Table of Contents
About the Authors iv
Contributors vi
Reviewers ix
Preface xi
Acknowledgments xv
Unit 1 Changing Landscape of Healthcare in the United States 1
1 Ambulatory Nursing: An Overview 3
History 3
Defining Ambulatory Care 5
Social, Economic, and Policy Influences 7
Ambulatory Nursing Roles: An Overview 8
Comparison: Ambulatory and Acute Care Nursing 12
Summary 15
2 Healthcare Delivery 18
The 19th Century 18
The 20th Century 19
The 21st Century 20
Care Delivery Models 26
Registered Nurse Roles in Ambulatory Care 32
Future of Ambulatory Care Nursing 36
3 Social, Economic, and Policy Influences on Ambulatory Care 40
Social Determinants of Health 41
Public Health and Social Determinants of Health 41
Public Health Efforts for Populations in the 21st Century 42
Ambulatory Care for Specific Vulnerable Populations: Applications of Population Health 44
Implications of Social Determinants of Health on Ambulatory Care Nursing Practice 46
Summary 47
Unit 2 Measuring Impact 51
4 Nursing Practice: Regulation and Advocacy 53
Regulation of Nursing 53
Scope of Practice 56
Regulatory Agencies 61
Professional Organizations 62
Shared Responsibility 63
Advocacy 64
Summary 66
5 Measurement and Value 68
Introduction 68
History of Evaluating Quality in Healthcare and Nursing 70
Centers for Medicare and Medicaid Services Leadership of Measurement and Value 74
Individual Satisfaction Measurement 78
Nursing Measurement and Benchmarking in Ambulatory Care 78
Summary 82
6 Research, Evidence-Based Practice, and Quality Improvement 87
Introduction 87
Comparison: Research, EBP, and QI 88
Ambulatory Care Principles Applied to Research, EBP, QI 94
Ambulatory Care Personnel and Roles 95
Research and EBP Competencies for Nurses and Nurse Leaders 96
QI Competencies for RNs and Nurse Leaders 98
Research/QI/EBP Application 98
Use of Data to Facilitate Research, EBP, and QI 100
Summary 104
Unit 3 Fundamentals for Ambulatory Care Nursing 109
7 Engaging Individuals and Families in Health 111
Introduction 112
Quality Context for Engaging individuals and Families 112
Why Engaging Individuals and Families Is Nursing's Priority 114
Defining individual and Family Engagement 117
Framework for Individual and Family Engagement 117
Person- and Family-Centered Care 121
National Alliance for Quality Care (NAQC) Guiding Principles for Consumer Engagement 129
Health Literacy 133
8 Care Coordination 146
Care Coordination in U.S. Healthcare 147
Care Continuum, Care Coordination, and Proliferation of Terms 148
Transitional Care 149
Scope and Standards of Practice for Care Coordination and Transition Management 151
Roles of Registered Nurses in Care Coordination 152
Roles of Registered Nurses During Care Transitions 154
Care Coordination and Care Transition Tools 156
The Role of Health Information Technology in Care Coordination 158
Summary 159
9 Telehealth and Virtual Care Nursing 163
Overview and Origins of Telehealth Nursing 163
Current Issues 166
Telehealth Nursing Practice 168
Nursing Process in Telehealth 169
Decision Support Tools 172
Telehealth Skills, Competencies, and Certification 174
Telehealth Nursing Practice Models 175
Remote Care Management 179
Future Challenges and Opportunities 180
Summary 181
Unit 4 Ambulatory Settings: Roles and Competencies 185
10 Primary Care 187
History and Definitions 187
Workforce 189
Patient-Centered Medical Home and High-Functioning Primary Care 189
Team-Based Care 191
Registered Nurse Roles in Primary Care 195
Primary Care Registered Nurse Competencies 196
Behavioral Health in Primary Care 200
Population Health 201
Complex Care Management 202
Pediatric Primary Care 203
Insurance and Economic Issues 204
Health Information Technology, Data Tracking, and Clinical Decision Support Systems 205
Economic Impact of the Primary Care Registered Nurse Role 207
Summary 209
11 Episodic Care 212
Introduction 212
Professional Nursing Practice in Episodic Care Settings 218
Considerations in Select Episodic Care Settings 220
Episodic Home-Based Services 230
Summary 232
12 Medical Specialty Clinics 236
Overview and Context 236
Nursing Role in Specialty Practice 238
Specialty Clinics for Noncommunicable Chronic Diseases: Four Examples 240
Chronic Infectious Diseases 243
Mental Health and Substance Misuse in Specialty Care 244
Virtual Care in Specialty Clinics 247
Referrals to Primary Care 248
Diagnostic Testing 249
Summary 249
13 Population Health: Ambulatory Care Focus 252
Overview 252
Population-Focused Practice in Ambulatory Care 253
Emerging Policies and Healthcare Agencies 254
Specialty Populations 255
Roles of the Registered Nurse in Population-Focused Clinics 255
Population-Specific Settings 257
School-Based Healthcare 260
Summary 265
14 Underserved Populations and Cultural Considerations 269
History and Overview 269
Health Equity and Disparities 271
Assessment of Health Risks 272
Diversity in Research 274
Rural Communities 274
Individuals Seeking Refuge and Immigrants 275
Individuals Experiencing Homelessness 278
Native Americans and Alaska Natives 279
Cultural Humility 281
Diversity Within the Nursing Workforce 283
Summary 283
Unit 5 Advancing Ambulatory Care Nursing 287
15 Ambulatory Care: Educating the Next Generation 289
Preparing Nursing Students for Ambulatory Roles of the Future 289
Current Practice Patterns 290
New Roles 291
Ambulatory Care Practice Arenas 293
Educational Curricula and Practicums to Support Ambulatory Nursing Prepare Educational Innovations 298
Measuring Critical Thinking and Decision-Making in Ambulatory Care 299
Transition to Practice in Ambulatory Settings 300
Summary 300
16 Infrastructures That Support Ambulatory Professional Nursing Practice 304
Nursing as a Profession 305
The Context of the Care of Individuals 306
Reinforcing Ambulatory Nursing Practice Through the Ambulatory Medical Record 309
Professional Development in Ambulatory Nursing 314
Quality and Safety Education for Nurses and Interprofessional Collaboration 318
Transition to Practice Nurse Residency Programs 319
Summary 323
Index 327