| The purpose of this study was to identify and operationalize EverCare Nurse Practitioner (NP) practice activities and to examine the similarities and differences in the performance and frequency of performance of EverCare NP practice activities across five demonstration sites. The study was guided by the Conceptual Model of Nursing and Health Policy (Fawcett & Russell, 2001), Ryan's (1999) conceptualization of the EverCare NP roles, and the research literature on NP roles and practice activities. One hundred thirty-one EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) activities were identified through telephone interviews (N = 11), participant observation (N = 5), and a focus group (N = 4). Two content validity tests (N = 11; N = 15) (CVI ≥ .78 for all retained items) and internal consistency reliability testing (N = 127; Cronbach's alpha = .78--.96) yielded 99 activities arranged in six role subscales---Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator.; Analysis of ENPRAS responses from 127 EverCare NPs revealed that EverCare NPs spent more time on Clinician and Communicator/Cheerleader role activities than on activities associated with the other roles. Considerable consistency in performance of NP activities across the five demonstration sites was noted, with significant differences across sites only in the amount of time spent on the Collaborator and Coach/Educator roles. A positive relation was found between EverCare NP patient caseload and frequency of performance of the Clinician and Care Manager/Coordinator roles. Studies are needed to examine the effect of such variations on resident-specific and site-specific outcomes.; The results of the study indicate that EverCare NPs provide proactive primary care to long stay nursing home residents. Policy makers, health care providers, and the public should consider the findings of this study when considering a national model of care for this population. |
