Page 100 - Encyclopedia of Nursing Research

CLInICAL TRIALS n 67

patient encounter time to health promotion to improve the delivery of clinical preventive
(Courtney & Rice, 1997). Given the empha- services among clinicians, once again inclu-
sis on health promotion and disease preven- sive of nPs, have been developed empirically C
tion in nP clinical practice, little research rather than being based on a sound theoret-
has occurred since 1992 regarding nP per- ical understanding of underlying cognitive
formance in these areas of clinical preven- processes that may influence the extent to
tion. Since 1992, pressure on nPs to see which clinicians deliver clinical preventive
more patients in a given amount of time has services to their patients. Examining the
increased, and there may be a gap between variables that may influence nurses’ deliv-
what nPs believe to be the ideal and what is ery of clinical preventive services based on
actually practiced (Birkholz & viens, 2001). theory has the potential to inform the design
Although physician adherence to clini- of theory-based interventions to improve the
cal preventive services guidelines has been delivery rates among the patient populations
found to be uneven (Finney Rutten et al., nPs typically serve, the diverse and chron-
2004; Gottlieb et al., 2001; Kiefe et al., 2001; ically underserved populations such as the
Lopez-de-Munain et al., 2001; Ma et al., 2004; elderly, the poor, and those in rural areas.
natarajan & nietert, 2003; nelson et al., 2002;
Solberg et al., 2001; Stange et al., 2000; USPSTF, Cynthia G. Ayres
2000), nPs and their adherence to guidelines
have not been as closely examined. Studies
that have specifically examined nPs to gain
a better understanding of their delivery CliniCal trials
of clinical preventive services are few and
far between. Furthermore, there has been
very little research conducted to assess the A clinical trial is a prospective controlled
knowledge and behaviors specific to nPs experiment with patients. There are many
in the area of delivering clinical preven- types of clinical trials, ranging from studies
tive service based on USPSTF guidelines. to prevent, detect, diagnose, control, and treat
Additionally, the nPs’ attitudes, beliefs, and health problems to studies of the psycholog-
behaviors about preventive care activities ical impact of a health problem and ways to
have not been fully examined using a theo- improve people’s health, comfort, function-
retical framework from which effective, the- ing, and quality of life.
ory-based interventions could be developed The universe of clinical trials is divided
and tested. differently by different scientists. Clinical
Although the goal to improve the deliv- trials are often grouped into two major clas-
ery of clinical preventive services in primary sifications, randomized and nonrandom-
care is undisputed, progress in this area is ized studies. A randomized trial is defined
slow. Studies that have examined primary as an experiment in which therapies under
care practice to improve the delivery of clin- investigation are allocated by a chance mech-
ical preventive services have included nPs anism. Randomized clinical trials are com-
under an umbrella term of “clinicians” dom- parative experiments that investigate two
inated by physicians and examined under or more therapies. nonrandomized clinical
a medical practice model. However, nurses, trials usually involve only one therapy, on
particularly nPs, by virtue of their nursing which information is collected prospectively
philosophy and education as well as their and the results compared with historical
scope of practice, may be unique in their data. Comparing prospective data with his-
attitudes, beliefs, and behaviors about pre- torical control data introduces biases from
ventive care. Moreover, strategies designed many sources. These potential biases are