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This final report discusses activities and outcomes of "Caring for Infants and Toddlers with Disabilities: A Continuing Education Program for Nurses (CFIT Nurses)," a Virginia program designed to develop and implement a model of training to ensure that nurse practitioners and registered nurses have the information and skills needed to be full participants in community-based early intervention systems of services for infants and toddlers with disabilities and their families. Working with a State Leadership Planning Group of key stakeholders, CFIT Nurse developed a model of training that combines an introductory seminar with independent study. The curriculum includes information related to the nurses role in child find, evaluation and assessment, Individualized Family Service Plan (IFSP) development, IFSP implementation and service coordination, and transition. The introductory seminar uses an interdisciplinary panel to present information about the early intervention system, share family stories, and present strategies nurses can use to increase their early intervention involvement. A comprehensive 400-page manual that includes 3 audiotapes, practice activities, supplementary readings, and state and national resources supports the independent study. The training was field-tested with 284 participants. Nurses made significant gains in knowledge and competency and were highly satisfied with project materials. Appendices include curriculum materials. (Contains 27 references.) (Author/CR)

The progression of qualified surgical nurses toward capable proficiency was examined in an ethnographic study during which 25 nurses, including 4 who transferred to other wards, were observed to determine whether social mediation affects the process of proficiency development. The nurses were observed for 18 months. Data were also gathered through invited observations of episodes of skilled behavior during which sequences of digital photographs of the nurse practitioners' actions were taken and knowledge maps linking scientific knowledge to nursing tasks and processes were sketched. After the observations, the nurse practitioners shared their reactions to the photographs and knowledge maps in post-observation interviews. The following were among the key findings: (1) the cognitive capacity for multiple representations of knowledge use enables engagement in the changing array of patient problems and the provision of solutions; (2) capable practitioners create and sustain their performance through strategies for emotional control that are transmitted directly to patients; (3) postqualifying newcomers are less able to project the practical implications of deliberative practice; and (4) collaborative working accelerates newcomer recognition of significant clinical signs during routine working, thereby giving newcomers access to distributed knowledge within settings characterized by a skill mix algorithm of 60% health care assistants to 40% qualified nurses. (Contains 18 references.) (MN)

The Visiting Clinician Program (VCP) was established in 1996 at a public medical school to provide individualized continuing education to participants and to foster closer ties between academic health center faculty and community practitioners who serve as preceptors for health professions students. Various methods have been used to evaluate the program, with focuses on program implementation and processes and program outcomes for participants. Specific sources of data were program management systems, end-of-day surveys of visiting clinicians, periodic interviews with visiting clinicians, follow-up surveys of clinicians who have completed the program, and surveys of faculty hosts. Findings indicated the following: (1) the program enrolled 103 clinicians; (2) visiting clinicians identified 139 specific learning needs, the most frequently identified areas being diabetes, cardiology, pain, adult obesity, sports medicine, dermatology, and computing in medical practice; (3) the program had financial and political costs and constraints; (4) administrative aspects of the program were satisfactory both for visiting clinicians and host faculty; (5) program participants engaged in 587 half- or full-day sessions in 116 different areas since the program began and earned 2,884 hours of continuing medical education credit; and (6) the program appeared to be a vehicle for building and strengthening collegial relationships between program participants and the faculty members who host them. (YLB)

Surveys were mailed to all nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives (CNMs) registered in California, asking questions about education, labor force participation, specialty, and location and type of practice site, as well as the demographic characteristics of these professionals and their patients. Response rates for each of the three professions (66 percent of 7,341 NPs, 57 percent of 2,938 PAs, and 70 percent of 859 CNMs) were sufficient to provide a broad overview of these professions at the state level but insufficient for analysis of supply in small geographic areas within the state. Major findings of the survey include the following: (1) the numbers of these professionals have grown dramatically over the past decade, with half of each profession completing education in the 1990s; (2) most of these medical care providers are practicing in their fields, and most spend most of their working hours providing direct patient care; (3) the majority of NPs, PAs, and CNMs provide primary care services in a wide variety of settings; (4) these providers care for large numbers of underserved persons; (5) most NPs, PAs, and CNMs are in their 40s and 50s, and most were educated in California; and (6) minority groups are underrepresented in all three professions. (Survey forms are included in this report.) (KC)

This report identifies issues in state financing of programs to train nurse practitioners and physician assistants and presents findings of a national survey of 51 such training programs. An introductory chapter gives the main arguments for increased use of nonphysician providers of primary health care; this is followed by a chapter on barriers to the development of such training programs, including costly tuition and faculty shortages. The third chapter details the way one state, Virginia, has addressed the issue of training nurse practitioners. Chapter 4 discusses issues for nurse practitioner education, including program expansion and budgetary pressures, and offers a comprehensive definition of the nurse practitioner role. In chapter 5 issues for physician assistant education are examined, including managing program expansion, graduate employment, and program budgetary pressures. A definition of the physician assistant role is included. The sixth chapter briefly describes the national survey in the context of state support for training programs. The survey's results are detailed in the seventh chapter. A concluding chapter notes that state financial support is important to the vast majority of training programs that receive it and that nurse practitioner programs are better supported than physician assistant programs. Appendices include the survey form and a listing of program respondents by state. (DB)

Utilizing the professional expertise of school nurses, the Des Moines (Iowa) Public School system is committed to providing professional health services and health education for students, employees, and the community in order to promote success in the learning process. The health services program is an integral part of the total school program in the Des Moines public schools. The program provides for direct health services, including appraisals and preventive and remedial aspects for students and staff. Health education and health promotion are provided through planned, correlated, incidental instruction, and integrated learning. Safety is provided for through review of the physical environment, which contributes to student success in the teaching and learning process. The health services program ensures direct service and ongoing collaboration with community agencies for students, staff, and parents to decrease barriers to learning. This paper provides an input evaluation, a process evaluation, and a product evaluation of the 1993-94 health services program. A Comprehensive School Health model recommended for districts by a health advisory committee is under review. (LL)

This publication reports the findings of an expert panel convened by the National Center for Nursing Research to address health promotion for older children and adolescents (ages 8 through 18), the role of nurses, and the contributions of nursing science. Three chapters focus on basic science, intervention, and application. Each chapter includes an introduction, a review of the state of the science, a discussion of research needs and opportunities, and a list of research recommendations based on the identified needs and opportunities. The first chapter, "Life Transitions in Late Childhood and Adolescence: Critical Points for Promoting Healthy Behavior," examines the effects of biological, cognitive, emotional, and social transitions on development and behavior. Chapter 2,"Approaches for Designing and Implementing Interventions," discusses basic concepts and principles of health promotion, types and features of successful interventions, and the effects of self- and health-related perceptions. The final chapter, "Strategies and Settings for Nursing Interventions," considers approaches for providing health promotion services to youth, and the use of traditional and nontraditional settings for health promotion. Bibliographical sketches of panel members are included. (Contains approximately 100 references.) (LL)

A study examined the effectiveness of existing nursing education programs to prepare individuals in the United Kingdom for employment as community specialist practitioners in the context of public health. The study was designed in three strands as follows: (1) a questionnaire-based source of 52 directors and leaders from community specialist programs; (2) a survey of 109 senior nurses across England; and (3) focus groups, interviews of 76 individuals, and document analyses to determine the relationship between education and practice. Community specialist practitioners did not generally see public health work as "core" work. Community specialist roles were in transition. Prior experience in community settings was deemed important in further learning about public health work. It was suggested that interdisciplinary learning be incorporated into curricula to provide a strong base for collaborative working and that developments in practice-based learning and assessment be transferred from other settings to address issues raised in relation to community specialist courses. (Contains 11 tables/figures and 69 references. The following are among the items appended: information on those interviewed; examples of public health practice in health visiting, district nursing, and practice nursing; standards outlined in the feasibility study on national standards for specialist practice in public health; and the questionnaires.) (MN)

The outcomes of advanced neonatal nurse practitioner (ANNP) programs in the United Kingdom were examined. The different programs of education currently available for nurses wishing to become ANNPs were compared, and the outcomes of ANNP programs, as demonstrated in the levels of performance of practitioners undertaking different programs, were evaluated. Parents' perceptions of the ANNP's role were explored, and the career intentions and attrition rates of those completing or undertaking specific ANNP programs were mapped. Data were collected through the following activities: analysis of documentary material and information for eight ANNP programs; self-completion questionnaires completed by 297 NNPs, NNP students, midwifery managers, and clinicians; semi-structured interviews with 20 NNPs and 12 parents; diary checklists completed by 68 NNPs and 25 senior house officers; and observations of 30 NNPs. The programs reviewed differed significantly from one another in the following respects: academic levels, qualifications, assessment strategies, and goals in terms of clinical practice. Nearly half the students stated that their educational programs had not adequately linked clinical practice with theory. The study established that comparable standards, validation documentation, and core curricula must be developed for NNP programs throughout the United Kingdom. (Contains 79 tables/figures and 71 references.) (MN)

A 32-item Computer Self-Efficacy Scale (CSE) was developed to measure perceptions of capability regarding specific computer-related knowledge and skills. Bandura's theory of self-efficacy (1986) and Schunk's model of classroom learning (1985) guided the development of the CSE. Each of the skill-related items is preceded by the phrase "I feel confident." A five-point Likert-style response format was used. Data from 414 subjects who were learning to use computers in three settings were used to conduct analyses for assessing the reliability and construct validity of the instrument. The subjects included graduate students, adult vocational students, and nurses. Data were collected on beginning level self-efficacy, advanced level self-efficacy, mainframe self-efficacy, and willingness to exert effort. A principal factor analysis with oblique rotation produced a conceptually meaningful three-factor solution with high alpha reliabilities. Additional analyses provided some support for the theoretical propositions of self-efficacy, but suggested that the males and females in this study differed in judgments of their computer capability. Research using actual measures or observations of performance, effort expenditure, and persistence are needed to continue the exploration of the predictive validity of the three types of efficacy judgments generated by the CSE. Nine tables and one flowchart are included. (TJH)

Since the ultimate effectiveness of any health care encounter rests in the provider's ability to gain the compliance of his or her client toward the prescribed medical treatment, a study compared clients' perceptions of the compliance-gaining strategies of both physicians and nurse practitioners, and investigated whether these perceptions were mediated by clients' self-reported health locus of control, or by seriousness of illness. Subjects, 121 students at a large midwestern university who had visited the campus Student Health Center within the last 4 months, rated compliance-gaining strategies for both physicians and nurse practitioners across three health care scenarios. The three scenarios represented the extremes and the median in subjects' severity of illness ratings of 10 health care scenarios. Results indicated that subjects perceived physicians more favorably than nurse practitioners in their use of the "request for feedback" strategy across all three health care scenarios. Nurse practitioners were perceived more favorably than physicians in their use of the "reassurance and empathy" strategy in one of the three scenarios. Perceptions of physician and nurse practitioner use of the remaining four strategies did not differ significantly. In addition, self-reported locus of control did not discriminate subjects' perceptions of health care provider, compliance-gaining strategy, or severity of illness. (Nine tables of data are included; 47 references and three appendixes--containing a list of compliance-gaining strategies, a health locus of control scale, and the 10 medical scenarios--conclude the study.) (SR)

This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and (3) the effects of changing the payment method on the health care costs of patients, third-party payers, and society. Chapter 1 summarizes the case study and defines and describes NPs, PAs, and CNMs. Chapter 2 reviews studies comparing the care provided by these practitioners with that provided by physicians as well as studies that gauge patients' satisfaction with physicians' acceptance of the care provided by these three groups. Chapter 3 considers access to health care; and chapter 4 focuses on productivity, costs, and employment. Chapter 5 analyzes the implications of various payment modifications for the employment and practice of NPs, PAs, and CNMs and for health care costs; examines the effects new developments could have on the three groups; and assesses how payment modifications might influence the roles of these practitioners and the costs of health care. Appendixes describe the methodology of the study, provide a detailed description of payment for services by third-party payers in the public and private sectors, and list 268 references. (KC)

A model program to educate primary care nurse-practitioners for rural areas illustrates successful collaboration between university and rural health settings. Part of the Intercampus Graduate Studies program of the University of California--San Francisco School of Nursing and the University of California--San Diego School of Medicine, the model reflects concern with family health care needs in rural San Diego County. During its first year, Academic Year 85-86, the program established student preceptorships in two rural community health clinics. The university offers didactic content for preparation of the Family Nurse-Practitioner/Nurse-Midwife through its curricular program, selects students for preceptorship placement, provides faculty orientation/development for community/clinical preceptors, provides academic faculty member site visits, and conducts program evaluation. The community health center provides resources/facilities for patient care including preceptor supervision of students and ancillary personnel/supplies and collaborates in program planning/evaluation and preceptor development. The Clinical Preceptor shares patient care sessions with a student, incorporating material specific to rural health. The model demonstrates feasibility of "town/gown" collaboration, promotes job selection based on realities of rural settings, and increases rural community visibility to the university community. Feasibility study results and a map and organization chart of the California Area Health Education Centers systems are included. (LFL)