Connie M Ulrich1, Qiuping Pearl Zhou2, Alexandra Hanlon3, Marion Danis4, Christine Grady4. 1. University of Pennsylvania School of Nursing, Department of Medical Ethics and Health Policy, and New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA 19104, USA. Electronic address: culrich@nursing.upenn.edu. 2. George Washington University, Ashburn, Virginia, VA 20147, USA. 3. University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA. 4. Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
Abstract
PURPOSE: Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. METHODS: This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. RESULTS: Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. CONCLUSIONS: Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care.
PURPOSE: Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. METHODS: This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. RESULTS: Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. CONCLUSIONS: Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care.
Authors: E S Williams; T R Konrad; M Linzer; J McMurray; D E Pathman; M Gerrity; M D Schwartz; W E Scheckler; J Van Kirk; E Rhodes; J Douglas Journal: Med Care Date: 1999-11 Impact factor: 2.983
Authors: Ezekiel Emanuel; Neera Tanden; Stuart Altman; Scott Armstrong; Donald Berwick; François de Brantes; Maura Calsyn; Michael Chernew; John Colmers; David Cutler; Tom Daschle; Paul Egerman; Bob Kocher; Arnold Milstein; Emily Oshima Lee; John D Podesta; Uwe Reinhardt; Meredith Rosenthal; Joshua Sharfstein; Stephen Shortell; Andrew Stern; Peter R Orszag; Topher Spiro Journal: N Engl J Med Date: 2012-08-01 Impact factor: 91.245
Authors: Connie M Ulrich; Marion Danis; Sarah J Ratcliffe; Elizabeth Garrett-Mayer; Deloris Koziol; Karen L Soeken; Christine Grady Journal: Nurs Res Date: 2006 Nov-Dec Impact factor: 2.381