburban or rural areas than by participants practicing in urban areas. As no prior literature examined a potential relationship between frequency and importance, the findings of this project and its use of inferential statistical tests constitutes a seminal appraisal of the current state of primary care NP CPS in one multistate/ jurisdiction region, providing information to NONPF for consideration of recommendations for curricular content. The identification of frequently performed CPS, which may lie within a RN or medical assistant scope of practice, merits further investigation. Examination of why NPs are performing CPS which can be performed by RNs or medical assistants needs to be addressed to facilitate clearer identification of actual CPS required in academic NP programs. In conclusion, this project advanced the examination of primary care NP CPS, furnishing data to facilitate the design of future studies exploring these topics, as well as to drive formation of a list of core CPS for primary care NPs for standardization of CPS curricular requirements.

• Publisher: ProQuest Dissertations & Theses
• Subject: Data collection / Frequency of occurrence / Identification / Literature / Noun phrases / Nursing / Patients / Polls & surveys / Public health / Public Health Education / Research subjects / Rural areas / Rural urban differences / Urban areas
• ISBN: 9798678181480