Nurse Practitioner Directed Care and Effectiveness

Bookbinder, M., Glajchen, M., McHugh, M., Higgins, P., Budis, J., & Solomon, N.,… Portenoy, R. (2011). Nurse Practitioner-Based Models of Specialist Palliative Care at Home: Sustainability and Evaluation of Feasibility. Journal of Pain and Symptom Management, 41(1), 25-34. 

The article is aimed at defining the feasibility and effectiveness of two nurse practitioner (NP) models of home-based palliative care: in the first one, an NP team up with a social worker; in the second, an NP is assigned to home-based palliative teams through a Hospice program. The study took two years, and 226 cases were analyzed for the first model while 456 were attributed to the second one. The feasibility of the models was compared with the help of financial analysis; for the first program, the progress data was also collected and analyzed with the help of generalized linear modeling. It was concluded that the first model was very effective and led to significant improvements in the patients’ physical and emotional well-being, but it was much less economically reasonable when compared to the second one. The number of hospice referrals was 360% higher in the second model. The research provides information concerning various models of NP palliative work. The effectiveness of the second model is not analyzed, even though hospice referrals should have altered it. Also, the authors admit that they intended to prove the fact that the first model is not feasible, but the thoroughness and a large sample of their study limit the possibility of bias. The authors conclude that the second model is preferable in the urban environment due to its increased feasibility. The role option of the study is NP; the problem raised is the effectiveness of NP palliative practice. From the point of view of this problem, the study appears to contribute by demonstrating the models and their characteristics that can affect the effectiveness and feasibility of NP palliative care and intervention.

Dyar, S., Lesperance, M., Shannon, R., Sloan, J., & Colon-Otero, G. (2012). A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study. Journal of Palliative Medicine, 15(8), 890-895.

The article is devoted to the effectiveness of NPS palliative interventions with respect to oncology patients. The authors insist that the topic is under-researched, and they want to provide scientific evidence to the fact that NP intervention is of importance for palliative care. During the study, the quality of life outcomes were the indicators of NPs’ effectiveness; the care elements that were studied included discussion-based palliative interventions. The data was gathered from 26 participants who had been randomly selected for intervention and control group; it was collected through specifically modified tools (that included interviewing), coded, and analyzed statistically. The results demonstrate that palliative intervention was beneficial for the mental and emotional well-being of the patient. The main limitation of the study is small sample size as well as its relatively short timeframe. The research was meant to be conducted for a longer period of time with the total of 100 patients, but these plans were rejected because of the ethical issue of keeping the control group from receiving palliative care. The authors will search for other ways of assessing palliative care effectiveness. The authors conclude that discussion-based interventions of NP are capable of improving the quality of life of palliative patients, and their study provides scientific evidence to the fact. This article is perfectly suited for the identified problem: it is meant to answer the question concerning the effectiveness of NP in palliative medicine. As rightfully pointed out by the authors, it is a relatively underdeveloped and underresearched field. The article discusses only part of possible interventions, but it is a significant contribution to the study of the problem.

Kaasalainen, S., Ploeg, J., McAiney, C., Martin, L., Donald, F., & Martin-Misener, R.,… Sangster-Gormley, E. (2013). Role of the Nurse Practitioner in Providing Palliative Care in Long-Term Care Homes. International Journal of Palliative Nursing, 19(10), 477-485. 

The study is a part of a greater research devoted to the role and integration of NPs in long-term care (LTC). The specific purpose of the work was to find out if and how NPs can provide quality palliative care in LTC setting. To achieve it, the study employed quantitative methodology: the previously collected interview data (143 participants of a previous study) concerning a diverse sample of LTC settings (rural and urban, various regions) was managed with the help of N-Vivo 9.0 program (labeling, categorizing, coding) to ensure unbiased interpretation. The results of the study indicate that NPs were most effective in the terms of medicine management (32% of requests), mostly pain medications, which is understandable since about 44% of the residents were dying with pain. Other roles, which had been proven to be significant by the study, included educative function, decision-making, and the coordination of the interdisciplinary staff of an LTC environment. Finally, the authors emphasized the fact that family satisfaction with the care of the residents was positively correlated with the intervention and care of an NP. However, it should be pointed out that the participants volunteered for it, which means that negative experiences are less likely to be included. Another drawback of the study is the size sample that is not very large and limited to five LTC establishments, even though they demonstrate various settings. The authors conclude that NP’s contribution to LTC settings care is multidimensional and leads to the optimization of palliative care. The article contributes to the understanding of the role of NP in palliative care, which corresponds to the role option (NP) and the chosen topic (palliative care).

Lukas, L., Foltz, C., & Paxton, H. (2013). Hospital Outcomes for a Home-Based Palliative Medicine Consulting Service. Journal of Palliative Medicine, 16(2), 179-184. 

The article is devoted to the analysis of a particular type of NP-conducted palliative consulting service called Optimizing Advanced Complex Illness Support. The research involved 369 patients who had been diagnosed with advanced complex illness; the NP intervention activities included assessment, recommendations, and guidance as well as care planning. The key control variables of the study included data on admissions, readmissions, hospital days, and costs among others. The data concerning 18 months prior to the usage of the service and 18 months after it was gathered by the study. The statistical analysis included normalizing or dichotomizing data (when possible) to make it analyzable. The results were positive, and most variables were demonstrating various levels of improvement; the only variable that turned out to be an exception was the number of emergency department visits. Still, the authors point out that the results are only preliminary, and further research on the topic is necessary. A major limitation of the study is the lack of randomized control design. The sample also has limitations: it included primarily white people; the number of men was larger than that of women. The authors mention the funding organizations and prove that they had no financial interest in the results of the article. The article is a proof of the significance of NP palliative intervention and its potential positive results, which means that it provides the positive answer to the question that is connected to the chosen role of NP. Admittedly, the research focuses on a specific service, and it does not attempt to demonstrate the relative effectiveness of individual interventions, but it provides the overall characteristic of a palliative service and proves that it is effective.

References

Bookbinder, M., Glajchen, M., McHugh, M., Higgins, P., Budis, J., & Solomon, N.,… Portenoy, R. (2011). Nurse Practitioner-Based Models of Specialist Palliative Care at Home: Sustainability and Evaluation of Feasibility. Journal of Pain And Symptom Management, 41(1), 25-34.

Dyar, S., Lesperance, M., Shannon, R., Sloan, J., & Colon-Otero, G. (2012). A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study. Journal Of Palliative Medicine, 15(8), 890-895.

Kaasalainen, S., Ploeg, J., McAiney, C., Martin, L., Donald, F., & Martin-Misener, R.,… Sangster-Gormley, E. (2013). Role of the Nurse Practitioner in Providing Palliative Care in Long-Term Care Homes. International Journal of Palliative Nursing, 19(10), 477-485.

Lukas, L., Foltz, C., & Paxton, H. (2013). Hospital Outcomes for a Home-Based Palliative Medicine Consulting Service. Journal Of Palliative Medicine, 16(2), 179-184.