1a) Medically Underserved1b) Physician Primary Practice Site1c) Facility Based Practice1d) Physician Alternate Site-Physician reachable, on site 10% of the time, within 75 miles of primary practice, BME can waive many supervisory requirementsN5350 FINAL Study Guide Test QuestionsWeek 2: 8/25-29A) For History and Evolution (JENN)1. Who is credited to be the first advanced practice nurse role?- Nurse Anesthesia in 1800’s- perhaps the oldest advanced nursing specialtyo Sister Mary Bernard at St. Vincent’s Hospital was the first anesthetist2. Who is credited to be the founder of the first nurse practitioner role?- Loretta Ford-1965- Colorado3. Who is (are) the oldest primary care providers in the history of advanced practice nurses?- Midwifes in 1700’s- perhaps the oldest primary health care providero Martha Bullard, 1785 is the oldest noted in publication4. What are the roles of APRNs? How are they different from each other?- To provide health care to individuals, family, groups in a variety of health care settings (homes, hospitals, institutions, offices, clinics, etc)- APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist5. What states are responsible for being the first to have advanced practice language in their nurse practice act?- Idaho (language read- “assess, diagnose, treat”)6. What is NONPF? What is their influence for APRNs?- National Organization of Nurse Practitioner Faculty- They have developed domains and competencies- Organized role competencies (policy, ethics, quality, leadership, etc)7. How is the NP role different from PA role?- PA’s work directly under a MD, NP’s can function independently- NP’s focus on multiple practice and nursing models- PA’s focus on medical tasks utilizing a medical framework8. What are the key elements of OTA, Brown, Safriet and Mundinger? - OTAo NP’s provide equivalent care to MD’s.o Patients who receive care form an NP show decreased patient symptoms.- Brown1o Patient satisfaction and resolution of pathological conditions were greater for NP’s over MD’so NM’s use less technology/ analgesiao NM’s achieved equivalent neonatal outcomes- Safreito There is abundant data on the NP role in providing high quality, cost effective care/o There are major restrictions on the practice of NP’s and these barriers should be removed.- Mundingero Compared outcomes in patients who were randomly assigned to either NP’s or MD’s. Results showed that patient outcomes were comparable.1. How does the Texas Board of Nursing define the NP role?- A RN approved by the board to practice as an APN based on completing an advanced education practice programacceptable by the board. The term includes an NP, nurse midwife, nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public/private clinics and private practice. The APN acts independently and/or in collaboration with other health care professionals in the delivery of health care services.2. Where and when did the role first begin?- 1965- University of Colorado-PNP3. What factors have supported initiation of the role and its development over time?1. Changes socially/culturally- WW2, Vietnam war- needed anesthetist- Communities needed midwives, lack of prepared OB’s2. Changes in the Health care system- No physicians to administer anesthesia- Decrease in medical interns and MDs, and was therefore an increased need for the NP4. What are 3-5 major research outcomes (process or outcomes findings) about NP impact that you can document?1. NP’s provide equivalent care to MD’s- Process measures: Adequacy of pedi exams, medication prescribed, short and long term compliance- Outcome measures: improved patient functioning, resolution of acute problems, decreased pain or discomfort in children2. NP’s provide superior care to MD’s- Process measures: # of diagnostic tests, effectiveness of interpersonal management skills- Outcome measures: reduced patient symptoms, better HTN control, increased weight reduction, pain decreased in adult patients, improved activity and decreased anxiety in chronicpatients3. Patients are generally satisfied with the quality of care provided by them, particularly with the interpersonal aspects of care.4. NP’s are a solution to healthcare system issues such as Access to Care, Quality of care and Cost of Care25. What are 3 major questions about the NP role and its impact that research should address?1. Does eligibility reimbursement for nurses cause loss of quality of care or incentive to help more people?2. Would requiring a DNP for APN cause less nurses to become APN and therefore cause a greater shortage for the growing population.3. Does have limitations on prescriptive authority cause a delay in care and pain management?6. What are 3 major healthcare system issues that can be impacted by the NP role? Describe how these can be impacted.1. Assess to care2. Quality of care3. Cost of care*According to Safreit, in order for NP’s to be part of the solution, barriers to practice that exist must be removed.- Scope of Practice: no protocols, full authority to practice with no supervision- Unlimited prescriptive authority- Full reimbursement- Autonomy as a provider: hospital privileges7. What are 3 issues that can impact the NP role either positively or negatively? Describe how the issues can impact the role and what you think needs to be done to promote a positive outcome.1. DNP: positive side is lengths of programs are lengthy anyways with no change in credentialing awarded. You would not have to do or much extra, and you would have a DNP. Negative side is this might push nurses from continuing their education and the need for care providers should take precedent over professionalized agenda. 2. Prescriptive authority: increasing prescriptive authority could impact the role positively in that patients will not have a delay of care. Pain could be better managed.3. Eligibility for reimbursement: offers larger groups of people in communities primary care but can also cause competition as NP’s and MD’s attempt to serve the same population. Also, umbrella corporations tend to give the NP a min number of patients to see and then offer incentive pay to see more. Loss of quality of care? B) For