Abstract
Dr Dorothy Brooten and her colleagues have been widely recognized for their impact on advanced practice nursing through their studies of affect of advanced practice nurses (APNs) on both quality and cost of care. Their work has been cited as an outstanding example of testing an innovative model of healthcare delivery. They developed and tested a model of transitional nursing care in which APNs provide direct patient care both before and after discharge. The following article describes the functions of clinical nurse specialists (CNSs) in the first test of the model, which was with very low birthweight infants (VLBWs), and funded by the Robert Wood Johnson (RWJ) Foundation.
The VLBW study was followed by a Program Grant funded by the National Institute for Nursing Research (NINR) that supported 3 studies: women undergoing unplanned cesarean sections and their infants, high-risk pregnant women and their infants, and women after hysterectomy surgery.
Brooten and her colleagues recognized the need to test models for care and to include measures of cost, as well as other patient outcomes. Their work has demonstrated time and again that improved quality in relation to patient outcomes and decreased cost are associated with the interventions of APNs.
Given the financial constraints that exist currently, there is even more reason to continue to test outcomes related to APN practice. Thanks to Brooten, we have a body of work related to transitional nursing care. What we need are studies related to other aspects of APN practice.
Barbara Hazard Munro, PhD, RN, FAAN
Various studies have been conducted which explore the different functions of the clinical nurse specialist (CNS). This study details the functions of CNSs providing direct patient care before and following hospital discharge of very low birthweight infants and effect on patient outcome. The study reports on CNS interactions with 36 families whose infants were discharged early from the hospital, and who received discharge planning, teaching, and home followup for 18 months.