Nursing Care Model for the Chronically Ill Pilot Project

Nursing Care Model for the Chronically Ill

Sharon Cumbie, PhD, RN, CS
Principal Investigator
University of Wyoming
School of Nursing
sacumbie@uwyo.edu

Overview:

Purpose: The prevalence of chronic conditions is increasing dramatically and yet health care systems often lack adequate plans for managing chronic illness. Typically care is fragmented and focused on treatment of symptoms with minimal client engagement in their own health care process. Effective management for chronic conditions requires a transformation of health care away from a system focused on episodic care toward a proactive one that emphasizes health promotion across a lifetime. The long-range goal is to enhance health outcomes for chronically ill persons through the implementation of an advanced nursing practice model for process engagement. The objective of this project was to refine and test the protocol for a nursing intervention consistent with this model in a clinic in a rural county that serves low-income uninsured persons.

Aims: The specific aims of this study were to: (a) pilot test the client-centered nursing intervention with selected chronically ill rural persons in a clinic setting, and (b) evaluate client, practitioner, and interdisciplinary team impressions of the nursing intervention.

Methods: The overall structure for this research was evaluation research that utilizes an embedded single-case study design with a multi-method component approach for a process analysis. Process, or intervention, analysis was appropriate to the need to obtain descriptive information about the process by which a procedure gets implemented and how it functions in actual operation. Study participants were four adult clients of the Downtown Clinic in Laramie, Wyoming, a free clinic for uninsured persons, with complex chronic illness. Theoretical sampling was used to identify participants based on demographic and clinical factors such as gender, age, ethnicity, and diagnosis. The case unit of analysis for this study was the episode of care involving the chronically ill person, the Advance Practice Nurse, case manager, and the health care team. Within each episode of care, three subunits were examined: baseline data, process of care, and outcomes. A number of strategies were used for the analysis of data, which include the following: case-oriented approach; cross-case analysis; variable-oriented approach; pattern clarification; pattern-matching, and; interactive synthesis involving cross-case analysis. The results of this study are significant in the further development of the nursing intervention protocol for broader implementation with chronically ill rural dwellers in a variety of settings.

Team:

	Virginia Conley, PhD, ARNP, CS Co-Investigator University of Wyoming School of Nursing vconley@uwyo.edu

	Mary Burman, PhD, RN, FAAN Co-Investigator University of Wyoming School of Nursing mburman@uwyo.edu

	Clarann Weinert, SC, PhD, RN, FAAN Co-Investigator Montana State University-Bozeman College of Nursing cweinert@montana.edu

Dissemination:

Presentations

Cumbie, S.A. (2003). A Model for facilitating participation in health process [poster]. University of Wyoming College of Health Sciences Research Day, Laramie, WY.
Cumbie, S.A.; Burman, M.E.; Conley, V.; Weinert, C. (2004). Practice Theory Development: Refining an advanced practice nursing model for chronically ill rural dwellers [poster]. National Congress on the State of the Science in Nursing Research. Washington, D.C. October 7-9.
Cumbie, S., Conley, V., Burman, M.E., & Weinert, C. (2005). Practice theory development: A model for person-centered care [poster]. 38th Annual Communicating Nursing Research Conference, Western Institute of Nursing, San Francisco, CA.

Publications

Cumbie, S., Burman, M., Conley, V., & Weinert, C. (2004). Practice, theory, development: Refining an advanced practice nursing model fo chronically ill rural dwellers [Abstract]. Nursing science: Working toward a healthier nation [CD]. Washington, DC: National Congress on the State of the Science in Nursing Research.
Cumbie, S., Conley, V., & Burman, M. (2004). Advanced practice nursing model for comprehensive care with chronic illness: Model for promoting process engagement. Advances in Nursing Science 27 (1), 70-80.
Cumbie, S., Conley, V., Burman, M.E. (2004) Advanced practice nursing model for comprehensive care with chronic illness. Advances in Nursing Science. 27 (1), 69-79.
Cumbie, S., Weinert, C., Brown, J., & Sherard, P. (2006). Evaluation of a model for person-centered care. Manuscript submitted for publication.
Cumbie, S.A. & Weinert, C. (April, 2006).Rural research: Lessons from the field [Abstract]. Communicating Nursing Research Conference Proceedings, 14. Albuquerque, NM.
Cumbie, S.A. & Weinert, C. (October, 2006).Rural research: Lessons from the field [Abstract]. National State of the Science Congress in Nursing Research. Washington, DC.