Nurses, especially as they grow into an advanced practice role, use physiological theory in many varied ways, from predicting short- and long-term disease processes to predicting outcomes of prescription medication and other therapies. The nurse is cautioned to use a mindset that is open to diverse frameworks and evaluate research that tests physiological phenomena and its application to clinical practice, thereby assisting the patient in attaining optimum wellness. This chapter reviews a selection of physiological theories that may be used by nurses, especially those in advanced practice roles. It helps introducing the nurse to a broad scope of physiological frameworks that can be used to guide nursing care and enhance the wellness possibilities for patients. The physiological frameworks discussed include: genetic and genomic frameworks; disease causation frameworks; immunological frameworks; motor and skeletal stress frameworks; frameworks for understanding pain mechanisms; and sleep disturbance and fatigue frameworks.

This chapter explores the experiential process of parents as they promote health for their overweight or obese child. It provides nursing knowledge for future studies specific to the needs of parents and their children during their search for guidance, intervention, and support. The chapter then guides health promotion strategies that may address the escalating and burdensome health care costs associated with obesity and obesity-related disease. A grounded theory approach provided the methodology for understanding the complex, dynamic process specific to health promotion by parents within the context of their world. Consistent with grounded theory methodology, data were continually coded and analyzed beginning with the onset of data collection. During axial coding, the data are analyzed for structure and process. The chapter presents an abbreviated discussion of the theoretical model, the pathway to making change, its concepts, processes, relationships, and contextual conditions.

The research literature on outcomes of advanced practice registered nurses (APRNs) and specifically nurse practitioners (NPs) has highlighted that in primary and urgent care settings, NPs provide care of equivalent quality. An evidence brief from the Veterans Affair's Quality Enhancement Research Initiative's Evidence-based Synthesis Program identified that there was no difference in health status, quality or life, mortality, or hospitalizations favoring either APRN or physician care. This chapter provides a practical framework that ambulatory care NPs can use in implementing outcome measurement in their practices. It reviews the purpose and importance of measuring and documenting outcomes of individual NP practices and summarizes some of the literature on NP outcomes. The chapter describes the categories and examples of outcome measures relevant to ambulatory NPs, and discusses practical considerations for selecting outcomes and a measurement approach. It provides examples of how to approach outcome measurement in practice.

This chapter begins with an overview of evidence-based practice (EBP) including generally accepted definitions, central tenets, barriers and facilitators, and trends over time. Additionally, it explores an overview of the necessary underlying components of EBP, these being the actual providers of EBP and the competencies required of EBP providers, specifically advanced practice registered nurses (APRNs). Additionally, the expectations and responsibilities of the doctorate of nursing practice (DNP), APRNs, and other advanced nursing practice specialties are included in the EBP competencies with leading initiatives to improve health outcomes. Multiple definitions of EBP have been proposed and have evolved over the years. One of the most common definitions of EBP in use today was derived from an initial proposal for evidence-based medicine by Sackett et al. Regardless of profession or country of practice, much has been written over the past 20-plus years.

The doctorate of nursing practice (DNP) degree, as the highest level of formal education for advanced nursing practice, presents a distinct opportunity to advance nursing knowledge. The evolution of the DNP degree has occurred within the context of burgeoning knowledge, changes in health care delivery, escalating demands of chronic illness care, diverse patient populations, and globalization. DNP-prepared nurses will have opportunities to transcend current barriers and affirmatively impact health care while bridging research and practice. A fundamental learning experience to equip nurses for these opportunities is the DNP project. The DNP project demonstrates synthesis of coursework, methods of inquiry, and practice in attaining The Essentials of Doctoral Education for Advanced Practice Nursing (American Association of College of Nursing [AACN], 2006). This chapter presents ideas to guide use of the DNP project as well as to sharpen thinking behind this innovative form of scholarly inquiry.

The impact Doctor of Nursing Practice (DNP)-prepared nurses have on patient, health care, and policy outcomes is becoming more evident as the numbers of DNP graduates increase and studies analyzing these outcomes become more prevalent. DNP prepared nurses are equipped to design and evaluate innovative patient care models, evaluate cost effectiveness of patient care strategies and influence health policies at various levels. The number of nurses obtaining the DNP degree continues to grow, and recommendations have been made to make the degree required for advanced practice by 2025. This chapter presents an overview of the DNP degree and reviews the outcome literature related to DNP practice. It helps the reader to examine the current research available related to DNP outcomes, explore rationale for the limited numbers of studies of DNP-related outcomes, and to identify areas for future research related to DNP outcomes.

Changes in the health care landscape are emphasizing the need for providers to demonstrate outcomes. Government regulatory agencies, insurance companies, institutional administrators and consumers expect high-quality patient care outcomes at the individual and aggregate levels in order to improve overall health and reduce fiscal waste. This chapter describes a number of different methods and outcome measures that might be used to evaluate an advanced practice registered nurse’s (APRN’s) contributions to quality patient care. Examples of actual APRN outcome projects illustrate the methods and demonstrate the importance of determining appropriate outcome data for measurement. The chapter helps readers to discuss reasons why measuring outcomes of APRNs is essential to the role of the APRN outcomes, identify at least three outcome measure categories that can be influenced by an APRN, discuss the benefits and pitfalls of using benchmark/aggregate data to measure APRN, and describe methods to measure and monitor APRN outcome data.

The pervasive problems of the nation’s healthcare system call for increasing numbers of advanced practice registered nurses (APRNs) prepared as highly proficient, competent providers and equipped with evidence-based knowledge and skills to improve the health of the population. APRNs are prepared to improve the health and outcomes of patient populations and/or delivery systems. This chapter describes four APRN-led initiatives implemented across diverse settings including acute care, long-term care, assisted living, and home care. These exemplars highlight how APRNs serve as change agents to improve processes and healthcare outcomes. Key strategies to promote successful change are evident across these exemplars including identifying the problem with data, using evidence-based approaches, collaborating with key stakeholders, and identifying evidence-based methods that were feasible within the specific setting. Moreover, these exemplars show that using collaborative teams promote high value care and positive outcomes for the populations served.

Scholarly inquiry historically has been housed in university settings with the main responsibility for research and other scholarly activities assigned to academicians (Schlotfeldt, 1992). However, clinical scholarship represents a perspective of scholarly inquiry that extends beyond the traditional practices of science. Understanding the historical context of clinical scholarship provides a foundation for discussing new ways to think about theory and knowledge development in nursing. This chapter focuses on clinical scholarship in nursing, including a historical look at movements related to scholarship. Drawing from these historical perspectives and contemporary events, the future of clinical scholarship, particularly in reference to advanced practice nurses, is presented. Reflecting on the evolution of clinical scholarship in nursing as well as reviewing the contemporary movements of evidence-based practice (EBP) and translational research may offer insights into ways that practicing nurses can be active participants in the development of nursing knowledge in the 21st century.