Toward a theory of home health care nursing practice
Leslie J. Neal-Boylan, PhD, APRN
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Current theories of home health nursing practice in the United States are not based on research. The purpose of this study was to build a substantive theory of home health nursing practice using a qualitative methodology. A grounded theory study of 26 home health nurses practicing in the tri-state area of Virginia, Washington, D.C., and Maryland was conducted to explore how home health nurses define their practice. The nurse participants varied in nursing background, level of education, home health nursing experience, age, race, position within the organization, and the type of organization that employed them. Unstructured interviews that were audiotaped verbatim were used to elicit information related to how home health nurses define their practice. The tapes were transcribed and became the data. Data were coded by hand and with the assistance of The Ethnograph (Qualis Research Associates, 1995), computer software used to analyze data from qualitative research studies. Participants were also sent summaries of the interviews and asked to provide feedback to ensure the accuracy of the researcher's interpretations. The data revealed that home health nurses move back and forth through a 3 stage process by which they become autonomous in practice. Confidence was determined to be key to autonomy while the physician-nurse relationship, reimbursement restrictions, unfamiliar clinical situations, and the patient entity were determined to be factors that restrict nurse autonomy. The core category in this research was determined to be adaptation. Subcore categories of adaptation were: Professional autonomy, taking a broader view, and finishing the story. Specific strategies and properties describe each subcore category and are affected by time and experience. Implications for nursing education, administration, ethics, and policy emerged from this research. Recommendations for future research were identified based on the need for testing of the new theoretical model.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 9821694; ProQuest document ID: 304483474. The author still retains copyright.
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