Preventive Services: Role of the Nurse Practitioner;Rept. for 1 Sep 96-30 Aug 00

摘要

The purpose of the report is to describe current practices of military nurse practitioners with regard to clinical preventive services$ develop a grounded theory that explicates factors that facilitate and inhibit the delivery of clinical preventive services$ describe the military consumer's experience of care given by nurse practitioners$ and determine the essential features of a clinical preventive health care system within the military, the feasibility of initiative implementation, and the readiness of the system for implementation. The entire population of military nurse practitioners (Air Force, Army, and Navy) in the Department of Defense was invited to participate (N = 403) with 246 consenting participants (61%). Additionally, 32 patients/clients of a subset of 20 military nurse practitioners also consented to participate. Instrumentation: Preventive Care Survey II (Ronan, 1996), procedures consistent with qualitative methodologies for content analysis, grounded theory, and phenomenology. A descriptive quantitative/qualitative survey designed was used in Phase I, Grounded Theory in Phase II, Phenomenological approaches in Phase III, and triangulation methodologies in Phase IV. Quantitative and qualitative data analysis for Phase I were used to describe the clinical preventive services offered by military nurse practitioners as well as aspects of practice that detracted from and facilitated the ability to provide these services. In Phase II, data were used to develop a grounded theory that explicated the impact of social-structural and social-psychological processes in the delivery of clinical preventive services from the perspectives of military nurse practitioners. Interviews with patients/clients in Phase III were analyzed to capture a description of the essence of the care experience from the perspective of the military consumer through phenomenological approaches. In Phase IV data triangulation analysis, a comparative thematic matrix of the three previous data sets was used to form a theoretical schema including the milieu of military health care and the presence of clinical preventive services, the role of the nurse practitioner within this system, and the process of military nurse practitioner-client transactions within the health care experience.