Ethical Issues With Nurse Practitioner /Physician Assist

该方案是一项描述性的、横断面的、具有全国代表性的研究，旨在调查非医生从业者(NPs和PA)对与初级保健实践相关的伦理问题的看法。初级保健中的NPS在临床实践中围绕正义、权利、责任、非恶意和仁慈等问题表达了伦理冲突。为NP确定的其他道德冲突包括与管理式护理组织的安排、专业责任、看到越来越多的患者的压力，以及为降低成本而进行的奖金和账单做法。随着NPs和PA的预测趋势大幅增加，对影响道德实践的因素的了解将与塑造NPs和PA在提供高质量、高成本效益的卫生保健方面的未来作用相关。此外，为了评估货币激励对提高邮寄的自我管理问卷的回复率的有效性，受试者被随机分配到三个激励组中的一个。将使用描述性统计和中心趋势(频率、平均值、标准差)的测量以及双变量相关性来分析数据。多元回归将被用来确定预测实践中的道德冲突和感知到的高质量护理交付的因素。从2002年11月开始，向美国3900名非内科临床医生邮寄了调查问卷。有关道德冲突和对执业的影响的数据目前正在分析中。手稿正在审查中。

This protocol is a descriptive, cross-sectional, nationally representative study to investigate nonphysician practitioners' (NPs and PAs) perceptions of ethical issues associated with primary care practice. NPs in primary care have expressed ethical conflicts in clinical practice centering on issues of justice, rights, responsibility, nonmaleficence, and beneficence. Other ethical conflicts identified for NPs include arrangements with managed care organizations, professional accountability, pressure to see an increasing volume of patients, and bonus and billing practices to lower costs. With the projected trends for NPs and PAs substantially increasing, knowledge of factors that influence ethical practice will be relevant in shaping the future role of the NP and PA for the provision of quality cost-effective health care. Additionally, to evaluate the effectiveness of monetary incentives to increase response rates to a mailed self-administered questionnaire, subjects were randomly assigned to one of three incentive groups. Data will be analyzed using descriptive statistics and measures of central tendency (frequencies, mean, standard deviation) as well as bivariate correlations. Multivariate regression will be utilized to determine factors that predict ethical conflict in practice and perceived delivery of quality care. Surveys were mailed, beginning in November 2002 to 3900 Nonphysician clinicians in the U.S. Data on ethical conflicts and impact on practice are currently being analyzed. Manuscripts are under review.