DNP Role Development for Doctoral Advanced Nursing Practice, Second Edition

92 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION

■ APRN PRACTICE OUTCOMES

Compelling evidence of the effectiveness of APRN- managed care has been in the litera-
ture since the 1970s (Lenz, Mundinger, Kane, Hopkins, & Lin, 2004). A variety of patient
outcomes of APRN- provided care have been studied, primarily in comparison to that
provided by physicians. Patient satisfaction with, and quality outcomes of, APRN care
have been studied extensively in the United States across the past three decades, and
more recently in Canada, Britain and other European countries that have adopted
advanced practice/ NP roles. Satisfaction with the quality of NP- provided care in pri-
mary care, emergency departments, and specialty- care settings have consistently been
found to be high, while researchers acknowledge that various methods, definitions,
instruments, data sets, and time frames have been used in the measurement of these
outcomes. However, across multiple studies and reviews, findings consistently docu-
mented quality of, and patient satisfaction with, APRN- provided care to be equivalent
to or higher than physician- provided care (Carter & Chochinov, 2007; Cooper, Lindsay,
Kinn, & Swann, 2002; Dierick- van Daele, Metsemakers, Derckx, Spreeuwenberg, &
Vrijhoef, 2009; Horrocks, Anderson, & Salisbury, 2002; Jennings, Lee, Chao, & Keating,
2009; Kleinpell, Ely, & Grabenkort, 2008; Knudtson, 2000; Roblin, Becker, Adams,
Howard, & Roberts, 2004). For example, Mundinger and associates’ large randomized
controlled trial of NP- provided primary care, compared with physician- provided care,
with a 2- year follow- up, demonstrated no significant differences in patient satisfaction,

Authors Design Related Findings

Roots and

McDonald (2014)

Descriptive,

qualitative, case

study

NPs added to rural Canadian fee for service

practices; extended access and appointment

times, emphasis on team approach, increased

satisfaction, increased connection to community

services for patients

Sawatsky, Christie,

and Singal (2013)

Randomized trial NP- directed care after cardiac surgery more likely

to result in higher rating of functional status and

fewer reported symptoms, higher satisfaction with

amount and quality of services received

Van Leuven and

Prion (2007)

Descriptive,

naturalistic

Interview NPs for perspectives on health

promotion activities in practice; health promotion

viewed as implicit in nursing role; differentiates

NP from MD; valued by NPs; obstacles: time,

patient care needs, limitations of scope of practice,

patient scheduling, practice model (HMO vs.

other practice)

CBI , Caring Behaviors Inventory; CNS, clinical nurse specialist; COPE, creativity, optimism, planning, and
expert information; HMO, health maintenance organization; NP, nurse practitioner; PNP, PhD in nursing program.

Sources : Benkert et al. (2002); Benkert, Hollie, Nordstrom, Wickson, and Bins- Emerick (2009); Castro and Ruiz
(2009); Donohue (2003); Green and Davis (2005); Hayes (2007); Kotzer (2005); Kozlowski, Lusk, and Melnyk
(2015); Roots and McDonald, 2014; Sawatsky, Christie, and Singal (2013); Van Leuven and Prion (2007).

TABLE 3.1 Sample of Studies Examining Influence of Disciplinary Underpinnings on
NP Practice Outcomes (continued )