An exploration of nurse practitioner care to homebound frail elders.
OBJECTIVE
To identify and classify care activities of nurse practitioners (NPs) providing primary care for frail homebound elders and to describe NPs' perceptions of the outcomes of their care activities.


METHODS
Three focus groups were held with 24 NPs with at least 1-year experience in caring for frail homebound elders to elicit NPs' descriptions of their practice. In addition, individual interviews with 10 NPs and participant observation of 2 NPs visiting elders in their homes validated the data. The total sample size was 36 NPs. Field notes and audiotapes were transcribed for analysis and coded using Brykczynski's existing domains and competencies of NP practice.


CONCLUSIONS
Most of the care activities of NPs providing primary care to frail elders in their home involve management of patient health and illness, case management, and the teaching-coaching function. The NP informants believe that they prevent medication errors, falls, emergency room visits, hospitalizations, and even death. They reported that they improve their patients' quality of life and help to provide a peaceful death when death is imminent.


CONCLUSIONS
Further refinement of the proposed model is needed in order to examine the effectiveness of NP care on clinically relevant patient outcomes.
Dick
Karen
K
College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts 02125-3394, USA. karen.dick@umd.edu
Frazier
Susan C
SC
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001900:Boston; D019090:Case Management / Q000458:organization & administration; D003152:Community Health Nursing / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration; D006699:Home Care Services / Q000458:organization & administration; D018577:Homebound Persons / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires