NURSE PRACTITIONER JUDGMENTS ABOUT INTERACTION AND PARTICIPATORY DECISION-MAKING IN PRIMARY CARE SETTINGS.

Persistent Link:
http://hdl.handle.net/10150/184244
Title:
NURSE PRACTITIONER JUDGMENTS ABOUT INTERACTION AND PARTICIPATORY DECISION-MAKING IN PRIMARY CARE SETTINGS.
Author:
Lamb, Gerri S.
Issue Date:
1987
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
The purpose of the study was to test a theoretical model explaining nurse practitioner judgments about the amount of interaction and participatory decision-making between nurse practitioners and physicians. The specific aims of the study included: (1) to examine the influence of nurse practitioner perceptions of care complexity and expected benefit-cost ratio of physician involvement on interaction and participatory decision-making; (2) to test a theory that integrates two alternative explanations of amount of interaction and participatory decision-making derived from social exchange theory and technology theory; and (3) to investigate the effect of practice rules on the relationships in the theoretical model. The study used a mathematical correlational design with a causal modeling methodology for model testing. A convenience sample of 38 nurse practitioners participated. Major concepts in the model were measured using a four scale magnitude estimation instrument developed for the study. The instrument consisted of operational definitions for each of the concepts and a set of 18 clinical situations scaled according to care complexity. Psychometric properties of the instrument including stability, internal consistency, content and construct validity were estimated. Matching of responses across two modalities was used to validate the production of ratio level data. Multiple regression techniques were used for theoretical model testing. In the test of the theoretical model, both care complexity and expected benefit-cost ratio had a significant impact on the nurse practitioners' judgments about amount of interaction and participatory decision-making. Predictions derived from social exchange theory and technology theory were supported. The effect of practice rules on the relationships in the model could not be determined since the index of practice rules did not achieve an acceptable level of stability. Nurse practitioner judgments about interaction and participatory decision-making were influenced by perceptions of care complexity and expectations of the benefits and costs of interaction with a specific physician. An understanding of the factors that affect nurse practitioner judgments about interaction and participatory decision-making may be used to guide interventions that enhance the fit between these structures and outcomes of care.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Nurse practitioners.; Nurse-physician joint practice.; Nurse and physician.; Health care teams.; Decision making.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Nursing; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Hinshaw, Ada Sue
Committee Chair:
Hinshaw, Ada Sue

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleNURSE PRACTITIONER JUDGMENTS ABOUT INTERACTION AND PARTICIPATORY DECISION-MAKING IN PRIMARY CARE SETTINGS.en_US
dc.creatorLamb, Gerri S.en_US
dc.contributor.authorLamb, Gerri S.en_US
dc.date.issued1987en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThe purpose of the study was to test a theoretical model explaining nurse practitioner judgments about the amount of interaction and participatory decision-making between nurse practitioners and physicians. The specific aims of the study included: (1) to examine the influence of nurse practitioner perceptions of care complexity and expected benefit-cost ratio of physician involvement on interaction and participatory decision-making; (2) to test a theory that integrates two alternative explanations of amount of interaction and participatory decision-making derived from social exchange theory and technology theory; and (3) to investigate the effect of practice rules on the relationships in the theoretical model. The study used a mathematical correlational design with a causal modeling methodology for model testing. A convenience sample of 38 nurse practitioners participated. Major concepts in the model were measured using a four scale magnitude estimation instrument developed for the study. The instrument consisted of operational definitions for each of the concepts and a set of 18 clinical situations scaled according to care complexity. Psychometric properties of the instrument including stability, internal consistency, content and construct validity were estimated. Matching of responses across two modalities was used to validate the production of ratio level data. Multiple regression techniques were used for theoretical model testing. In the test of the theoretical model, both care complexity and expected benefit-cost ratio had a significant impact on the nurse practitioners' judgments about amount of interaction and participatory decision-making. Predictions derived from social exchange theory and technology theory were supported. The effect of practice rules on the relationships in the model could not be determined since the index of practice rules did not achieve an acceptable level of stability. Nurse practitioner judgments about interaction and participatory decision-making were influenced by perceptions of care complexity and expectations of the benefits and costs of interaction with a specific physician. An understanding of the factors that affect nurse practitioner judgments about interaction and participatory decision-making may be used to guide interventions that enhance the fit between these structures and outcomes of care.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectNurse practitioners.en_US
dc.subjectNurse-physician joint practice.en_US
dc.subjectNurse and physician.en_US
dc.subjectHealth care teams.en_US
dc.subjectDecision making.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineNursingen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorHinshaw, Ada Sueen_US
dc.contributor.chairHinshaw, Ada Sueen_US
dc.contributor.committeememberAtwood, Jan R.en_US
dc.contributor.committeememberPhillips, Lindaen_US
dc.identifier.proquest8803261en_US
dc.identifier.oclc700047665en_US
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