title: A unique practice model for Nurse Practitioners in long-term care homes.
abstract: OBJECTIVE
  This paper is a report of a study examining a practice model for Nurse Practitioners (NPs) working in long-term care (LTC) homes and its impact on staff confidence, preventing hospital admission, and promoting early hospital discharge.
  
  
  BACKGROUND
  The recent introduction of NPs in LTC homes in Ontario, Canada, provided an opportunity to explore unique practice models. In a pilot project, two full-time equivalent NPs provided primary care to a consortium of 22 homes serving approximately 2900 residents. The practice model was based on the specific needs of the homes and residents.
  
  
  METHODS
  The NPs working in this project prospectively collected data (from July 2003 until June 2004) on their clinical activities and resident outcomes. Directors of Care (n = 18) of the participating homes completed a questionnaire (March 2004) assessing the impact on prevention of hospitalization and staff confidence.
  
  
  RESULTS
  The NPs had 2315 clinical contacts in the 1-year period; the majority (64%) were follow-up contacts. Many contacts were for uncomplicated medical problems or more complex but straightforward medical issues, and had positive outcomes. Hospital admission was prevented in 39-43% of cases. NPs had a positive impact on improving staff confidence, but no impact on facilitating early discharge from hospital.
  
  
  CONCLUSIONS
  Practice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Hamilton Family Health Team and Geriatric Psychiatry Service, St. Joseph's Healthcare Hamilton, CMHS, Hamilton, Ontario, Canada. mcaineyc@mcmaster.ca
authors.forename: Carrie A
authors.initials: CA
authors.lastname: McAiney
authors.forename: Dilys
authors.initials: D
authors.lastname: Haughton
authors.forename: Jane
authors.initials: J
authors.lastname: Jennings
authors.forename: Dave
authors.initials: D
authors.lastname: Farr
authors.forename: Loretta
authors.initials: L
authors.lastname: Hillier
authors.forename: Pat
authors.initials: P
authors.lastname: Morden
mesh_terms: D000368:Aged; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D016294:Models, Nursing; D009722:Nurse Practitioners / Q000592:standards* / Q000706:statistics & numerical data; D009730:Nursing Assessment / Q000592:standards; D009735:Nursing Homes / Q000458:organization & administration*; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012017:Referral and Consultation / Q000706:statistics & numerical data