Page 357 - Encyclopedia of Nursing Research

324 n NuRSe-LeD GROuP CLINIC vISITS

the variety of settings in which nurses work, self-management of their identified prob-
ascertaining other antecedents of nurse lems (Watts et al., 2009). Physicians involved
N engagement, and establishing interventions in shared group clinic visits spend signif-
to promote nurse engagement warrant fur- icantly less time (up to 65% less time) with
ther investigation. examination of the rela- patients than they do when seeing the same
tionship between nurse engagement and number of patients in individual clinic vis-
patient outcomes is also justified. its. Notably, patients in group clinic visits
In summary, engaged nurses are those had up to 35% longer face-to-face interaction
with a positive and satisfying emotional state with the multidisciplinary health care team
while working that is characterized by vigor, providers than did those in individual clinic
dedication, and absorption. Nurse engage- appointments (Bagley, 2000). The nurse-led
ment is positively associated with existential group clinic visits model enhances patients’
fulfillment, self-transcendence, job satisfac- level of engagement in collaborative care
tion, and empowerment and is negatively by providing extensive patient education
associated with increased workload, turnover and self-management guidance, promoting
cognitions, and job search behavior. Health patients’ interaction, promoting social sup-
care and nursing administrators could ben- port, sharing problem-solving strategies, and
efit from attention to these findings. In addi- reducing health care costs (Jaber, Braksmajer,
tion, nurse engagement should be considered & Trilling, 2006). Thus, the group clinic visits
a worthy topic for further exploration. may benefit patients with chronic illnesses
that require frequent follow-up and contin-
Beth Palmer uous self-management education due to the
complexity of chronic illness care.
At group clinic visits led by an APN,
patients can be actively involved in prob-
Nurse-led group lem solving to overcome common barri-
ers, such as modifying dietary choices,
cliNic visits improving adherence to medications, and
timely reporting of symptoms (Harrison
et al., 2002; Kasper et al., 2002; O’Connor,
Group clinic visits are defined as clinic- 2001). One recent pilot group clinic visit
visits-shared appointments with more than for patients with heart failure (HF) found
one patient, all facing the same common improvement of patients’ HF knowledge at 8
medical conditions. The nurse-led group weeks’ follow-up after the group clinic visit
clinic visits model is focused on patient self- (yehle, Sands, Rhynders, & Newton, 2009).
management and education aimed at improv- Another study reported improvement in
ing health care services access, improving patients’ depression and self-care manage-
interactive patient-to-patient and patient-to- ment index score at 6 months, and there was
provider discussion, and promoting patient a 20% increase in the use of prescribed med-
satisfaction (Bartley & Haney, 2010; Watts ications (Lin, Cavendish, Boren, Ofstad, &
et al., 2009). The role of the advanced prac- Seidensticker, 2008).
tice nurse (APN) in the group clinics includes Group clinic visit methods of health
providing physical examinations, managing care delivery are now being widely pro-
polypharmacy or other treatment-related moted by the American Academy of Family
issues, and integrating care across multiple Physicians, as part of their Practice 2010
providers. In some clinics, the APN facili- initiative and by the American College of
tates multidisciplinary health professionals’ Physicians’ Innovations for practice manage-
group discussions with patients to address ment (American College of Physicians, 2005;