Date of Award

2006-07-01

Degree Name

PhD Nursing

Dissertation Committee

Patricia A. Roth, EdD, RN, Chairperson; Diane C. Hatton, DNSc, RN, APRN, BC; Ann M. Mayo, DNSc, RN, CNS

Keywords

clinical innovations, Nurse Practitioners, nursing, patients

Abstract

Adoption of clinical innovations by Nurse Practitioners (NP) is a complex phenomenon, rooted in personal values and influenced by challenges within health care environments. When clinical innovations are adopted or rejected by NPs, this decision has meaning for patients, NPs, health care agencies, and society. The decision controls the opportunity for patients to access a clinical innovation that could reduce morbidity and mortality, save money, and provide satisfaction related to the health care encounter. The purpose of the study was to increase knowledge about NP adoption of clinical innovations, particularly emotionally-laden clinical innovations. The lines of inquiry focused on what clinical innovations were thought by NPs to be emotionally-laden, whether the NPs adopted or rejected the emotionally-laden clinical innovation, the reasoning behind their decisions, and an examination of how they were involved in providing information or treatment to patients related to the innovation. A qualitative approach using grounded theory methodology was chosen. Sixteen nurse practitioner participants, practicing in adult primary care settings, were individually interviewed. Data analysis was accomplished using the constant comparative method, with an audit trail and expert review. Analysis generated a grounded theory. Philosophy of Care (context) involved the development of an individual philosophy of care and included patient choice, equal treatment, provision of information, and advocacy. Work Environment (conditions) involved aspects of the NP's work environment and included work setting, economics, time, power and role, and co-workers. Innovation Adoption (process) included the aspects of discovery, evaluation, and actual adoption or rejection of the innovation. Doing the Right Thing was a sub theme of the process. The Adoption Spectrum showed that innovation adoption could be consistent, intermittent, or conditional. Innovation rejection could be overt or covert. Values Continuum: Congruence to Dissonance (consequences) involved aspects of being at risk, being ambivalent, and being satisfied. Congruence occurred when NP personal and professional values were in agreement with the perspectives of the patient and agency; dissonance occurred when values were in conflict. Support of timely and appropriate adoption of clinical knowledge benefits society. A sophisticated understanding of how new knowledge is incorporated or rejected by NPs is a prerequisite to the intelligent development of nursing research and education.

Document Type

Dissertation: Open Access

Department

Nursing

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Included in

Nursing Commons

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