• Carrie A McAiney, Dilys Haughton, Jane Jennings, Dave Farr, Loretta Hillier, and Pat Morden.
• Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Hamilton Family Health Team and Geriatric Psychiatry Service, St. Joseph's Healthcare Hamilton, CMHS, Hamilton, Ontario, Canada. mcaineyc@mcmaster.ca
• J Adv Nurs. 2008 Jun 1; 62 (5): 562-71.

AimThis paper is a report of a study examining a practice model for Nurse Practitioners (NPs) working in long-term care (LTC) homes and its impact on staff confidence, preventing hospital admission, and promoting early hospital discharge.BackgroundThe recent introduction of NPs in LTC homes in Ontario, Canada, provided an opportunity to explore unique practice models. In a pilot project, two full-time equivalent NPs provided primary care to a consortium of 22 homes serving approximately 2900 residents. The practice model was based on the specific needs of the homes and residents.MethodsThe NPs working in this project prospectively collected data (from July 2003 until June 2004) on their clinical activities and resident outcomes. Directors of Care (n = 18) of the participating homes completed a questionnaire (March 2004) assessing the impact on prevention of hospitalization and staff confidence.FindingsThe NPs had 2315 clinical contacts in the 1-year period; the majority (64%) were follow-up contacts. Many contacts were for uncomplicated medical problems or more complex but straightforward medical issues, and had positive outcomes. Hospital admission was prevented in 39-43% of cases. NPs had a positive impact on improving staff confidence, but no impact on facilitating early discharge from hospital.ConclusionPractice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.

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