The Association of Self-esteem With Caregiving Demands, Coping, Burden, and Health Among Caregivers of Breast Cancer Patients: A Structural Equation Modeling Approach.

BACKGROUND: We investigated how caregiver self-esteem was associated with caregiving demands, coping, burden, and health. OBJECTIVE: The aim of this study was to investigate how caregiver self-esteem is associated with caregiving demands, coping, burden, and health. METHODS: Sixty-one caregivers of breast cancer patients were selected from a study conducted at a cancer clinic in the Southeastern region of the United States. Guided by the revised Stress and Coping Theory, a secondary analysis of cross-sectional data was conducted. We used structural equation modeling to analyze paths between caregiver self-esteem and caregiving demands (ie, hours spent on caregiving), coping, burden, and health. RESULTS: Caregivers who effectively coped with stressful situations through strategies such as positive thinking, seeking social support, and problem solving were more likely to have higher levels of self-esteem; in turn, higher levels of self-esteem decreased caregiver burden and improved caregiver overall health. CONCLUSIONS: This study highlights the importance of self-esteem among caregivers of breast cancer patients. Additional research is needed to provide more insight into the influence of coping strategies on caregiver self-esteem, as well as the role of caregiver self-esteem on caregivers' and patients' well-being. IMPLICATION FOR PRACTICE: Healthcare providers need to consider caregiver self-esteem and other associated caregiver characteristics to identify caregivers at risk of higher perceived levels of burden and poor overall health.

Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?

OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models. RESULTS: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having ~$500-$700 less health care costs per patient per year (P<0.0001). CONCLUSIONS: Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150-190 million dollars in 2013.

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients.

Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.

Research productivity following nursing research initiative grants.

BACKGROUND: In 1995, VA's Office of Research and Development launched the Nursing Research Initiative (NRI), to encourage nurses to apply for research funding and to increase the role of nurse investigators in the VA's research mission. This program provides novice nurse researchers the opportunity to further develop their research skills with the guidance of a mentor. PURPOSE: Since the NRI's inception, its impact on the research career trajectory of budding nurse researchers had never been fully explored. METHODS: An electronic quality improvement survey was developed to collect information about the scope of work and research trajectory of VA nurse researchers undertaken since they received NRI funding. FINDINGS: NRI awardees demonstrated research productivity in several areas including research funding, peer-reviewed publications; participation on journal editorial boards and grant review committees; and mentorship. The majority of past NRI grant recipients (78%) have maintained employment within the VA system and benefit from the expertise, mentoring, and support of other nurse researchers. NRI grant recipients confirm the value of the VA NRI mentored grant funding mechanism and its association with a productive research trajectory with survey respondents demonstrating an average return on investment of $7.7 million in research funding per person. CONCLUSION: The experiences derived from the NRI accelerated the professional growth and research productivity of this group and it guided future opportunities to design, implement, and test nurse-led interventions.

Assessment of Research Capacity Among Nursing Faculty in a Clinical Intensive University in The Philippines.

BACKGROUND: Many nursing studies are conducted in the United States, Europe, and Australia, where only a fourth of the world's population resides. There is a need to promote nursing research in Asia to enhance the contextual relevance of their evidence-based nursing interventions. A first step toward this goal is to determine the perceived research capacity among nursing faculty in academic settings in the Philippines. METHODS: This study described the perceived research capacity among nursing faculty of the University of Santo Tomas - College of Nursing, Manila, Philippines. The study used a survey that contained four sections: subject demographics; knowledge and skill on research designs and research process; research involvement, services, and incentives; and factors affecting research involvement. Chi-square test of homogeneity and MANOVA analyzed the gathered data. RESULTS: Findings showed that the faculty perceived themselves as knowledgeable and skillful in conducting research. However, current teaching assignments hindered their capacity to conduct research. University-sponsored incentives and college-based research services had also remained underutilized despite their availability. Overall, heavy teaching load was the greatest hindrance to research endeavors. CONCLUSION: Actions must be taken to reconfigure effort allocations with careful consideration of existing university and institutional bylaws.

Chronic care management for the elderly: an opportunity for gerontological nurse practitioners.

PURPOSE: To discuss the role that gerontological nurse practitioners (GNPs) may play in providing chronic care management for the elderly. DATA SOURCES: Review of recent literature on chronic care management, personal experience of the authors in caring for older adults under the chronic care management model, and a case study. CONCLUSIONS: GNPs are the most appropriate practitioners to provide and coordinate chronic care management to the population that needs it most--the elderly. IMPLICATIONS FOR PRACTICE: Demographic shifts in the United States have increased the number of people with chronic illnesses; however, the nation's healthcare delivery system has not significantly evolved to meet the changing needs of its population. As a result, many people, especially older adults, suffer needlessly, and healthcare costs continue to rise. Chronic care management may alleviate older adults' chronic health problems, reduce expenditures for their health care, and promote their satisfaction and quality of life.