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Patient Outcomes Affected by Using Nurse Practitioners"Literature Review" Chapter

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¶ … patient outcomes affected by using nurse practitioners instead of medical doctors?

In the next few years in the United States, the demand and need for primary health care services is expected to increase, due both to the increase in population and the Affordable Care Act (ACA) passage. Different researchers show that nurse practitioners have already been trained in order to provide different services of health care so they would help in fulfilling the demands. Because the demands would increase, and meeting the present growing needs of healthcare would become more important, there is need to ease the restrictions and policies so that nurse practitioners are encouraged, motivated, and incentivized to get more involved in this sector (NGA, n.d).

The relationship between healthcare providers and the satisfaction of patients/clients is a very multi-faceted and complex matter. The satisfaction of patients, utilized by different agencies as a benchmark and indicator of the care results, has showed acceptability regarding the nurse practitioners in different hospitals and clinics. However, studies related to the satisfaction of the patients in the primary care environment regarding the nurse practitioners are not available yet. This particular matter of interaction between the patient and the nurse practitioner is highly important and relevant in this sector as it creates new and easy ways of providing good health care to the patient. Data and information regarding different elements of the delivered primary care by the nurse practitioners is missing in literature, but its presence would benefit the NPs and the society, which is also the main purpose of this paper (Agosta, 2009).


The growth and aging of the population of America, and the expansions of health care and other actions that come under the Affordable Care Act (ACA), are predicted to increase the importance and demand for primary care services. In 2010, a passage was included in the ACA that gave way to the enrollment of around 2 million people in health insurance. By 2016, this number is expected to rise as high as 30 million. However, in 2012, the states of America were given an option by the Supreme Court to decide whether they wanted to expand their programs. This has however, held ACA's decision and the full nature of the expansion of insurance under ACA is not yet clear. Despite that ruling, the 16 million people who can obtain the new subsidies regarding the private covering, given by health insurances under ACA and its mandate, would have high stemming coverage (NGA, n.d).

Some studies suggest that the need for primary care in America would reach between 15 and 25 million visits annually by 2019. This means that the requirement for physicians would reach to between 4 thousand and 7 thousand physicians needed. This increase would also impact the current shortage of physicians for primary care. According to the Health Resources and Services Administration (HRSA), more than 35.2 million living under 5870 Health Professional Shortage Areas (HPSAs) throughout the country are not able to receive the proper services of primary care (NGA, n.d.).

According to the Interactional Model of Client Health Behavior by Cox, the clients of healthcare are complex and unique. Their personal aspects consist of factors such as worldliness, emotions, motivation, personality characteristics, social influences, and demographic traits; all of these factors independently and collectively do their work in influencing the decisions, perceptions and health behavior of the client. The satisfaction of clients regarding the health care services is a relevant pointer towards the health care services and whether they are able to provide the individuals with influential outcomes and facilities (Alazri & Neal, 2003). The viewpoint of satisfaction with the services of health care is an important factor and part of the outcomes of health and (Agosta, 2009).

Theoretical framework or model

This study used the Nursing Role Effectiveness Model (NREM), developed by Irvine et al. (1998). This model provides the complete framework of an organization for discussion, analysis, data and methodology. The models expect that the routine effectiveness of nurses impacts the outcomes of patients and works as the base for improvements and evidence based-practice. The model uses the work of Donabedian (1988) and includes three factors to represent nursing. These three factors are patient and health outcomes, role of nurses, and structure (Irvine et al., 1998).

All these three factors are then divided further into categories of patient type, institution type, and type of care. The 'role of nurse' is divided into an interdependent role, a dependent role, and an independent role; 'structure' is divided into patient, organization, and nurse (Evangelista et al., 2012). The patient and health outcomes are divided into safety outcomes, quality and nursing outcomes, and patient outcomes.


The variables of structure include patient structure, clinic structure, organizational structure, and PNP structure. Further examples of PNP structure include appointment availability, patient-chief complaint, and testing and support staff of clinic, leadership, hospital nursing, practice scope, and PNP education.

The variables of 'process' include the interdependent, dependent and independent PNP practice functions because they are related to the clinics of PNP cardiology. The examples in this study are usage of practice guidelines, correct use of consulting with the colleagues, disease and diagnosis management and PNP assessment.

The variables of 'outcome' include safety and quality outcomes, nursing outcomes and patient outcomes. The examples include management and diagnosis of congenital heart disease, correct assessment and satisfaction of nursing, satisfaction of the patient and access to appointments (Evangelista et al., 2012).

Literature Review

Patient satisfaction with NPs

A study by Bryant & Graham (2002) related to advanced NPs and patient satisfaction showed that effective technical competency, control over decisions, and receiving health information and support have all influenced the satisfaction of the patient in a very positive manner. Different factors and elements within the system of health care finally determine the opinion of a person related to the services that he/she has achieved. Different qualities of NP were identified by Zoller, Lackland, & Silverstein (2001) and Donohue (2003), these included correct duration of the visit of the patient, and specific information gained from health education. Other researchers stated socioeconomic, health status, and age to be the most important elements (Branson, Badger, & Dobbs, 2003; Powers & Bendall-Lyon, 2003). The patients who were highly satisfied viewed their health status in a more positive way, and were more likely to return for more visits for their checkups (Powers & Bendall-Lyon, 2003). More positive factors that influenced the perception of the patients included delivery and feedback, communication, education, and personal expectations (McKinley, Stevenson, Adams & Manku-Scott, 2002; Powers & Bendall-Lyon, 2003; Roblin, Becker, Adams, Howard, & Roberts, 2004; Agosta, 2009).

Satisfaction was the dependent variable in Gagan & Maybee (2011)'s study. This particular factor was taken from the studies of Thrasher & Purc-Stephenson (2008). The total number of satisfaction was measured by combining the responses of the first ten questions as well as items eleven and fifteen from the survey conducted. The patients selected their choices by ticking the box that represented a Likert scale of four points which included: 1 = strongly agree, 2 = agree, 3 = disagree, and 4 = strongly disagree. The score of satisfaction came out to be 15.598 out of the usable 179 responses. The range was from 12 to 25 and the SD was 4.71. A low score meant that the patient was satisfied with the services he/she got. In a nutshell, most of the patients either agreed or strongly agreed with satisfaction about the NP's services provided to them. (Jo Gagan & Maybee, 2011).

The study of Gagan & Maybee (2011) analyzed the total score of satisfaction to see whether the respondents' traits or their visits to the clinic were linked with satisfaction. Satisfaction and age presented a positive link because the lower the score, the more satisfied the patient was, so the patients who were young were more satisfied. There was also an average link between satisfaction and clarity of role (the patients were satisfied if the differences were clear) (Jo Gagan & Maybee, 2011).

Satisfaction and waiting times did not show much correlation. Longer waits were not linked with low satisfaction, nor were shorter waits linked with high satisfaction. Gender differences also did not show any difference between the satisfaction levels. Both male and female showed equal satisfaction in the work of nurse practitioners that they had received. Educational level also did not show any correlation with satisfaction. The different levels of satisfaction identified in the data and census of U.S. As ten various levels were all the same (Jo Gagan & Maybee, 2011).

A study stated that the patients were normally satisfied by the care that was provided to them by both the general and the nurse practitioners. The scores received by both the categories were similar but the nurses' score had a slightly higher edge as compared to the scores of the general practitioners. The difference between the general and the NPs as found through the scores existed in giving attention to the effect… [END OF PREVIEW]

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