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This study describes the clinical experiences of doctorally prepared nurses whose primary professional role is providing care as advanced practice nurses. Telephone interviews were conducted with 20 participants who lived and practiced in 13 states. Practice settings for these nurses included inpatient acute care and various outpatient/community health settings. Several themes describe the nature of the participants' practice: management of patient care, interwoven partnerships, leadership, and practice values. Major themes relating to the contribution of doctoral education to practice were abilities gained and changes in image and status. The findings of this study demonstrate that doctorally prepared nurses are actively involved in nursing practice by affecting patient outcomes, promoting cost-effective care, and using clinical research.

The purpose of this research multiple case study was to determine case management roles as demonstrated by four clinicians employed at a university medical center. Multiple sources of evidence were used to collect data, including interviews, nonparticipant observations, and chart audits. Case management was defined by the clinicians as a process for delivery of health care at the institution studied. Despite a lack of a uniform framework for case management practice, the clinicians used similar case management components. Chart audits demonstrated deficits and inconsistency in documentation that were supported by interview and observations. It was recommended that exposure to formal case management models and theory could strengthen clinical practice in this area. Additionally, investigation of factors that facilitate and/or impede consistent documentation of interventions and patient outcomes, particularly by CNSs is recommended.

A single case study design was used to explore the nursing process and intervention related to discharge preparation of one family with a child requiring complex care at home. Helping methods described by Orem were used to categorize identified nursing interventions. Discharge readiness was assessed to verify consideration of conditions for discharge. The major study question was "How is discharge preparation conducted?" Collected data provided evidence to support each of three case study propositions: (1) patients and their home caregivers are involved in discharge preparation as planners and as learners, (2) nursing interventions occur in five major helping areas as outlined by Orem, (3) discharge preparation addresses each component of discharge readiness. The case study design was effective as an approach to explore nursing interventions, verify considerations of discharge conditions, and refine the concept of discharge readiness. A decision trail is presented for nurses to replicate the process with questions related to their practice.