"Parents’ Intentions to Use Paediatric Nurse Practitioner Services" is an excellent example of a paper on care. The purpose of this research is an investigation of factors that influence the behavioural choice of parents to use a particular paediatric nurse practitioner in an emergency department. The sample consisted of one hundred twenty-eight parents whose children were first triaged by a staff nurse and then matched the inclusion criteria of the study. They were then approached by researchers and asked to participate. The criteria included parents who had children between one and sixteen years of age and also spoke English. The children also had to meet fast track criteria with only minor trauma. The data collection process included a questionnaire completed by one hundred parents who met the above conditions. The information recorded included demographic variable, a survey of the role responsibilities and tasks that parents would be satisfied to have a nurse practitioner provide versus a physician, and what the parent understood as the characteristics of the nurse practitioner role. The data was originally collected in 2002 and percentages were complied for the role responsibilities as well as the characteristics perceived. To preserve the patients right and confidentiality the hospital ethics review board approved the study.
A consent form was presented to parents detailing the purpose and intention of the study as well as the requirements of participation. Parents completed the questionnaire prior to being seen as undue influence may have occurred after the child’ s diagnosis. The researcher was available for any additional questions and clarification as needed. Regarding internal validity controls, a panel of three emergency care paediatricians determined the fast track criteria validity. Also, a panel of nurses who had experience with designs studies of this nature help to determine the validity of the questionnaire overall. Then Cronbach’ s alphas were calculated for each of the attributes of innovation used on the Nurse Practitioner Innovation Scale. The original study used an across-methods triangulated study and this particular paper uses the quantitative data gathered by that study. The study may have begun with a bias towards the fact that many studies have shown that NP’ s more than adequately perform care in emergency settings for non-urgent or minor emergency healthcare needs. The questionnaire itself was only reviewed by Doctors and nurses who may have not asked the same questions that the parents may have had concerning their care. The questions not asked may have been critical to assessing internal validity in this respect. Nurse practitioners are seen as a cost-effective sharing of duties to help enhance the level of care in an emergency room situation. The study appears to raise more questions than answers. For the most part, the public is ambiguous as to the actual role of NP’ s in general and while the study shows that they are comfortable with the level of care in most respects, some areas they feel are beyond the NP’ s expertise and require a doctor to handle and diagnose. They evaluated 12 criteria in this area and the findings range from 100% comfort level to 74% comfort level. The accuracy of the study can only be found in its results. The table provided gives details on each of the criteria listing the task of “ taking illness history” as universally accepted by all to the “ ordering and interpreting of X-rays” as being the most doubtful. So it would appear that the more perceived expertise required the less comfortable participants were with NP’ s. The value in this finding certainly promotes the idea of more information about NP’ s and their training be disseminated to the public. The original study used an across-methods triangulated study that was performed in 2002. The quantitative data that was gathered by that study was used in this research.
Regression analysis was used to understand the demographic data and percentages were compiled regarding the other data gathered.
The study used both descriptive and correlational methods to gather and analyse results. Demographic variables did not appear to play any significant influence regarding the data. The independent variables presented were the age of the child, symptom rating of a child by parents, previous knowledge of NP practice, demographics, and the five attributes of innovation. “ Logistic regression, calculated using SPSS statistical software version 11.0, was used to analyse the data, as the dependent variable was nominal and the independent variables were a combination of nominal and continuous data types. ” (Forgeron & Martin-Misener: 2005: 234) The instrument used was a self-report questionnaire containing four-parts.
1) a one-page fact sheet with a definition of an NP and type of care provided; 2) demographic data; 3) types of care parents would accept from an NP; and 4) was titled Paediatric Nurse Practitioner: Attributes of Innovation Scale, it used a 10-point Likert-type scale. The questions were designed to gather information as regards the NP as the innovation. The questionnaire had a 78% response rate which is considered exceptional since the mean response rate is usually 50%. However, some concern is needed concerning the validity and reliability of this instrument. As previously stated only doctors and nurse were used to evaluate the questions which may have limited their effectiveness. The authors also note that larger studies gathering data on actual use and not just intentional use is needed to qualify these indications. Overall the study shows the misperception and needs for further education to change behaviours regarding parental choices for NP emergency service. There are some threats to the external validity of the study. As noted, the public was not asked to provide an analysis of the instrument used in the research, hence their concerns may not have been adequately addressed. This could invalidate the external results going forward since the practical needs of the parents may not have adequately been addressed by the instrument used. The study does point out the concerns and comfort level presently experienced by parents choosing the services of a Nurse Practitioner.
This is an important step towards generalizability and will certainly compel future researchers to fine-tune the instrument as well as perform resultant research on actual choices made cornering the use of NPs in this setting.
ReferencesForgeron P. & Martin-Misener R. (2005) Parents’ intentions to use paediatric nurse practitioner services in an emergency department. Journal of Advanced Nursing 52(3), 231–238